Does the PUMa contribution use income from two years ago?

Yes. The cotisation subsidiaire maladie (art. L380-3-2 CSS) is assessed on N-2 income — for a 2026 contribution, your 2024 income, converted at the DGFiP reference rate.

Am I covered in both countries?

LAMal covers care in Switzerland and, for frontaliers, in France. PUMa/CMU centres cover in France; routine treatment in Switzerland generally requires complementary cover. Where you actually receive care often matters more than the monthly difference.

What changes in 2028?

From 1 January 2028 frontaliers are due to be integrated into the Swiss risk-compensation system (OPCM consultation closed 3 December 2025), which is expected to increase LAMal frontalier premiums.

LAMal or CMU? Get your monthly cost for both

Last updated 31 July 2026AdminLanding Editorial

You have 3 months to exercise the droit d'option, and the choice is irrevocable. Compare both systems on 2026 official rates — free — then file the form your CPAM needs.

Use the free calculator All frontalier tools

LAMal vs CMU calculator — free

Your monthly cost under each system, on 2026 official rates.

Gross annual Swiss salary (CHF)

The PUMa contribution is assessed on your N-2 income — the year before last.

Dependants to cover

Children or non-working spouse, excluding yourself.

Your age band (LAMal tier)

Enter your gross annual Swiss salary to compare the two systems.

Track your frontalier net salary too

Net Frontalier converts your Swiss gross to French net with the current rates. See the cross-border hub

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Quick answer

A frontalier living in France and working in Switzerland has 3 months from the start of employment to choose between Swiss LAMal and French PUMa/CMU — the droit d'option — after which LAMal applies by default and the choice becomes irrevocable. LAMal is a flat premium per insured person (about 521 CHF/month for an adult, 148 CHF per child, OFSP 2026 average) and covers care in Switzerland; PUMa/CMU is 8% of income above a deduction of 25% of the PASS (48,060€ in 2026), assessed on N-2 income, and covers the whole household in France. Low-to-mid salaries and larger families usually pay less under PUMa/CMU; high earners covering only themselves usually pay less under LAMal. From 1 January 2028 frontaliers join the Swiss risk-compensation system, which is expected to raise LAMal premiums.

What the comparison does not tell you

The deadline beats the arithmetic

The 3-month window runs from the start of your Swiss employment, not from when you move or when you first hear about the option. Miss it and you are affiliated to LAMal by default — no matter which system the numbers favoured. Because the option is exercised once and is then irrevocable for the duration of your cross-border employment, this is one of the few French administrative deadlines with no practical recovery route.

Where you want to be treated

LAMal gives you routine care in Switzerland; PUMa/CMU centres your cover in France. A frontalier whose family doctor, specialists and hospital are all on the Swiss side may rationally pay more for LAMal. Conversely, someone who lives, has children and receives all care in France often finds the Swiss premium buys them very little. Run the numbers first, then weigh them against where your care actually happens.

Household size moves the answer

This is the structural difference between the two systems. LAMal charges a premium for every insured person — each child adds roughly 148 CHF a month. PUMa/CMU is a single contribution on your income that covers the household regardless of size. A couple with three children therefore sees a very different result from a single frontalier on the same salary, which is why the calculator asks for dependants rather than assuming.

The 2028 reform is already scheduled

Frontalier LAMal premiums currently sit outside the Swiss risk-compensation pool. From 1 January 2028 that changes, and premiums are expected to rise. If today's comparison puts the two options within a few tens of euros of each other, the reform may well decide it for you — worth factoring in given the choice cannot be undone.

Frequently Asked Questions

Cost comparison, droit d'option, coverage, PUMa basis, 2028 reform.

LAMal or CMU — which is cheaper for a frontalier?

It depends almost entirely on your salary. LAMal is a flat premium per person (around 521 CHF/month for an adult in 2026, OFSP average), so it does not rise with income but is multiplied by each person you cover. The French PUMa/CMU contribution is 8% of your income above a deduction of 25% of the PASS (48,060€ in 2026) and covers your whole household at no extra cost per person. The result: PUMa/CMU is usually cheaper for lower salaries and for large families, LAMal for high earners covering only themselves. The free calculator above gives your exact crossover point.

What is the droit d'option and how long do I have?

Cross-border workers living in France and employed in Switzerland have 3 months from the start of their Swiss employment to choose between Swiss LAMal and French PUMa/CMU. The choice is exercised once and is irrevocable for the duration of the cross-border employment, except on specific life events (marriage, birth, loss or change of employment). If you do not exercise it within the 3 months, you are affiliated to LAMal by default — which is why the deadline matters more than the arithmetic.

Does LAMal or CMU cover me in both countries?

LAMal covers you in Switzerland and, as a frontalier, also in France for treatment received there. PUMa/CMU covers you in France, and in Switzerland it gives access to emergency care but not routine treatment on the same terms — frontaliers who choose CMU and want to be treated in Switzerland generally need complementary cover. This is the single most common reason a frontalier picks the more expensive option on purpose: where you actually want to be treated usually matters more than the monthly difference.

Is the PUMa contribution really based on income from two years ago?

Yes. The cotisation subsidiaire maladie (Art. L380-3-2 of the Code de la sécurité sociale) is assessed on your N-2 income — for a 2026 contribution, your 2024 income, converted at the DGFiP reference rate. This creates a lag that catches people out: a salary increase shows up in your contribution two years later, and a drop in income does not reduce it immediately.

What changes for frontaliers in 2028?

From 1 January 2028, frontaliers are due to be integrated into the Swiss risk-compensation system (compensation des risques). The OPCM consultation closed on 3 December 2025. The expected effect is an increase in LAMal frontalier premiums, since frontalier policyholders currently sit outside that pooling mechanism. If you are close to the crossover point today, it is worth re-running the comparison before the reform takes effect.

How do I actually declare my choice?

The choice is declared to your French CPAM using the dedicated option form, accompanied by proof of Swiss employment. If you choose LAMal, you must also request exemption from PUMa affiliation. Getting the form wrong or sending it late is what causes the default LAMal affiliation. AdminLanding generates the completed choice form for your CPAM as part of the France-Switzerland pack.

Important: AdminLanding is a technology platform, not an insurer, health fund or regulated adviser. This calculator applies published 2026 official rates (OFSP premium tables, URSSAF PUMa formula, PASS) to the figures you enter, for information purposes only — it is not financial, legal, tax or insurance advice, and it does not account for complementary cover, insurer-specific premiums (the real LAMal spread is roughly CHF 350–700 for adults) or your personal medical situation. Verify with your CPAM, your Swiss insurer or a qualified professional before exercising the droit d'option, which is irrevocable.

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