Health insurance for Swiss abroad: obligations

Context

In brief

• Anyone receiving an AVS/AI pension is required to choose a basic health insurance within 3 months.
• The basic insurance can be Swiss or from the country of residence in the agreed EU/EFTA states.
• Only funds with more than 500,000 insured persons may cover those who leave Switzerland for the EU.

• What: insurance obligation for AVS/AI recipients abroad.
• When: decision within the first 3 months of residence (except Spain).
• Where: EU/EFTA countries (including the United Kingdom) and non‑EU countries.
• Who: Swiss retirees, posted workers, citizens without Swiss income.
• Amount: fixed deductible of 300 CHF for Swiss funds that cover abroad.
• Regulation: Federal Law on Health Insurance (LAMal).
• Authorities: AVS compensation funds, Organization of Swiss Abroad (OSE), Federal Department of Foreign Affairs (FDFA).

On 22 April 2025 Swissinfo published an article outlining the health‑insurance rules for Swiss citizens moving abroad. The analysis starts with the fundamental distinction between retirees and non‑retirees. Anyone receiving an AVS or AI pension from Switzerland is, in principle, obliged to take out basic health insurance under LAMal. However, Switzerland has negotiated optional rights with several countries, including all neighbours and Spain. In these states the retiree can decide whether to keep Swiss coverage or join the local scheme. The decision must be made within the first three months after the change of residence, with the exception of Spain where it can be postponed.

The article emphasizes that Swiss coverage is reserved for funds with more than 500,000 insured persons. Only these are authorised to guarantee coverage for people moving to an EU country. In addition, the deductible is set at 300 CHF, regardless of the country of residence. Premiums, as in Switzerland, vary canton by canton, but abroad they depend on the average claim cost in the host country; for example, a Visana policy in Poland costs almost five times as much as a CSS policy.

For citizens who do not receive an AVS/AI pension the situation changes. If a Swiss citizen moves to London for work, they must take out the mandatory basic insurance in the United Kingdom, because the place of work is the determining criterion. If they move to London without working and without receiving a Swiss pension, they can remain insured by a Swiss health fund. This possibility is not provided for by LAMal but by the Federal Insurance Contract Act (LCA). Funds may freely decide whether to accept, reserve, or reject the coverage.

These provisions have concrete impacts on emigration planning: retirees must assess within three months which coverage – Swiss or local – is more advantageous, taking into account the fixed deductible and the differentiated premiums. Workers on assignment or posted have a temporary Swiss coverage, usually for two years, extendable up to six years at the decision of the AVS funds. The article invites readers to consult the FDFA website for official information and the OSE for advisory services.

"Anyone receiving a Swiss AVS pension must decide within three months where to take out basic insurance" (Swissinfo, 22 Apr 2025).

To explore premium differences between funds, you can use the insurance comparator.

Operational details

Implications for Swiss pensioners who emigrate

The rules outlined in this article introduce a series of practical choices for pensioners. First and foremost, the requirement to decide within three months means a precise timeline for financial planning. The fixed deductible of 300 CHF is an extra expense compared to the Swiss cantonal model, where the deductible may vary. This can affect the calculation of the net cost of coverage, especially for those with frequent medical expenses.

Another key factor is the difference in premiums between insurance funds. Funds with more than 500,000 insured persons, such as CSS or Visana, offer lower rates thanks to a broader risk pool. However, the case of Poland shows that premiums can vary dramatically (Visana is nearly five times more expensive than CSS). For those moving to countries with high healthcare costs, the option agreement may be more advantageous if the country offers lower premiums or a smaller deductible.

From the perspective of the federal system, the possibility to choose the country of insurance strengthens pensioners' freedom of movement, but requires coordination between Swiss authorities (AVS funds, FDFA) and the health authorities of the host countries. LAMal remains the reference legal framework, but exceptions (e.g. Spain) show only limited flexibility.

Workers without AVS/AI pension

For workers who do not receive a pension, the rule is more complex. If the workplace is abroad, the host country's regulations require local insurance. This means that a Swiss citizen employed in London must register with the NHS (National Health Service) or a private British insurance, depending on UK requirements. The difference compared to LAMal is that the federal law on insurance contracts (LCA) allows Swiss funds to offer coverage voluntarily, but it is not mandatory.

This flexibility creates scenarios of potential double coverage: a worker can keep the Swiss fund as a backup, but must still pay the host country's premiums. The decision depends on the cost-benefit ratio, the duration of the assignment, and the presence of any bilateral agreements between Switzerland and the country of employment.

Comparison before/after current regulations

Before the EU/EFTA option was defined, many pensioners had to automatically keep Swiss coverage, even if living in countries with higher healthcare costs. The current right of option allows you to choose the most economical solution, but introduces the three-month deadline and fixed deductible. For workers, the distinction between secondment (Swiss coverage for a maximum of two to six years) and permanent relocation (local obligation) remains unchanged, but the possibility of a backup via LCA adds an extra choice.

Impact on the cantons

Cantons no longer have a direct role in choosing insurance for residents abroad, but the difference in premiums remains influenced by the canton of origin, since funds calculate premiums based on the average cost of claims of their insured, which depends on the canton of provenance. This can create disparities between insured persons from cantons with higher premiums (e.g. Zurich) and those from less expensive cantons (e.g. Ticino). Pensioners should also consider this aspect when deciding their coverage.

To check how premiums affect your situation, you can use our health insurance calculator.

Useful planning tools

To estimate your pension strategy, use the pension planner and the pillar 3 simulator.

Key points

Step‑by‑step guide to choosing basic health insurance abroad

1. Check your pension: make sure you receive an AVS or AI pension from Switzerland. If yes, you are subject to the LAMal obligation. 2. Identify your country of residence: verify whether the country is on the EU/EFTA list with the right of option (including neighboring countries and Spain). The list is available on the DFAE website. 3. Three‑month deadline: mark the start date of residence on your calendar and count three months to make a decision. Only for Spain can the deadline be postponed. 4. Compare insurers: see which Swiss insurers have more than 500,000 insured persons (e.g., CSS, Visana). Check the premiums specific to the country of residence; the deductible will still be 300 CHF. 5. Request quotes: contact the selected insurers and ask for a quote that includes annual premium, deductible and geographic coverage. 6. Evaluate the local option: obtain information on premiums and deductibles of the local health‑care system. Compare them with the Swiss quote. 7. Decide and subscribe: within the three months, inform the Swiss insurer of your choice or subscribe to the local insurance. Keep the confirmation for possible tax checks. 8. Update AVS: notify AVS of the new coverage status to avoid penalties.

Emergency scenarios

• If the decision is postponed (Spain only), you can keep Swiss coverage for up to 12 months, but you should check the specific conditions with the insurer.
• If you miss the deadline: the Swiss insurer may consider the coverage terminated and impose penalties or request a refund of premiums not owed.
• If you move to another country again: you must repeat the procedure within three months of the new move.

Useful tools

• Health insurance calculator to compare premiums and deductibles.
• DFAE website for the list of countries with the right of option.
• Organization of Swiss Abroad (OSE) for personalized advice.

💡 Practical tip: keep a digital folder with all insurance documents (contracts, confirmations, AVS communications); it makes interactions with insurers and authorities much easier.

🔗 To learn more about the cost of living in relation to insurance premiums, visit our cost of living section.

Source: swissinfo.ch