All persons who work or reside in Switzerland are generally subject to the Swiss social security system, including health insurance. Hereinafter the conditions under which foreign nationals can be exempted from this health insurance obligation are outlined.
Compulsory health insurance
Irrespective of nationality or origin, all persons resident in Switzerland must take out insurance with a Swiss health insurance within three months of taking up residence (Art. 3 para. 1 of the Federal Law on Health Insurance ["KVG"]).
This insurance obligation also applies to foreign nationals who have a short-term residence or residence permit valid for at least three months. Foreign nationals who are employed in Switzerland for a maximum of three months are also subject to compulsory health insurance if they do not have equivalent insurance coverage for treatment in Switzerland. For certain persons, the insurance obligation applies even if they are resident abroad, particularly if a pension is drawn exclusively from Switzerland (see also Art. 1 para. 2 of the ordinance to the KVG ["KVV"]).
Furthermore, based on social security agreements between Switzerland and other countries, there may also be an insurance obligation in Switzerland in certain other constellations.
However, certain persons can apply to be exempted from this insurance obligation. The following provides an overview of in practice common cases in which an exemption for foreign nationals is possible. A general distinction is made between EU/EFTA citizens and third-country nationals.
EU/EFTA nationals
EU/EFTA citizens working in Switzerland are generally subject to compulsory health insurance in Switzerland, regardless of their place of residence. Foreign statutory health insurance (EHIC) does not change this if the person is gainfully employed, even if only to a limited extent. An exception applies to persons not in gainful employment who are in education or training. They can be exempted from compulsory health insurance with the EHIC.
In constellations in which the person concerned works in both the EU/EFTA and Switzerland, the individual case must be examined, whereby the scope of the activity in the country of residence is particularly decisive for the question of social security subordination and thus also the health insurance obligation.
However, cross-border commuters from Germany, France, Italy and Austria, i.e. cross-border commuters who are also resident in one of these countries, have an option of exemption. This means that these persons can choose whether they wish to remain insured in their country of residence, provided that they are sufficiently insured there. To do so, an application must be submitted to the competent cantonal office within three months of the start of the insurance obligation.
If EU/EFTA citizens are posted to Switzerland by their employer, they can also be exempted from the insurance obligation if they are exempt from the mandatory old age and disability insurance (AHV/IV) contribution obligation. The latter is generally the case for postings/secondments of up to 24 months and a maximum of six years.
Family members of non-exempt person working in Switzerland who are not gainfully employed are generally subject to compulsory insurance in Switzerland, unless they can provide proof of equivalent insurance in their country of residence.
If EU/EFTA citizens live in Switzerland but only receive an income from the EU/EFTA, in particular in the case of pensioners or unemployed persons, there is generally no obligation to take out health insurance in Switzerland.
Insured persons can seek treatment in their country of residence or work regardless of the country of insurance, with the costs being covered by the relevant insurance provider.
Third-country nationals
In principle, third-country nationals are also subject to compulsory health insurance in Switzerland (in accordance with the conditions outlined above). Social security agreements between Switzerland and these countries (so-called contracting states) can and often do provide for special regulations on health insurance, for example, in the case of secondments or for pensioners from the contracting state who are resident in Switzerland. For employees who are posted/seconded to Switzerland from a contracting state (except the UK, India, Japan and North Macedonia) and wish to be exempted from the Swiss insurance obligation, employers must ensure that the benefits under the KVG for treatment in Switzerland are insured for the entire duration of the exemption. In the absence of such special rules, these nationals must take mandatorily take out health insurance in Switzerland.
Furthermore, an exemption may be possible in the case of compulsory insurance in the country of origin/third country and an unreasonable double burden. An application must also be submitted to the competent cantonal authority within three months of the start of the compulsory insurance.
In addition, third-country nationals who are staying in Switzerland solely for the purpose of education or training may also be exempted from the insurance obligation under certain conditions.
Other cases in which exemption is possible
There are other cases in which exemption from compulsory health insurance is possible, although not all of them will be discussed here. However, it is important to know that people who are only in Switzerland for medical treatment or a medical cure are not subject to compulsory health insurance.
A list of the competent cantonal authorities is available here
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
