Residence and registration open the door to care

Swedish health care is provided by the regions, which are responsible for care for the people living in them; a country summary from an EU health workforce project describes it as residence-based rather than an insurance scheme a person buys into. Cash benefits such as sickness benefit sit with a separate body, the Swedish Social Insurance Agency (Försäkringskassan).

The usual way in is the population register kept by the tax agency, Skatteverket. Someone who plans to live in Sweden for at least a year is generally registered and given a personal identity number, the personnummer, while shorter stays get a coordination number instead. Försäkringskassan says people in the register are generally entitled to care and pay only the standard patient fee. The number alone does not grant residence-based welfare rights, which depend on actually living or working in Sweden.

Employing someone in Sweden without a Swedish company

Skatteverket’s guidance lets a foreign employer with no permanent establishment in Sweden register as an employer and take on staff working there directly. The employer pays employer social security contributions (arbetsgivaravgifter), and rules that took effect on 1 January 2021 also require it to withhold preliminary income tax for work done in Sweden and file monthly PAYE returns.

There is an alternative: employer and employee can sign a social security agreement under which the employee registers and pays the contributions personally, while the employer still withholds and reports tax. That option is not open to a foreign company with a permanent establishment in Sweden, which pays the full contribution rate. Some companies prefer an employer of record or a local entity to handle payroll and Swedish employment law, and our guide to health coverage for EOR and contractors abroad compares those routes in general terms. Confirm the right setup with a local adviser or tax professional.

Contributions and sick pay, with 2026 rates

Sweden has no employer health-insurance mandate. What the employer does pay is contributions on salary and benefits, which Skatteverket gives as 31.42% at the standard rate for 2026. A foreign employer with no permanent establishment pays a reduced rate, 18.8% for 2026, because the general payroll tax part does not apply to it. Rates are published each year, so confirm the figure for the year you hire.

Sick pay is a direct employer cost. The employer pays sjuklön for the first 14 calendar days of an illness, after a qualifying-day deduction, and from day 15 the employee can claim sickness benefit from Försäkringskassan. A medical certificate is needed from day 8.

Private health insurance as a taxed benefit

Employer-paid private health insurance (sjukvårdsförsäkring) is a recognised benefit, and Skatteverket treats it as taxable for the employee. Its value is the employer’s cost, normally the premium, and it is taxed when the employer pays. Where a policy covers both taxable and tax-free care, Skatteverket accepts a standard share of the premium as the taxable part unless the employer documents a lower one.

Three related points are worth knowing. Care for an employee who falls ill on a work trip abroad is not a taxable benefit. Employer-paid care for an employee’s relative is taxed to the employee as an indirect benefit. And group life and group sickness insurance under collective agreements are generally tax-free.

Where an international plan fits in Sweden

Public care comes with residence and registration, and employer contributions are owed on salary whatever policy is in place, so an international plan changes neither. It is best seen as private access added on top, and when the employer pays for it, the taxable-benefit rule above applies.

The same is true across setups. Whether you register as a foreign employer, use an employer of record or open a local entity, the employee’s access to regional care rests on being a registered resident, which leaves the employer’s choice mainly about whether to add private cover and for whom.

Before registration, and visitors from elsewhere in Europe

Registration in the population register, for stays of a year or more, is the step that lets a newcomer use care at normal patient fees. People who are not registered still receive care that cannot wait, but they usually pay the full cost themselves, which is worth keeping in mind for a new hire who has only just arrived.

EU, EEA and Swiss nationals with a European Health Insurance Card pay the same patient fees as residents, which can help a European hire in the weeks before registration.

Getting connected with a benefits partner

Our part in health cover is the introduction: on request, Mithril1 connects employers with a benefits partner that handles health coverage for remote and international teams. On this page’s quote form, note that the employee works from Sweden, whether they are registered there yet, how many people work for you outside the US and whether relatives would be included, and we will hand it to the partner. The partner and the insurer decide who is eligible, which plans are available and what they cost.

Hiring in other countries too? See the overview of international health insurance for remote employees, or return to the employee benefits hub for every benefits page.

A few useful answers

Common questions

Can a US company employ someone in Sweden without a Swedish entity?

Yes. A foreign employer with no permanent establishment can register with Skatteverket, pay employer contributions and withhold income tax. Some companies still choose an employer of record or a local entity.

Is employer-paid health insurance taxable in Sweden?

Yes. Skatteverket treats it as a taxable benefit valued at the employer’s cost, normally the premium, taxed when the employer pays.

What employer contribution rate applies in Sweden in 2026?

Skatteverket gives 31.42% as the standard rate for 2026, and 18.8% for a foreign employer without a permanent establishment in Sweden.

Does an international plan replace Swedish public care?

Public care in Sweden comes with residence and registration rather than with a policy, so an international plan is best seen as an addition, not a replacement.

Who pays when an employee in Sweden is off sick?

The employer pays sick pay for the first 14 calendar days, and from day 15 the employee can claim sickness benefit from Försäkringskassan.

International Health Insurance for Remote Employees in Sweden