All foreigners living and working in Germany need expat health insurance. It is mandatory to show proof of health insurance when applying for a German VISA or residence permit. Once you become a German resident it is compulsory to take out health insurance in Germany, according to law, and register with either public health insurance (Gesetzliche Krankenkasse, GVK) or private health insurance (Private Krankenversicherung, PVK).
Choosing Between Private and Public Expat Health Insurance in Germany
Expats in Germany can choose either private or public health insurance depending on their country of origin, occupation, and length of stay.
For some occupational groups, it is not compulsory to take out public health insurance. If you are self-employed, freelancer, student, or civil servant you can become either voluntary insured in the public health insurance, or take out private health insurance without any further criteria.
If you are employed in Germany, it is compulsory to take out public health insurance unless you reach the compulsory/mandatory insurance limit of €62,550 per year (€5,212.50 per month) in 2020. Anyone earning above this can also become voluntarily insured with public health insurance or become eligible for private health insurance.
If you are a temporary visitor from a third-country nation, which does not have a social security agreement with Germany, you will not qualify for public health insurance. Thus you would need to take out private health insurance in Germany.
Temporary Visitors from EU Countries
Temporary visitors from EU countries have the right to stay and work in Germany without further requirements. They are covered by the European Health Insurance Card (EHIC) for short stays (up to one year) but would require to get valid German health insurance for long stays.
Public Health Insurance in Germany
The Government Health Insurance system, also called public health insurance in Germany, is based on the solidarity principle. This means that everyone pays a fixed base contribution percentage and the coverage contains the same benefits for all.
Half of the contribution cost (50%) is covered by your employer (for employees) and includes family co-insurance cover as well. So the public health insurance in Germany will cover you with the same benefits no matter your state of health, however, it may be more expensive than private health insurance for young and healthy persons.
The total contribution rate for 2020 is 14.6% plus an additional contribution dependant on the public health insurance provider you choose. During 2020 the average additional contribution rate is 1.1%.
It is compulsory for employees to take out public health insurance in Germany if they earn below the compulsory/mandatory insurance limit of €62,550 per year (€5,212.50 per month) in 2020. Self-employed, freelancers, students, and civil servants are free to choose public or private health insurance.
Private Health Insurance in Germany
Every person can take out private health insurance as long as the regulations for voluntary health insurance applies to them. This applies to self-employed, freelancers, students and civil servants, but also to employees who earn above the compulsory insurance limit of €62,550 per year.
The biggest difference from the cost of private health insurance in Germany compared to public health insurance, is that it is based on the age and state of health of the person insured. Apart from this, the cost is mainly determined by the different tariff/coverage included and the deductible amount, among others.
Expat Health Insurance for Self-employed and Freelancers in Germany
Self-employed persons and freelancers are able to join public health insurance voluntarily or private health insurance without any further requirements.
By being insured publicly, you have to pay base contributions of 14.6% plus the additional contribution amount for the chosen health insurance provider. It is also important to note that there is a minimum contribution assessment of €1,061.67 in 2020. This means a minimum of €155.00 + additional contribution is payable per month regardless of your income.
Self-employed persons and freelancers also need to pay the full amount themselves, unlike employees and civil servants who get half the cost covered by their employer. However, if you have a family, the public health insurance includes statutory family insurance. This means you pay nothing extra to include family members under your insurance policy.
Private health insurance is a good solution for many young and healthy self-employed persons and freelancers. It often provides better benefits at a lower cost compared to public health insurance. However, some things need to be taken into consideration to ensure it is the best choice. A free consultation with an independent insurance broker is recommended to get good independent advice for your situation.
Expat Health Insurance for Students in Germany
Students also have a choice between private health insurance or public health insurance in Germany for the duration of their studies. For the majority of expat students are often very cheap because of their age and health condition.
For German students, you may already be covered under the statutory family health insurance, and thus do not need to pay additional insurance coverage. This generally applies to persons up to the age of 25 if they are still in school or vocational training.
Childbirth and Maternity Care in Germany
Generally, public health insurance coverage includes the basic costs of pregnancy and childbirth. For those with private health insurance, your coverage often includes private hospitals and single room accommodation depending on the tariff. It is however important to check prior to giving birth what your insurance covers.
Dental Insurance Coverage in Germany
Public health insurance in Germany covers routine checkups and basic dental care such as fillings and dental hygiene. However, it often covers it only partially and a co-payment is likely to apply. Dental supplement insurance can be taken out with a private health insurance provider to increase your coverage and reduce co-payments.
Private health insurance companies often include dental coverage, even major dental work at private institutions.
Sick Leave Coverage for Expats in Germany
Employees generally pay a contribution rate of 14.6%, which includes entitlements to sickness benefits from day 43 (6-weeks). It is your employer who pays your salary during this period. After this, the public health insurance pays up to 70% of your salary (up to €3,176 per month before tax) up to a maximum of 78 weeks over a 3-year period.
Self-employed persons and freelancers on the other hand pay a reduced contribution rate of 14% without the right to sickness benefits. This means they have no income for the entire period.
Expats who have private health insurance are often covered in the event of an illness and are covered according to their insurance policy.
How to Apply for Expat Health Insurance
Employees are automatically enrolled into public health insurance with a regional provider. But they can notify their employer if they want to be insured by a specific health insurance prover (Krankenkassen).
Self-employed persons need to arrange their own registration and enrolment with a health insurance provider.
Both the registration of public health insurance and private health insurance is quite straight forward. The main difference between private health insurance is that they require a health condition evaluation by a doctor.
Co-payments and Reimbursements Costs for Expats
When being insured with public health insurance, you will receive a health insurance card (Krankenversichertenkarte) which you will need to show each time you visit a doctor. There are no upfront payments for the services you are covered for.
Although main services such as GP visits, hospital care (inpatient and outpatient), medical treatment, x-rays, sick leave, mental health care, rehabilitation, prescription drugs, and childbirth include, you may be subject to a co-payment, also called “Zusatzzahlungen” when you require medical help. This is usually a one-off payment each quarter of €10. It does not apply for the quarters do not seek medical help.
The private health insurance in Germany works with a reimbursement method. This means you will have to pay the cost for treatments and medication and present the invoice to the private health insurance company. This is usually a fast process so you would not actually need to pay this from your own pocket. The coverage of costs for your private health insurance depends on your tariff (if the cost is covered 100%) and your deductible (the amount you pay until the remaining is covered). Sometimes it is wise not to claim anything as many private health insurance providers pay back a certain amount of your contributions if nothing is claimed throughout the year.