Medical Insurance in Germany

Medical Insurance in Germany

4. January 2018

Since 2009, each individual residing in Germany has been obliged to take out medical insurance in Germany. Health insurance is necessary even for short-term stays in Germany; otherwise no visa is likely to be issued.

German Health Insurance System ➤
 Statutory Health Insurance ➤ Private Health Insurance ➤
 Students ➤ Guest Workers ➤
 Guest Scientists ➤ Au Pairs ➤
Tips, Links ➤

German Health Insurance System

German health insurance is structured into a dual system consisting of statutory health insurance (SHI) and private health insurance (PHI). Statutory health insurance is accessible to everyone, however there are certain requirements for the private health coverage. People from the European Economic Area* (EEA) and from countries, with which Germany has signed the social security agreement** can be insured in the health insurance system of their home countries. Benefits of these insurances could vary compared to Germany. Although the insured person might have to pay additional fees or take the supplementary insurance.

* EU /EAA countries: 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), Israel***, Croatia, Morocco, Macedonia, Montenegro, Serbia, Turkey and Tunisia
*** The agreement applies exclusively to maternity assistance within the health insurance scheme.

Statutory health insurance (GKV/SHI) and the solidarity principle


Statutory health insurance applications depend on income. The basis is the total gross income out of which a fix rate of 14.6% (as of 2018) is collected. This is equally shared in between the insured person and the employer (7.3% each). Every health insurance company collects an additional amount paid only by the employees. Should the contribution assessment ceiling (€4.425/m as of 2018) is reached the income above will not be calculated for the premium. Due to the family insurance policy statutory health insurance also covers children and spouses for free of charge.

There are people with certain social status must become the members of a statutory health insurance fund.
Employees (gross income below the income threshold for compulsory insurance)
Pensioner (if the pre-insurance period is fulfilled)
Recipient of unemployment benefit

Benefits in private health insurance (PKV/PHI)

Private health insurance (PHI) is not applicable for every person. If the gross salary is above the income threshold for compulsory insurance (€ 4.950/m as of 2018) employees can be insured in the private health insurance scheme. Those persons fitting to this system have to apply for exemption from compulsory insurance. A minimum period for permanent stay in Germany is often required by the private health insurance providers. Foreign policy holders must to have a long-term insurance period. Some of the private health insurance providers offer unique rates for these individuals, which are defined to their needs and period of stay.
To get the private health coverage you might be questioned about your health conditions (health check). As soon as the insured person returns to his/her home country the German health cover ends.

Good to know Premiums of private health insurance are estimated based on the state of health condition, age and benefits of the insured person regardless of his/her salary range. Contributions are different for every single insured person. The private health insurance brings many times more comprehensive benefits than the statutory health insurance and are barely subject to the governmental regulations. Benefits included could be precisely applied by the insured person. The covered persons have to pay treatment costs upfront and the insurance provider fronts these due to the cost reimbursement principle after invoices.
There are people with certain status who are normally privately insured. 
Employees (gross income above the income threshold for compulsory insurance)
Public servants
Self-employed persons and freelancers

Supplementary insurance

Those individuals who would like to cover health insurance gaps in their coverage should apply for supplementary insurance. This option is offered by the private health insurance providers regardless of income. Typical types being used include supplementary nursing care, dental insurance or hospital insurance.

Health insurance for international students in Germany

International students who applying for a specialist degree at a German college or university have to have proper health insurance coverage. Without a proof of health insurance they cannot start their studies.

Compulsory insurance for students in GermanyBased on the country of origin, age and reason of the stay there are different conditions available. Normally there are five different groups students belong to.1 Students from EEA countries* or countries signed the social security agreement with Germany**.2 Students from all other countries3 Students aged 30 or over or passed their 14th semester4 Attendees in preparatory language courses5 International doctoral students and scholarship holders

Health insurance for EU citizens under 30 years / 14 semesters

By providing the proof of health insurance of their home countries, those students who came from EEA countries* or the ones that have social security agreement** with Germany could be dispense from the compulsory health insurance.

Health insurance in the country of originHealth insurance options in Germany Additional requirements 
Statutory health insuranceRecognition by the statutory health insurance schemeEuropean Health Insurance Card (EHIC) from the home country
Private health insurancePrivate health insuranceConfirmation of health insurance provider from the home country
No insuranceStatutory or Private health insuranceOver the age of 30 only the private insurance is applicable

NOTE: International students who are privately insured in Germany but are over 30 years might need a proof of exemption from the statutory health insurance fund. Statutory health insurance admission is not possible after that during their study stay.

Compulsory health insurance for non-EU citizens

International students from all other countries have to apply either for the statutory or private health insurance in Germany along their stay. At the age of  30 or after the 14th semester they have to take the private coverage. The same will apply for those who are planning to take pre-language courses in Germany.

Statutory health insurance rates (as of 2018)

Insurance for international studentHealth insurance ratesNursing care insurance ratesTotal 
Students without a child (from the age of 23)€ 66.33*€ 18.17**€ 84.50*
Students up to 23 or with a child€ 66.33*€ 16.55**€ 82.88*

*Statutory health insurance for international students are the same in all health insurance funds. Supplementary insurance fund is simply added to this.
**Nursing care insurance contributions amount to 2.55% for students with children, and 2.80 percent for students from the age of 23 without children.
It is suggested that International students investigate advice from the relevant student office prior starting the programme.

Working in Germany – Health insurance for international workers

An employee should be insured in the country he/she is working. Regardless if they their work stay for short or long term it is mandatory to join the German health insurance scheme.

Workers from EEA Member States* and from countries Germany has signed the social security agreement have to join the German health insurance scheme no matter if they are employees or self-employed. Same applies when the employed person moves into another member state or the employer is domiciled in another state. However there are two exceptions:

If an individual works as an employee in a member state and works as a self-employed 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

Employed individuals from outside the EU need to join the German health insurance scheme, meanwhile they have a residence as well as a work permit in place. Third-country nationals may apply for these permits at the local German embassy in their home countries or at a registration office for foreigners in Germany.

Work and research in Germany – Health insurance for international professionals and scientists

For international scientists and researchers it is also mandatory to have the right German health insurance in place. This applies for their children and spouses. For any third-country nationals is is recommended to investigate about the insurance options prior their departure. The only way to get their residence permits is to prove the health insurance. Legal regulations are listed below:

Origin, type of stayHealth insurance regulations 
International scientists from EEA countries* and countries with social security agreements** with GermanyHealth insurance from the home country is also valid in Germany (European Health Insurance Card). Form no. 1 or 101 from home health insurance fund or social security office is required
International scientists resident in Germany (long stay)Either German health insurance scheme may be required for statutory or private.
Alternatively, home country health insurance could be converted to entitlement tariff for the period of stay in Germany.
International scientists with employment contractGerman health insurance scheme required either for statutory or private
International scientists with scholarshipPrivate health insurance only

Health insurance for immigrating to Germany

Individuals with immigration interest to Germany need to join the German health insurance scheme in order to get permanent residency. Without the compulsory health insurance it is not possible to get the German visa.

Residential rights for EU citizens

People from EU member countries have the right to live in any of the member states even if they are not working there. Residential rights are defined by two conditions:

1. Subsistence level of earning has to be proved in the relevant EU country.2. Medical insurance coverage has to be taken in the country of immigration.

Options and regulations for non-EU citizens

Non-EU citizens who need visa to enter Germany have to have already the health coverage whilst entering the country. Conditions for statutory or private health insurance vary depending on their employment status.

Special regulations for asylum seekers in Germany

Individuals looking to get protection against political or other persecution in Germany are entitled for special status. No asylum seekers could be covered by statutory health insurance but in the case of sickness, they are authorized to benefits under the Asylum Seekers Benefits Act. Level of benefits vary based on the time of their stay.

Entitlement under § 4 AsylbLG includes:

Acute illness: medical treatment, provision of dressings and medicines, benefits that help in recovery
Nursing and medical care, midwife assistance, provision of medicines and dressings for pregnant women and women who have recently given birth
Check-ups and vaccinations

German health insurance for students, apprentices and au pairs

€450International students, interns and au-pairs willing to work in Germany have to have health insurance and accident insurance along their stay. If International interns and au-pairs make more than €450/m they have to take the compulsory health insurance by law. Private health insurance tailored to specific needs of internationals could be an option too for those who are from the EEA* and countries have social security agreement with Germany.**

Health insurance in Germany or from the home country?

Citizens from EEA* countries can join to the health care scheme in Germany with their European Health Insurance Card. Should the home country has a social security agreement** with Germany in place (including health insurance regulations) in some cases benefits may be claimed in Germany. These vary based on the agreement in place. If visitors are from neither of these countries private health insurance must be selected. The costs of the private and accident insurances are levied to the host family.Age restrictions for au-pairs
➤ in general: 18 to 27 years
➤ visa application: 18 to 27 years
➤  for non EU citizens: 18 to 27 years
➤ Max insurance period: 12 months
It’s recommended to look for independent advice in your home country. You may find out more at the relevant embassies abroad or registration offices for internationals or insurance companies as well as independent brokers.

NOTE: Rates and benefits vary depending on the health insurance provider – Be advised for options for persons who stay for a short term in Germany as part of Work & Travel programme. 

Useful tips for internationals in Germany

How to handle an emergency? In case of an unlikely event it is important to know who to contact and get medical assistance.
Important emergency numbers
(all numbers could be reached for free of charge)
Medical on-call service
112 ➤ Ambulance116117➤ Medical on-call service by the Association of Statutory Health Insurance Physicians➤Emergency department of the municipal hospital or the local university hospital
110 ➤ Police 

Medicines and pharmacies

In Germany pharmacies are indicated with a large “A” symbol after the word “Apotheke”. You can get your your medicines in the network of these however online orders have recently become very popular.

There are two types of categories:

  • over-the-counter medicines – available without a doctor’s prescription
  • prescription medicines – prior medical examination and doctor’s prescription as well as additional payment required

There is an emergency service system for pharmacies in Germany for urgent matters. The addresses of the relevant pharmacies are indicated in the latest newspapers or on the information board of any pharmacy.

Educational institutionsLinks 
Federal Foreign
Federal Office for Migration and
Federal Commissioner for Foreignerswww.bundes­auslaender­
The National Refugee
German Academic Exchange Service (DAAD)
Association of German Student Services (DSW)
Foundation for the Promotion of the Rectors’ Conferencewww.hochschul­
Secretary of the Standing Conference of the Ministers of Education and Cultural Affairs of the LänderCentral Office for Foreign
Society for Academic Study Preparation
and Test Development
TestDaF Institute
Federal Ministry of Education and
Federal Social Insurance Authoritywww.bundes­versicherungs­
Federal Agency for Civic Education (bpb)
German Liaison Office for Health Insurance Abroad (DVKA)
Health care facilities Links 
Federal Ministry of Health (BMG)www.bundes­gesundheits­
Federal Centre for Health Education (BZgA)
Federal Association for Prevention and Health Promotion (BVPG)
Independent Patient Counselling Germany (UPD)www.patienten­
German Red Cross (DRK)
Federal Association of Non-statutory Welfare (BAGFW)
German AIDS Service
German Centre for Addiction Issues (DHS)
German STI Society – Society for the Promotion of Sexual
German Nutrition
The Healthy Cities