Health Insurance – Affiliation to LAMal insurance for families of CERN personnel
On May 16, the HR department published in the CERN Bulletin an article concerning cross-border workers (“frontaliers”) and the exercise of the right of choice in health insurance:
« In view of the Agreement concluded on 7 July 2016 between Switzerland and France regarding the choice of health insurance system* for persons resident in France and working in Switzerland ("frontaliers"), the Swiss authorities have indicated that those persons who have not “formally exercised their right to choose a health insurance system before 30 September 2017 risk automatically becoming members of the Swiss LAMal system” and having to “pay penalties to their insurers that may amount to several years’ worth of contributions”. Among others, this applies to spouses of members of the CERN personnel who live in France and work in Switzerland. »
But the CERN Health Insurance Scheme (CHIS), provides insurance not only to all CERN employees and, under certain conditions, a few associates, but also to their families, namely their spouses, registered partners and dependent children.
In addition, in April 2015, the HR Department published the following information concerning the issue of health insurance for “frontaliers” who are dependents of members of the CHIS:
« 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. »
Since spring 2017, the Staff Association has been contacted by several staff members who reported that their spouse is summoned by the Canton of Geneva Health Insurance Service (SAM), or the corresponding Health Insurance Service of the Canton where they work, to join the Swiss health insurance (LAMal) even if they are affiliated to the CHIS. Previously, no such obligation had ever been mentioned, let alone implemented!
But this injunction applies not only to “frontalier” workers, but also to spouses, registered partners or children who have opted for the Swiss nationality, and the Swiss members of the personnel with short-term contracts, such as Swiss administrative students.
The Staff Association consulted a few people and various documents, the Swiss law and its implementing regulations, in particular the Ordinance on health insurance (OAMal) dated 27 June 1995 (state as on 1 July 2017).
The conclusion is that, for several months now, various Swiss services have had different interpretations of legal articles, but also that Swiss authorities, at the highest level, wish to solve this problem.
Indeed, a revision of the Ordinance on health insurance (OAMal) is being undertaken to explicitly mention the case of the beneficiaries of members of international organizations.
This new version of the OAMal should be published at the latest beginning of 2018. It should allow to revert back to the initial situation, and also allow all those who have been automatically affiliated to the LAMal to leave their LAMal insurer and revert to only using the CHIS.
In the meantime, what can you do, what should you do?
If you have already exercised your right to opt-in and the CHIS has been recognized as your basic insurance, we recommend that you do not contact the Health Insurance Service (or the equivalent service in another Canton) if the latter does not contact you. Also, and to the maximum possible extent, avoid any change in administrative situation that may cause this service to reopen your file.
If you have not yet exercised your right to opt-in, please comply with the instructions given by HR in its communication of April 2015 which mention to fill out the form for health insurance for “frontaliers” by ticking the LAMal box and providing your certificate of affiliation to the CHIS (to be requested from UNIQA). However, if the SAM, or the equivalent service, does not recognize the CHIS as your basic health insurance and forces you to join a LAMal insurer, we advise you:
- to protest against this decision (the most important is to not voluntarily join a LAMal insurance), and
- to demand, in the same message, that you can renounce this forced affiliation, leave the LAMal and join the CHIS once the situation has been clarified at the Swiss Federal level, notably following the publication of the new Ordinance on Health Insurance.
We, of course, continue to follow this major issue which is being actively managed by the Legal Service and the Host States Relations Service. We will keep you informed of any development.
