The Health Insurance System in Germany (2023)

Health insurance
in Germany

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)

Public servants

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

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

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.

**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:

1
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

2
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:

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:

1
Immigrants must demonstrate sufficient “means of subsistence” to earn a living in the relevant EU country

2
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)

110 →Police

(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

¹

EU

/EAA countries

: EU Member States and Liechtenstein, Norway, Iceland + Switzerland
²

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.