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CMU or LAMal? The cross-border worker’s choice

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LAMal or CMU, why choose?

From their first day of work in Switzerland, new cross-border workers must choose their health insurance; either the Swiss LAMal insurance or the French CMU. This is the right of option. The choice of the Swiss or French system must be made within the first three months of working in Switzerland.

If the cross-border worker does not choose, the choice will be made for him. They are automatically affiliated to the health insurance scheme of the country where they work: the Swiss LAMal.

This choice, made or imposed between the LAMal and the CMU, is all the more important, as it is irrevocable. As long as you work in Switzerland and are a cross-border worker, you cannot change this initial choice. If you change employers in Switzerland without going through a period of paid unemployment, you cannot change this choice. In order to change, there must be a period of interruption of work in Switzerland with, during this period, paid employment in France or the receipt of unemployment benefit.

The Swiss cross-border worker must therefore take the time to study the question carefully.

LAMal and CMU, the similarities

Before choosing between the LAMal (Loi sur l’Assurance Maladie) and the CMU (Couverture Maladie Universelle) health insurance, let’s take a closer look at the points, which are identical between these two insurances:

The reimbursements of benefits in France are identical for the LAMal and the CMU. They both entitle you to a ‘carte vitale’.

Whether you are covered by the CMU or the LAMal, a supplementary insurance is strongly recommended to improve reimbursements.

You are entitled to tax deductions on the CMU contributions similar to the LAMal premiums.

CMU vs. LAMal, what criteria should be used to choose?

The choice between LAMal and CMU is based on the following criteria:

  • The cost
  • Where the care is provided
  • Changes in income
  • Changes in family situation

The cross-border worker should also take into consideration:

  • The history of changes in health insurance changes
  • Changes in taxation
  • The local Alsace-Moselle scheme or the general French social security scheme

CMU vs. LAMal, the main differences

The LAMal and CMU cross-border worker health insurance schemes each have their respective strengths and weaknesses.

CRITERIALAMal cross-border workerCMU cross-border worker
CostThe contribution does not depend on your income; the cost is the same for all based on 3 age bracketsThe cost depends on your reference tax income (8%), the more you earn, the more you pay
Access to health careSwitzerland AND FranceOnly in France except in special cases
Change of incomeIf your salary increases, or if other income is added (rent, withdrawal from pillar insurance, inheritance, etc.) the amount of the LAMal health insurance premium does not increaseIf your salary increases or if other income is added (rent, withdrawal from pillar insurance, inheritance, etc.) the amount of the CMU contribution increases
Changes in family situationIf your spouse does not receive any income in France (salary or unemployment benefit) and you have children, each insured person is a contributor, there is no notion of free beneficiariesIf your spouse does not receive any income in France (salary or unemployment benefit) and you have children, each insured person is a contributor, and they are free beneficiaries

LAMal vs. CMU, the costs

The LAMal premium is not calculated in the same way as the CMU contribution. For the CMU cross-border worker, the contribution is calculated on the basis of the reference tax income (RFR) declared in France.

For the LAMal cross-border worker, it is the age bracket that determines the cost of the premium (0-18 years, 19-25 years, over 26 years).

As a result, for a Swiss cross-border worker with a salary of more than CHF 5,000 per month, it may be cheaper to choose the LAMal.

For other cross-border workers with a salary of less than CHF 5,000 and who receives rental income or capital income, the LAMal cross-border worker may also be more attractive. The right choice between CMU and LAMal depends on the detailed situation of each person and different circumstances for each of them.

If you have a question about the cost of each solution, our CMU-LAMal simulator is there to help you! Based on some simple data, it allows you to compare the cost of your LAMal worker insurance with that of the CMU.

CMU or LAMal, access to healthcare

The LAMal allows access to the Swiss and French health care schemes.

The CMU only allows access to the French health care scheme.

With a cross-border area with genuine medical deserts (Pays de Gex, Jura and Franche Comté etc.), access to a second healthcare network is sometimes a real necessity. The cross-border worker confronted, on the French side, with waiting lists of 6 months to consult a specialist can, with the LAMal, make an appointment in Switzerland. This is an undeniable advantage of the LAMal insurance compared to the CMU.

From a practical point of view, as cross-border workers have long working days in Switzerland with a lot of transport, access to care and treatment must remain straightforward.

It is a real advantage to be able to benefit from care close to one’s place of work in Switzerland in the event of a minor problem, periodic care on medical prescription (physiotherapists, etc.), X-rays, ultrasounds or even hospitalisation.

This advantage given by dual coverage (Switzerland and France) of the LAMal insurance is all the more important as it is known that a rapid diagnosis, made without delay, contributes to simplify the treatment and the cure.

LAMal – CMU, choose according to career development

You will advance in your career. You may have started your professional activity in Switzerland with short contracts, but how do you see your professional career continuing?

If your trial period continues with a permanent contract, you can expect to receive a salary increase.

In the case of high or rising incomes, the CMU is less suitable because its contributions are calculated on a percentage of your Taxable income (RFR°. The more you earn, the more you contribute. The LAMal, on the other hand, has a fixed premium that depends only on your age (over or under 25 years). The more you earn, the more you contribute. The LAMal cross-border worker, on the other hand, has a fixed premium, which depends only on your age (over or under 25 years).

LAMal – CMU, choose corresponding to your family situation

When choosing between LAMal and CMU, your family situation is also important. Perhaps you are planning to live as a couple and have children ? The notion of beneficiaries is then important for you. CMU insurance automatically covers your dependants who live in France with you. With the LAMal, if your partner and children are not covered in France, you will have to take out insurance for each of them (at a lower cost for the children).

If you are already a couple, and your spouse has his or her own health coverage in France, your future child will be affiliated to the French system through your spouse. Their health insurance is not affected by your choice between CMU and LAMal.

If you marry and your spouse works in France or receives unemployment benefits in France, your spouse and future children will be affiliated to the French social security system. The choice of CMU or LAMal is yours alone.

If your spouse does not work in France and does not receive unemployment benefit, then your choice of LAMal or CMU will apply to the whole family.

In all cases, the cost comparison requires an exchange with one of our specialists who will examine your situation and its ramifications in detail.

LAMal vs. CMU, changes and location

These two compulsory health insurance schemes, LAMal and CMU, follow different paths. In order to make the right choice between LAMal and CMU, you must take into account the changes in these insurance schemes. The future evolution of the scheme you choose will have an impact on the health care benefits available to you in the future, on reimbursements, on contributions and on premiums. For residents of Alsace-Moselle, you must also take into account the specific differences in reimbursement.

It is not a question here of detailing the ending of certain reimbursements, the increase in the responsibility of the insured, the constraints on the conventional sector…

The objective is to describe the axes of change and local factors.

CRITERIALAMal cross-border workerCMU cross-border worker
Cost trendsThe best LAMal cross-border worker contributions were stable for 6 years, for the last two years their cost has decreasedThe end of private health insurance for cross-border workers in 2015 was accompanied by an increase in the cost of health insurance for a large number of cross-border workers
Tax changesThe cost of the LAMal is not affected by changes in the cross-border worker's tax situationThe CMU cross-border worker's contribution depends on the cross-border worker's reference tax income, and is affected by changes in his tax situation
Difference in healthcare reimbursements in Alsace-MoselleCross-border workers from Alsace-Moselle insured under the LAMal scheme are reimbursed in France at 90% of the Social Security rateCross-border workers in Alsace-Moselle insured under the CMU are reimbursed in France at 80% of the Social Security rate

The decrease in LAMal contributions for cross-border workers

In Switzerland, health insurance funds have financial reserves that are monitored by the federal supervisory authorities. The funds cannot be in deficit.

The best tariffs of the basic LAMal were stable for 6 years. They have fallen in the last two years.

CMU contributions for cross-border commuters tend to increase

In France, the compulsory basic social security system has been in deficit for many years. The system is under threat.

The decision to delist drugs is made on a regular basis. The discrepancy between the agreed pricing system and the actual pricing system places an increasing burden on supplementary health insurance companies. This burden has become even heavier since supplementary health insurance became compulsory for employees in France. Their cost has increased further.

The main risk for cross-border workers with CMU is an increase in the contribution rate for the CMU. This contribution rate is currently 8%. What will happen tomorrow?

LAMal – CMU, the effects of taxation

France bases the calculation of the CMU contribution on Reference tax income (RFR). The French tax system and the health insurance contributions are linked. As long as this link exists, changes in the RFR have an effect on the contribution of the cross-border worker who has chosen the CMU.

In the Swiss system, the LAMal cross-border worker premium is independent of the cross-border worker’s income and tax situation. A tax change has no effect on the health insurance premium.

LAMal or CMU, the local scheme or the general scheme

Cross-border workers residing in Alsace-Moselle and affiliated to the LAMal cross-border worker scheme are covered by the local Alsace-Moselle social security scheme for treatment provided in France. They are reimbursed at 90% of the ‘approved’ rate.

The same cross-border worker residing in Alsace-Moselle who is affiliated to the CMU cross-border worker is reimbursed only at 80% of the ‘approved’ tariff because the CMU bases its reimbursements on the general Social Security scheme. The same reimbursement rate is applied throughout France.

CMU or LAMal, when you stop working in Switzerland

If you are cross-border worker and you stop working in Switzerland you will lose your cross-border worker status.

You therefore no longer have to choose between CMU cross-border or LAMal cross-border worker. The cross-border worker’s right of option no longer applies to you. The choice you made when you became a cross-border worker can therefore be revoked.

If you remain resident in France, working for a new employer or looking for work, you will no longer be affiliated to either the CMU or the LAMal.

You will be affiliated to the French social security system.

If you leave your residence in France and your work in Switzerland, you will be covered by the health insurance system of your next country of residence.

If you leave your residence in France and work in Switzerland, you will have to be insured under the LAMal insurance for residents in Switzerland.

To make the right choice, contact our specialists.

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