CMU contributions for cross-border workers: refunds are available!

Living in France, working in Switzerland: what about my health insurance?

Being a cross-border worker involves a great deal of administrative hassle: changing your bank account, health insurance, filing your tax return differently… France and Switzerland have signed an agreement allowing cross-border workers to choose their health insurance scheme. They therefore have the option of joining either the Swiss or the French system: 

• In Switzerland, employees can register with their local health insurance fund under the Swiss statutory LAMal scheme.
• In France, they can join the Social Security Scheme for Cross-Border Workers (CMU) through the Caisse Primaire d’Assurance Maladie.

Good to know: once you have chosen between LAMal and the CMU, the decision is final. You should therefore compare these two options carefully. You have three months from the date you start work in Switzerland to make your choice. Once this period has passed, if you have not chosen a health insurance scheme, you will automatically be enrolled in the Swiss scheme, LAMal.

So, CMU or LAMal? But what are the pros and cons of these two options?

Health insurance for cross-border workers on the Swiss side: LaMal

The LaMal (which stands for Federal Health Insurance Act) is the compulsory health insurance system in Switzerland. By taking out this insurance, French nationals working in Switzerland can benefit from Swiss health cover. This is a major advantage, as the Swiss healthcare system is renowned for the quality of its care. It also offers its members a great deal of freedom in choosing healthcare providers or doctors. For example, in Switzerland, it is possible to consult a specialist directly without having to see a GP first. The waiting times for reimbursement of medical expenses are also shorter.

However, it is important to note that the premiums for LaMal are high, much higher than French social security contributions. If your income as a cross-border worker is not high, this can be a significant burden. Be sure to compare the costs and financial commitments carefully before making your choice. Furthermore, to benefit from the most comprehensive health cover possible, many cross-border workers decide to take out supplementary cover in France, which incurs additional costs.

Under the Swiss health insurance scheme, you will have to pay a monthly premium, plus an excess and a 10% co-payment. For cross-border workers, this excess is set at CHF 300 (approximately €321 after currency conversion) per calendar year for adults. Children are not subject to the excess under their policy. In practical terms, this means that the first 300 Swiss francs spent on your healthcare covered by the LAMal will be at your own expense.

In France, the CMU for cross-border workers

What is the CMU for cross-border workers – Universal Health Cover for cross-border workers?

The CMU for cross-border workers, not to be confused with the traditional CMU (Universal Health Cover), historically refers to an insurance scheme for cross-border workers. The CMU allows cross-border workers in Switzerland: 

• to be affiliated to a French scheme
• to access medical care cover in France and Switzerland under certain conditions.

The CMU (Universal Health Cover) offers cross-border workers healthcare cover identical to that of the French General Health Insurance Scheme (social security). The CMU for cross-border workers scheme applies specifically to cross-border workers who do not choose to join the LaMal scheme in Switzerland. 

However, CMU cover remains limited, particularly for expensive treatments: hospitalisation, dental care and optical care. This is why the majority opt for supplementary insurance. With the CMU, cross-border workers can receive treatment in Switzerland, subject to certain conditions.

 

CMU reimbursements for cross-border workers

To calculate the amount of the insurance premium you will have to pay, the French authorities require cross-border workers to submit a tax return.

However, experience shows that the vast majority of cross-border workers make mistakes in this declaration, and most over-declare, which means that most cross-border workers pay too much for their CMU health insurance premium.

 

Why is health insurance compulsory for cross-border workers in France?

Have you completed your CMU declaration for cross-border workers correctly?

Depending on the time of year you registered, you must declare your income from the previous year or two years prior. This income can be found on the relevant French tax notice. There are various types of income you must declare, as well as various expenses that can be deducted. The URSSAF website provides a list of everything you must and can include in your declaration, as well as an explanatory guide to declaring income.

In summary, on your tax notice, the main tax details taken into account for the calculation of the CMU are:

• “salaries, pensions and net annuities”
• income received by the tax household
• the deductible CSG
• the reference taxable income

The instructions for completing the tax return form are not always entirely clear, and experience shows that around 80% of cross-border workers who have filed their returns have made mistakes and overpaid. This is according to David Talerman, a specialist in cross-border workers and author of the book “Working and Living in Switzerland”.

 

In which cases can you reclaim part of the CMU contribution?

What many cross-border workers do not realise is that it is, for example, possible to deduct from their income the amount of the CMU contribution paid in the same year, or even maintenance payments made.

The calculation of the CMU premium is closely linked to your tax return. The more “complex” your tax situation is (married, income from different sources, tax deductions in place, etc.), the greater the likelihood that you will make a mistake in your CMU declaration to the CNTFS.

In reality, there are many and varied factors taken into account when calculating the premium (and these may potentially relate to the tax status of a spouse working in France), which makes the calculation more complex.

 

In the event of an error in the calculation of the CMU premium, there is a three-year retroactive period

The good news is that you can request a correction to your previous declarations, and you can do so for the last three years.

This request can be made either via your account on the URSSAF platform or directly to the CNTFS.

Given the complexity of the calculation and the criteria involved, it may be worth seeking professional help.

 

Conclusion: take action and regain your purchasing power

Whether you decide to make your CMU correction yourself or with the help of professionals, you now have all the information you need to reclaim part of your CMU contribution.

 

What is the National Centre for Swiss Cross-Border Workers?

The CNTFS is the National Centre for Swiss Cross-Border Workers, an organisation for French cross-border workers employed in Switzerland. Directly linked to URSSAF, the CNTFS will calculate your health insurance contribution and manage the collection of funds based on your tax returns.

What is URSSAF – the Union for the Collection of Social Security and Family Allowances?

URSSAF is an official body primarily responsible for collecting social security contributions from employers. It oversees the collection of health insurance premiums from cross-border workers.

What is the CMU frontalier – Universal Health Cover for Cross-Border Workers?

The CMU for cross-border workers, not to be confused with the traditional CMU, historically refers to an insurance scheme for cross-border workers, now known as the CNTFS. The CMU allows cross-border workers in Switzerland:

• to be affiliated to a French scheme
• to access medical care cover in France and Switzerland under certain conditions.

 

The new 2025 health insurance rates for cross-border workers

LaMaL rates in Switzerland rise every year. But for 2025, a significant increase is expected for the 215,000 cross-border workers who cross the border every day to work in neighbouring Switzerland. 

How can this be explained? Healthcare expenditure in Switzerland is rising significantly year on year. For 2024, the country is forecasting a 3.6% increase, reaching 95.3 billion francs, and a 3.2% rise in 2025, for an estimated total of 98.4 billion francs.

To ease the burden on Swiss households and harmonise insurance premium levels across the cantons, a solidarity scheme has been introduced. This means that insurers whose policyholders are in better health – and therefore pose a lower risk – will have to pay higher premiums to compensate.

What impact will this have on cross-border workers? This change will indeed have a direct impact on cross-border workers. Their average age is 38, which is significantly lower than that of Swiss residents (54). Cross-border workers therefore constitute a population with a lower medical risk. They will thus have to contribute to this solidarity scheme to help balance the financing of health insurance in Switzerland. 

 

Taking out supplementary health insurance: the choice of many cross-border workers

If you have opted for the CMU, you should bear in mind that its cover is generally insufficient. Consequently, many cross-border workers between France and Switzerland decide to take out supplementary health insurance (or a supplementary health insurance scheme) to supplement the coverage of their healthcare costs. There are schemes specifically designed for cross-border workers. These schemes can cover part of the costs of hospitalisation, medical consultations, dental or optical care, which are often poorly covered by the basic scheme. 

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