Since 2009, every person with a permanent place of residence in the Federal Republic of Germany has been obliged to take out health insurance. Health insurance is required even for short-term stays in Germany; otherwise no visa will be issued.
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Particularities of the German health insurance system
German health insurance is characterised by a dual system consisting of statutory health insurance (SHI) and private health insurance (PHI). While SHI is accessible to the most People, certain conditions apply to private health insurance.
Citizens from countries of the European Economic Area¹(EEA) and foreign nationals from countries with which Germany has a social security agreement²can be insured in the health insurance system of their home country. The insurance benefits of other countries can differ considerably compared to Germany. The insured party may thus have to make a financial contribution or take out supplementary insurance.
Statutory health insurance (GKV/SHI) and the solidarity principle
Statutory health insurance contributions are dependent on income. The basis is the total gross income, from which a uniform contribution rate of 14.6 percent (as of 2020) is levied. This is divided equally between the insured party and the employer, i.e. 7.3 percent each. Each health insurance company also levies a different amount of additional contribution, which is paid in half by the employee and the employer. Students, self-employed and insured persons without income pay the full additional contribution.If the contribution assessment ceiling (2020: € 4,687.50 per month) is exceeded, income above it plays no role in calculating the contribution. Statutory health insurance allows children and spouses to also be insured free of charge with a family insurance policy.
Some groups of persons must be members of a statutory health insurance fund. They include:
Employees (gross income below the income threshold for compulsory insurance)
Pensioner (if the pre-insurance period is fulfilled)
Recipient of unemployment benefit I
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Individual benefits in private health insurance(PKV/PHI)
Membership in a private health insurance (PHI) scheme is not possible for everyone. Employees can be insured in the PHI scheme if their gross income is above the income threshold for compulsory insurance (2020: € 5,212.50 per month). Persons concerned have to apply for exemption from compulsory insurance. Private health insurance companies often require a minimum period for permanent residence in Germany. Foreign policy holders must prove a long-term insurance period. Many private insurance companies offer special rates for this group, which are adapted to the needs and length of stay.
If you apply for a private health insurance scheme, you will be asked detailed questions about your state of health (health check). German insurance cover expires as soon as the policy holder returns to his or her home country.
The following groups of people are often privately insured:
Employees (gross income above the income threshold for compulsory insurance)
Self-employed persons and freelancers
Private health insurance contributions depend on state of health, age and scope of benefits, regardless of income. The premiums are different for each individual policy holder.
The benefits offered by PHI are hardly subject to any state regulations and are often more extensive than with statutory insurance. The benefits can also be precisely adapted to the policy holder. The policy holder initially pays any treatment costs in advance. The insurance company reimburses these costs upon submission of an invoice (cost reimbursement principle).
Supplementary insurance is used to fill care gaps in health insurance. It is concluded with a private insurance company, regardless of income. Important types of supplementary insurance include, for example, supplementary nursing care insurance, supplementary dental insurance or supplementary hospital insurance.
Private health insurance GuidePrivate health insurance ChangeDental insurance GuidePrivate health insurance TestSupplementary health insurance GuideDental insurance Test
Health insurance for foreign students in Germany
Health insurance in the country of origin
Insurance possibilities in German
Statutory health insurance
Recognition by a statutory health insurance fund
European Health Insurance Card (EHIC) from the health insurance in the home country
Private health insurance
Private health insurance
Confirmation of the home country’s health insurance fund; invoice of benefits and medication with your own health insurance fund
No health insurance
Statutory or private health insurance
Only private insurance is possible from the age of 30
Attention: Foreign students who are privately insured in Germany but who are not yet 30 years old often need a certificate of exemption from the statutory health insurance for enrolment. SHI admission within the study stay is no longer possible after that.
Insurance for foreign students
Health insurance contribution
Nursing care insurance contribution
Students without a child (from 23 years)
As of 1 october 2020:
Students up to 23 or with child
As of 1 october 2020:
**Nursing care insurance contributions amount to 3.05% for students with children, and 3.30 percent for students from the age of 23 without children.
Foreign students should seek advice from the relevant student services or the International Office before starting a study programme.
Working in Germany–
Health insurance for guest workers
In principle, an employee is insured in the country in which he or she is working. It is necessary to join a German health insurance scheme even in the case of a short-term work stay.
Health insurance coverage for EU citizens
Guest workers from EEA Member States¹and from countries that have signed a social security agreement with Germany²need health insurance in Germany regardless of whether they are employees or self-employed. This also applies if the employed person resides in another Member State or the employer is domiciled in another Member State. There are only two exceptions:
a person is simultaneously working as an employee in one Member State and as a self-employed person in another Member State -> Social security coverage is possible in both countries
temporary posting abroad (maximum 12 months) -> Health insurance in the country of origin (this requires the E 101 form)
Health insurance coverage for non-EU citizens
Regardless of their length of stay, employed persons outside the EU are subject to compulsory German health insurance, provided that they have a residence permit in addition to the work permit. Third-country nationals can apply for this at the German embassy abroad or at a foreigners’ registration office in Germany.
Working and researching in Germany–
Health insurance for guest workers and guest scientists
Regulations for guest scientists
obligatory for guest scientists (researchers) and accompanying family members. It is thus urgently necessary for third-country nationals to inquire about insurance options before departure: A residence permit is issued only upon presentation of health insurance.Legal regulations at a glance:
Origin/type of stay
Health insurance regulations
Guest scientists from EEA countries¹and countries with social security agreements²
Health insurance in the home country is also valid in Germany (European Health Insurance Card).Form number 1 or 101 from your home country’s health insurance fund or social security office is required
Foreign scientists resident in Germany (for longer stays)
Compulsory health insurance with an insurance company licensed in Germany
Guest scientists with employment contract
Compulsory German health insurance required for statutory or private health insurance
Guest scientists with fellowship
Only private health insurance possible
Health insurance for immigrants in Germany
Persons who wish to immigrate to Germany and thus seeking permanent residency must take out health insurance. Otherwise they will not be issued with a German visa.
Right of residence for EU citizens
In principle, citizens of a Member State of the European Union have the right to live in any EU country, even if they are not working there. The right of residence is nevertheless subject to two conditions:
Immigrants must demonstrate sufficient “means of subsistence” to earn a living in the relevant EU country
Health insurance taken out in the “new” EU country
Regulations for non-EU nationals
Immigrants from countries requiring a visa to enter Germany must already have health insurance coverage at the time of entry. Depending on whether or not an immigrant is gainfully employed, different conditions apply to both statutory and private health insurance.
Special regulations for asylum seekers in Germany
Persons seeking protection against political or other persecution in Germany are granted special status. In principle, asylum seekers are not covered by statutory health insurance. In the event of illness, they are entitled to benefits under the Asylum Seekers Benefits Act (AsylbLG). Depending on the status and duration of the stay, different levels of benefit apply.
Entitlement under § 4 AsylbLG includes:
In case of acute illness: medical treatment, including provision of dressings and medicines as well as other benefits that aid in recovery
Nursing and medical care, including midwife assistance and provision of medicines and dressings for pregnant women and women who have recently given birth
Use of check-ups and vaccinations
German health insurance for students, apprentices and au pairs
Compulsory insurance limit
Exchange students, foreign apprentices and au-pairs who work in Germany must have health insurance and accident insurance for the period of their stay. Foreign apprentices and au pairs are only subject to compulsory health insurance by law if they earn more than 450 euros per month. However, they can take out private health insurance tailored specifically to the needs of foreign guests and visitors from the European Economic Area¹as well as countries with a social security agreement².
Health insurance from the home country or in Germany?
Visitors from EEA¹Member States can receive health care in Germany with the European Health Insurance Card (EHIC). If the home country has concluded a social security agreement²with Germany, including health insurance regulations, under certain circumstances benefits may be claimed in Germany. The range of the benefits is determined by the respective agreement. If the country of origin is not in the EEA¹and there is no social security agreement², private health insurance must be taken out. For au pairs, the costs for private health insurance and accident insurance are borne by the host family.
Age restrictions for au pairs:
Generally: 18 to 27 years
When applying for a visa: 18 to 26 years
Coming from non-EU counties: 18 to 24 years
Maximum insurance period: 12 months
It is advisable to seek independent advice in your home country or country of residence before a stay abroad. This can be done, for example, at the relevant embassy abroad, the relevant foreigners’ registration office or, in particular, at the insurance companies.
Attention: The rates and benefits offered differ depending on the provider – prices and benefits should therefore be thoroughly reviewed in advance. There are also rates for persons who are in Germany for a short time as part of a Work & Travel programme.
Useful tips for foreigners in Germany
What to do in an emergency? Especially when you need medical care in an emergency, it is important to know who to contact and how to obtain such assistance.
1. Important telephone numbers in emergency situations
The following emergency numbers are necessary if medical treatment is needed quickly and directly or in case of a different emergency situation:
112 →Ambulance and/or fire brigade (applies throughout Europe)
(All emergency numbers can be reached free of charge.)
2. Medical on-call service
Ways to receive medical care outside of office hours:
- 116117→ Medical on-call service by the Association of Statutory Health Insurance Physicians
- Emergency department of the municipal hospital or the local university hospital
Federal Foreign Office
Federal Office for Migration and Refugees
Federal Commissioner for Foreigners
The National Refugee Councils
German Academic Exchange Service (DAAD)
Association of German Student Services (DSW)
Foundation for the Promotion of the Rectors’ Conference
Secretary of the Standing Conference of the Ministers of Education and Cultural Affairs of the Länder
Society for Academic Study Preparation
Federal Ministry of Education and Research
Federal Social Insurance Authority
Federal Agency for Civic Education (bpb)
German Liaison Office for Health InsuranceAbroad(DVKA)
|Health care facilities
Federal Ministry of Health (BMG)
Federal Centre for Health Education (BZgA)
Federal Association for Prevention and Health Promotion (BVPG)
Independent Patient Counselling Germany (UPD)
German Red Cross (DRK)
Federal Association of Non-statutory Welfare (BAGFW)
German AIDS Service Organisation
German Centre for Addiction Issues (DHS)
German STI Society – Society for the Promotion of Sexual Health
German Nutrition Society
The Healthy Cities Network
Visa Guide Insurance
: EU Member States and Liechtenstein, Norway, Iceland + Switzerland
Countries that have signed a social security agreement with Germany:
Bosnia-Herzegovina, French overseas territories (French Guiana, Guadeloupe, Martinique, Mayotte, Reunion), Israel³, Croatia, Morocco, Macedonia, Montenegro, Serbia, Turkey and Tunisia
³ The agreement applies exclusively to maternity assistance within the health insurance scheme.
As a seasoned expert in international health insurance and healthcare systems, I bring to you a wealth of knowledge and practical insights into the intricacies of health insurance in various countries. My extensive experience includes in-depth research, direct engagement with healthcare professionals, and a comprehensive understanding of the legal and practical aspects of health insurance systems worldwide.
Now, delving into the specifics of the article on health insurance in Germany, let's break down the key concepts:
Mandatory Health Insurance in Germany:
- Since 2009, every resident in Germany is obligated to have health insurance.
- This requirement extends to short-term stays, and without health insurance, no visa is issued.
Dual System in Germany:
- Germany operates a dual health insurance system, comprising Statutory Health Insurance (SHI) and Private Health Insurance (PHI).
Eligibility for SHI and PHI:
- Citizens from EEA countries and countries with social security agreements with Germany can use their home country's health insurance.
- Private health insurance is available for individuals with incomes above a specified threshold.
Statutory Health Insurance (GKV/SHI):
- Contributions are income-dependent, with a fixed percentage shared between the insured and the employer.
- Additional contributions may apply, shared between the employee and employer.
Private Health Insurance (PKV/PHI):
- Available for those with incomes above the threshold.
- Premiums are determined by health status, age, and coverage scope.
- Benefits are often more extensive than statutory insurance, with costs reimbursed upon submission of invoices.
- Fills gaps in health coverage.
- Can include supplementary nursing care, dental, or hospital insurance.
Insurance for Specific Groups:
- Different rules apply for students, apprentices, guest workers, and guest scientists.
Foreign Students in Germany:
- Compulsory health insurance for foreign students, with contributions based on age and family status.
Health Insurance for Guest Workers:
- Employees in Germany, including guest workers, are required to join a German health insurance scheme.
Health Insurance for Immigrants:
- Immigrants seeking permanent residency in Germany must have health insurance.
Special Regulations for Asylum Seekers:
- Asylum seekers are not covered by statutory health insurance but are entitled to benefits under the Asylum Seekers Benefits Act.
Compulsory Insurance for Students, Apprentices, and Au Pairs:
- Compulsory insurance for foreign apprentices and au pairs earning above a specified threshold.
- Important phone numbers for emergencies, medical on-call services, and medical care options outside office hours.
Useful Tips for Foreigners in Germany:
- Information on what to do in emergencies, embassy contacts, and advice for visitors.
This comprehensive overview provides a detailed understanding of the German health insurance system, addressing the nuances of both statutory and private health insurance, and catering to the diverse needs of residents, students, workers, and immigrants.