Who is affected by the right of option?
The right of option applies to French residents (or some neighboring states) working in Switzerland under a frontier worker permit (G permit). By default, they are subject to Swiss LAMal. But under a bilateral agreement, they can request exemption from LAMal to remain covered by their national system (CMU/PUMA in France). This right must be exercised within 3 months of starting work — after that deadline, you're permanently enrolled in LAMal. B and C permits: no right of option, LAMal is mandatory.
LAMal or CMU: the factual comparison
LAMal: monthly premium varying by age, canton, insurer, paid entirely by the insured (no employer contribution). Coverage: drugs, hospitalization, family doctor in Switzerland. Care in France: reimbursed at LAMal rates (often below French rates). CMU/PUMA: contribution levied on gross Swiss salary (~8%), coverage in France at French rates (complementable with a mutuelle). Care in Switzerland: life-threatening emergencies only. Generally, young healthy cross-border workers opt for CMU (cheaper); families and older profiles prefer LAMal (Swiss coverage).
How to exercise the right of option
Step 1: contact your French CPAM within 3 months of your start date. Step 2: request the LAMal exemption form and complete it with your Swiss employment contract. Step 3: the CPAM issues an exemption certificate. Step 4: give the certificate to your Swiss employer (who will deduct the CMU contribution from your salary). If you miss the 3-month window, LAMal becomes mandatory and you permanently lose the right of option — a critical decision to make quickly from day one.
Family case: children and partner
The cross-border worker's choice doesn't automatically cover their family. Children living in France with a cross-border parent may be covered by PUMA in France or, if the other parent works in Switzerland, by LAMal. A non-working spouse in France cannot subscribe to LAMal alone — they must stay on PUMA in France. If your spouse also works in Switzerland (G permit), they also have the right of option and must make their own choice separately within the same 3-month window. Polia recommends treating the full family situation together before deciding.
