Recent rulings by the Swiss federal tribunal and a Geneva court reopen the possibility for some frontaliers (persons residing in France and working in Switzerland) to opt for or reintegrate the Swiss health insurance scheme (i.e. affiliating with a Swiss LAMal health insurance).
For information on the ruling by the Swiss federal tribunal, refer to the articles in l’Alsace 29 april 2015 and Tribune de Genève 28 April 2015. For information on the Geneva court ruling dated 29 January 2015 refer to Tribune de Genève 6 Mars 2015, and for an analysis of the consequences for Geneva, refer to lémanbleu 28 April 2015.
A recent decision by the ”Chambre des assurances sociales de la Cour de Justice du canton de Genève”, reported in the Tribune de Genève (link is external) (in French), has come to our attention. The ”Service de l’assurance-maladie (SAM) du Canton de Genève” gives their interpretation of the decision on their website (link is external) (in French). It is to be noted that the SAM take several precautions in their information (i.e. the use of the term “a priori”).
Depending on the exact situation of your spouse or registered partner, this decision may (or may not) open up options which until now seemed not to be available. However, we also want to draw your attention to the fact that the position of the French authorities is currently unknown, as stated in the last paragraph of the article in the Tribune de Genève and in the information from the SAM. If the French authorities were to take a different position from that of the Genevan court, the situation of persons concerned would be very complex and equally difficult to establish.
Having no further information than the above, we are unable to answer questions on what this information may lead to; however, we will continue to keep you informed of any developments.
We recently informed you that the Organization was still in discussions with the Host State authorities to clarify the situation regarding the health insurance of frontalier workers who are family members (as defined in the Staff Rules and Regulations) of a CHIS main member, and that we were hoping to arrive at a solution soon.
After extensive exchanges, we finally obtained a response a few days ago from the Swiss authorities, with which we are fully satisfied and which we can summarise as follows:
- Frontalier workers who are currently using the CHIS as their basic health insurance can continue to do so.
- Family members who become frontalier workers, or those who have not yet exercised their “right to choose” (droit d’option) can opt to use the CHIS as their basic health insurance. To this end, they must complete the form regarding the health insurance of frontaliers, ticking the LAMal box and submitting their certificate of CHIS membership (available from UNIQA).
- For family members who joined the LAMal system since June 2014, CERN is in contact with the Swiss authorities and the Geneva Health Insurance Service with a view to securing an exceptional arrangement allowing them to leave the LAMal system and use the CHIS as their basic health insurance.
- People who exercised their “right to choose” and opted into the French Sécurité sociale or the Swiss LAMal system before June 2014 can no longer change, as the decision is irreversible. As family members, however, they remain beneficiaries of the CHIS, which then serves as their complementary insurance.
- If a frontalier family member uses the CHIS as his or her basic health insurance and the main member concerned ceases to be a member of the CHIS or the relationship between the two ends (divorce or dissolution of a civil partnership), the frontalier must join LAMal.
We hope that this information satisfies your expectations and concerns. We would like to thank the Host State authorities for their help in clarifying these highly complex issues.
We remind you that staff members, fellows and beneficiaries of the CERN Pension Fund must declare the professional situation and health insurance cover of their spouse or partner, as well as any changes in this regard, pursuant to Article III 6.01 of the CHIS Rules. In addition, in cases where a spouse or partner wishes to use the CHIS as his or her basic insurance and receives income from a professional activity or a retirement pension, the main member must pay a supplementary contribution based on the income of the spouse or partner, in accordance with Article III 5.07 of the CHIS Rules. For more information, see www.cern.ch/chis/DCSF.asp (link is external).
The CHIS team is on hand to answer any questions you may have on this subject, which you can submit to email@example.com (link sends e-mail).
Note Verbale (link is external) from the Permanent Mission of Switzerland.
Reply of the French (link is external) Ministère des Affaires Etrangères et du Développement International to a request for clarification on the same issue made by AFIF (Association des fonctionnaires internationaux Français).
This announcement was also published in the CERN Bulletin Issue No. 47-48/2014 - Monday 17 November 2014 (link is external).
The following text was published in the Bulletin 17th October 2014.
Certain members of the personnel residing in France have recently received a letter, addressed to themselves and/or their spouse, from the French health insurance authorities (Assurance Maladie) on the subject of changes in the health insurance coverage of “frontalier” workers.
It should be recalled that employed members of personnel (MPE) are not affected by the changes made by the French authorities to the frontalier workers' "right to choose" (droit d'option) in matters of health insurance (see the below for more details), which took effect as of 1 June 2014, as they are not considered to be frontalier workers. Associated members of the personnel (MPA) are not affected either, unless they live in France and are employed by a Swiss institute.
For the small number of MPAs in the latter category who might be affected, as well as for family members who do have frontalier status, CERN is still in discussion with the authorities of the two Host States regarding the health insurance coverage applicable to them.
We hope to receive more information in the coming weeks and will keep you informed via this website and the CERN Bulletin.
The Organization is still in contact with the Host States' authorities for what concerns the Health Insurance of the spouses or children who have the status of "frontalier". We expect a reply in the coming weeks and we shall keep you informed on this site.
We recall here that the CERN members of personnel (employees and associates) are not concerned by the end of the "droit d'option" on May 31st 2014, except if they have a Swiss employer and live in France; in which case they are "frontaliers".
The MPAs who currently have a French private health insurance (so-called "assurance frontaliers") and who are not "frontaliers" (as defined before) may if their current insurance contract is not renewed get affiliated with the health insurance of their choice, including the CHIS. They are not forced to and cannot be affiliated with the French Health Insurance (CPAM).
The request for affiliation with CHIS will only be accepted if:
- it is done withing 30 calendar days from the end of the frontalier insurance, and
- on provision of a proof of termination of the insurance contract by the insurer.
The reimbursement rules of the French CPAMs (caisse primaire d'assurance maladie) for health care outside France, as modified by the decree 2014-516 dated 22 May 2014, can be found here:
Article R-332 (link is external)
Article R-380 (link is external)
The French Social Security Code has been amended with the following two decrees concerning health insurance of trans-border workers.
Decree no. 2014-516 dated 22 May 2014 (link is external)
Decree no. 2014-517 dated 22 May 2014 (link is external)
We have recently received a reply from the French Mission (link is external) in Geneva, concerning the situation of some of our members (members of family with frontaliers status) with respect to their health insurance. As not all cases are covered in this answer, the Organisation is pursuing investigations with the French and Swiss authorities in order to be able to give an informed reply to everyone.
The French Health Insurance website (ameli.fr (link is external)) has also been updated on 20th May with further information for cross-border workers working in Switzerland (link is external).
Despite our many interventions with the French authorities we have not yet received any reply to our requests for clarification concerning the situation of family members (spouses and children) working in Switzerland as "frontaliers" and having chosen the CHIS as primary health insurance. In this context we advise members of CHIS who are in this situation to not change anything until they receive more information, but to contact us through chis.info[at]cern.ch in case they would receive requests to change their health insurance from their employer or from any other source.
The French Ministry of Health has published a note clarifying how the French Assurance Maladie will be applied to cross-border workers residing in France and who need to integrate to the French Social Security system as from June 1st, 2014 (see press release (link is external), in French only).
This does, however, not provide the answer to the particular case of spouses/partners of CHIS main members who are residing in France and working in Switzerland. We are still waiting for a reply from the French authorities on this issue.
Detailed information on the options for health insurance for cross-border workers can be found in a Joint note on the right of choice in matters of health insurance (link is external) (in French only) published by the French and Swiss authorities on 1 February 2013.
General information on the status of cross-border workers is also available in a Guide du frontalier suisse (link is external) published in April 2013 by the French authorities CPAM, in French only).
We have taken note of the decision taken by the French Government to suppress the possibility for frontaliers to choose a private health insurance as of June 1st 2014.This decision does not concern the CHIS members, as CERN members of personnel do not have the status of frontaliers.
CERN is in contact with the other International Organisations, the Association des Fonctionnaires Internationaux Français and the French mission in Geneva in order to obtain more information concerning the spouses of CHIS main members that are frontaliers and are insured by CHIS or by a private insurance.
We shall keep you informed on this page as soon as we have more information. You may obtain additional information on the site of the l'Association des frontaliers franco-suisses (link is external).
The issue seems to be even more undecided now than a few months ago, according to an article by Le Pays Gessien (link is external) reporting on recent discussions between the Groupement transfrontalier européen (GTE) and experts in the French ministry of social affairs. It would appear that these experts had not taken into account the special situation of Switzerland, which is not in the European Union. This could make implementation of the foreseen new legal provisions very difficult, if not impossible ...
We will, of course, keep you informed of developments in this matter.
However, it being a simple respite, the CHIS, with the support of relevant services within the Organization, will stay abreast of the developments in this matter in order to, if necessary, take appropriate action. The first step should be, as indicated by the Tribune, that the French government "define the new system, which will enter into force on 31 May 2014."
It is to be noted that in their editions of 1 Octobre 2012 both Les Echos (link is external) and Libération (link is external) indicate that the effective date of the suppression would remain 1 May 2014.
We, as well, have heard about a possible future suppression of the French concept of "frontaliers" insurances (see the news articles in the Tribune de Genève (link is external) and the Echos (link is external)). Currently, no decision on the matter has yet been officially released. We do not, for the time being, have any indications on the effective date of this measure, nor on the alternatives to be proposed, nor on possible associated measures (e.g. the alignment of certain rates mentioned by Les Echos). Thus, we cannot, for the time being, answer your questions.