Do I have to pay the 300 CHF Swiss franchise if I see a doctor in France, Germany, or Italy?

Absolutely not. This is one of the biggest myths among cross-border workers. If you seek treatment in your country of residence using your local health card (obtained via the S1 form), local healthcare rules apply. The Swiss franchise and retention fee only apply to treatments physically received on Swiss territory.

What exactly is the S1 form (formerly E106)?

The S1 form is an official European coordination document. It is issued by your Swiss health insurance (LAMal/KVG) and must be submitted to the local health authority in your country of residence (CPAM in France, GKV in Germany, ASL in Italy). It instructs them to register you in their system and issue a local health card, while billing your care back to Switzerland behind the scenes.

Do I need supplemental insurance if I am affiliated with LAMal?

Yes, it is highly recommended. While LAMal gives you access to the public health system of your country of residence, local public systems rarely cover 100% of all costs (especially for dental care, vision, or private specialists). A local supplemental insurance (Mutuelle in France, Zusatzversicherung in Germany) is essential to cover the remaining out-of-pocket expenses.

What does LAMal cover in France, Germany & Italy? The S1 Form

📌 In Short (TL;DR): The Dual Benefit of LAMal

The core principle: If you are a cross-border worker affiliated with the Swiss LAMal (KVG) insurance, you are entitled to medical coverage on both sides of the border.
The Bridge (S1 Form): This document connects your Swiss insurance to the healthcare system of your country of residence (France, Germany, or Italy). It grants you a local health card.
Treatment in Switzerland: Swiss rules apply. You pay your own costs until you exhaust your Franchise (300 CHF), followed by a 10% retention fee.
Treatment in your home country: Local national rules apply. The 300 CHF Swiss franchise does not apply outside of Switzerland. You are covered just like any standard local resident.

When international cross-border workers exercise their "Right of Option" and choose to join the Swiss health insurance system (known as LAMal in French, KVG in German, LAMal in Italian), there is often immense confusion about how healthcare costs will actually be covered in daily life.

Will I have to pay the Swiss franchise if I go to my family doctor in France, Germany, or Italy? Do I have to pay upfront in Geneva or Zurich? What is the role of the local health authorities? This ultra-detailed article decodes the mechanics of healthcare coordination between Switzerland and neighboring countries, explaining why understanding the S1 form is the key to your peace of mind.

Analysis Table of Contents:

📄 1. The Key Document: The S1 Form explained
🇨🇭 2. Healthcare in Switzerland: Franchise and Retention Fee
🇪🇺 3. Healthcare in France, Germany & Italy (How it works locally)
📊 4. Concrete Comparison: Reimbursement Scenarios
🛡️ 5. The Role of Supplemental Insurance
💡 6. Tip: Paying your LAMal premium without hidden fees

1. The Key Document: The S1 Form (formerly E106) explained

The S1 form is the administrative bridge that connects the Swiss healthcare system to the healthcare system of your European country of residence. It is a standardized European coordination document.

How does it work in practice?

You sign a LAMal cross-border contract with a Swiss health insurance fund (e.g., Helsana, Swica, Sympany).
A few days later, this Swiss fund sends you two copies of the S1 form "Certificate of entitlement to healthcare" by mail.
You fill out this document and hand it over to the local health authority in your municipality of residence (CPAM in France, a statutory health insurance like AOK/TK in Germany, or the ASL in Italy).

🎯 The magic result of the S1 Form

As soon as your local authority validates your S1, they register you in their national system and issue your local health card (Carte Vitale in FR, eGK in DE, Tessera Sanitaria in IT). The Swiss and local governments make a behind-the-scenes agreement: your local authority will process your medical visits normally, but they will send the overall bill directly to Switzerland (which financially compensates your home country). For you, the process is invisible and completely transparent.

2. Healthcare in Switzerland: Rules, Franchise, and Retention Fee

When affiliated with LAMal, you have the right to consult any doctor, specialist, or public hospital in your canton of work in Switzerland.

However, the Swiss system works very differently from most European systems. It is based on the reimbursement principle (Tiers-Garant), and the strict rules of your LAMal contract apply:

The Franchise (Deductible): For the standard cross-border LAMal contract, the legal franchise is set at 300 CHF per year. This means you must pay the first 300 francs of medical expenses incurred in Switzerland entirely out of pocket during the calendar year before your insurance starts reimbursing anything.
The Retention Fee (Quote-part): Once the 300 CHF franchise is exceeded, the Swiss health insurance begins to reimburse, but it withholds a retention fee of 10% on all invoices. However, this fee is capped at a maximum of 700 CHF per year.
The Process: In Switzerland, except for specific hospitalizations, you usually pay the doctor first yourself, and then you send the invoice to your LAMal insurance via their mobile app to get your money back.

3. Healthcare in France, Germany & Italy

This is where the system becomes extremely advantageous for cross-border workers. If you fall ill and decide to see a doctor in your hometown in France, Germany, or Italy, only your national local rules apply, exactly as if you were a standard resident.

You simply present your local health card to your healthcare provider.

⚠️ End of the myth: The Swiss franchise does not apply abroad

This is the number one fear of new cross-border workers: "If I have a Swiss franchise of 300 CHF, will I have to pay my local doctors out of my own pocket until I reach this amount?". This is absolutely FALSE.
The 300 CHF Swiss franchise and the 10% retention fee apply strictly to care physically provided on Swiss soil. In your home country, the local public system covers you immediately according to their standard rates.

4. Concrete Comparison: Reimbursement Scenarios

To fully understand the radical difference in processing depending on which side of the border you are on, here is a comparison table for an identical scenario (Consultation with a general practitioner for the flu):

Scenario	Treatment in Switzerland (e.g. Geneva, Basel, Lugano)	Treatment in Country of Residence (FR, DE, IT)
Patient action	You receive an invoice and pay upfront (e.g., 120 CHF).	You present your local health card (Carte Vitale, eGK, or Tessera Sanitaria).
Point of contact	The mobile app of your Swiss LAMal insurer.	Your local public healthcare system handles it in the background.
If Franchise (300 CHF) is NOT yet reached	Reimbursement: 0 CHF. You pay the 120 CHF yourself. The amount is deducted from your franchise balance.	Covered according to local rules. The Swiss franchise is ignored. (e.g., in Germany and Italy, basic GP visits are generally free; in France, CPAM reimburses 70%).
If Franchise has already been reached this year	The insurance reimburses 90% (108 CHF) and keeps a 10% retention fee (12 CHF).	Identical: Covered by the local public health system according to standard national rates.

5. The Role of Supplemental Insurance

While the LAMal gives you excellent access to the public health system of your country of residence, local public systems rarely cover 100% of all costs. There are often gaps, particularly for extensive dental care, orthodontics, eyeglasses, or visits to fully private specialists.

Therefore, it is highly recommended to take out local supplemental health insurance (a "Mutuelle" in France, "Zusatzversicherung" in Germany, or "Assicurazione Integrativa" in Italy) to cover these out-of-pocket expenses and local co-pays (like the Italian "Ticket" or the French "Ticket Modérateur"), even if you are already paying a substantial LAMal premium in Switzerland.

6. Tip: Paying your LAMal premium without hidden fees

By choosing LAMal, you will have to pay a health insurance premium every month in Swiss Francs (CHF) to your Swiss health fund. This premium usually amounts to several hundred francs.

If you choose to transfer your entire Swiss salary to your Euro account in your home country, and then use your local bank to pay the LAMal invoice back in Switzerland via an international wire transfer, you will suffer a double exchange rate loss and often high international banking fees.

💡 The ibani solution for cross-border workers

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What does LAMal really cover in France, Germany & Italy? (The S1 Form Guide)