Statutory Health Insurance Guide for Foreigners in Germany - 2024

The statutory health insurance system in Germany

1883, Germany was the first country to introduce compulsory and partially employer-financed health insurance. It is the direct forerunner of today’s public health insurance in Germany and has become the model for social insurance systems in many other countries.

Germany’s statutory health insurance system covers 90% of all insured people. Statutory health insurance (Gesetzliche Krankenversicherung, GKV) is available in three variants: compulsory health insurance, voluntary insurance, and non-contributory family insurance.

Compulsory insurance

Statutory health insurance is compulsory for employees with an annual income of less than €69,300. They do not have the option of switching to private health insurance. They can currently decide between 95 statutory health insurance providers.

Voluntary insurance

Employees above the income threshold of €69,300, freelancers, the self-employed, civil servants, and students are exempt from insurance. They can decide whether to take out statutory or private health insurance.

Family insurance

If you have statutory insurance, you can insure your spouse and children free of charge under family insurance. Family insurance applies if co-insured people have no income or are below the income threshold of €505 per month (mini-jobbers: up to €538 per month, regular employees and working students: around €608 — income threshold of €505 + flat-rate allowance for income-related expenses).

Students can remain insured free of charge through their parents until they reach age 25, as long as they do not exceed these income limits.

Expats in public health insurance

Expats who live in Germany on a long-term or permanent basis are subject to the exact legal requirements as residents with a German passport. Consequently, expats can only switch to private health insurance if they are exempt from insurance.

However, some expats cannot take out public health insurance. This includes, for example, students taking a language or preparatory course or visiting academics who are not in a regular employment relationship with their university. Private health insurance providers such as ottonova and Feather offer special tariffs for students and expats who live in Germany temporarily. Alternatively, they can also opt for regular private health insurance.

We have prepared separate articles on health insurance for various expat groups in Germany.

Benefits of statutory health insurance in Germany

The insurance coverage of public health insurance includes all relevant health services:

• Outpatient medical services (general practitioners and specialists)
• Hospital treatment
• Remedies — for example, physiotherapy
• Medical aids — for example, visual aids or wheelchairs
• Psychotherapy
• Medication
• Preventive check-ups (for specific sicknesses and with age limits)
• Dental treatment and dentures
• Orthodontics (up to the age of 18, only from a certain degree of severity)
• Medical rehabilitation that is not covered by pension insurance

Statutory health insurance covers only medically necessary and cost-effective treatments. Statutory insured people must make additional payments for many health services. These co-payments are exceptionally high for specific dental treatments and dentures—some services are generally not reimbursed. Statutory health insurance dentists must always choose the cheapest treatment option.

Important: Before the start of treatment: confirmation of cost coverage!

Before undergoing treatments, not part of the standard service, you should inform your health insurance provider and ask them to confirm that they will cover the costs.

Private supplementary insurance for statutory insured people

With private supplementary insurance, you can use better medical services, especially for dental care, and protect yourself against high treatment costs. We particularly recommend supplementary dental insurance from FinTech insurers ottonova, Feather, and Getsafe, whose benefits are explicitly aimed at expats in Germany.

ottonova and Getsafe also offer supplementary hospital insurance for treatment by chief physicians and accommodation in single or double rooms.

If full private health insurance is an option, you can also obtain high-performance insurance policies from ottonova and Feather.

Statutory insurance cover abroad

With the European Health Insurance Card (EHIC), you receive insurance coverage from your German health insurance provider in all EU countries, Switzerland, Iceland, Norway, and Liechtenstein. With this card, you can use all services provided by the public healthcare systems in these countries.

Costs for treatment outside the EU are only covered by statutory health insurance in exceptional cases — usually for emergency treatment.

Costs of statutory health insurance in Germany

The current contribution to statutory health insurance is 14.6% of gross salary. For salaried employees, the employer pays half of this. The contributions are paid directly to the health insurance fund by the employer.

Freelancers and the self-employed must pay their health insurance contributions in full themselves. However, if they waive their entitlement to sick pay from the 43rd day of illness, they are eligible for a reduced contribution rate of 14% of their gross income.

The health insurance companies add an individual supplementary contribution to the statutory health insurance contribution, which averages 1.7%.

In addition to your health insurance contribution, you also pay a monthly contribution to long-term care insurance, which is compulsory in Germany. It currently amounts to 3.4% of your gross salary (4% for those without children). For salaried employees, the employer contributes 1.7%.

Choosing the right statutory health insurance company

If you want to take out statutory health insurance, you can choose between 95 public health insurance companies. They are obliged to accept all eligible people for statutory health insurance. Unlike private health insurance, age and pre-existing conditions, including serious illness, do not play a role.

Germany’s statutory health insurance providers are corporations under public law. They only cover treatment costs for doctors, dentists, and other medical service providers licensed by the statutory health insurance funds. Reimbursed medical services must comply with the guidelines of the legislator, the health authorities, and the health insurance providers for public medical care.

Application for insurance, change of insurance provider, termination

You usually apply online for insurance with a public health insurance provider. Once your application has been accepted, you will receive a health card from your insurer with your insurance number, personal details, and other information about your insurance status. You use it to prove your health insurance to doctors and other medical service providers. When traveling, you can automatically use your German insurance card as a European Health Insurance Card (EHIC).

There is a commitment period for public health insurance in Germany — you can change your health insurance provider after 12 months at the earliest. The new health insurance company will cancel your existing health insurance.

You must cancel your health insurance if you switch to private health insurance or no longer need it because you are moving abroad.

The notice period for all public health insurance companies is two whole months to the end of the month. Suppose your health insurance company increases its supplementary contributions. In that case, you can also exercise a special right of termination within the commitment period, but you can also only switch to your new insurance provider after two months.

A change of your public health insurance provider without a commitment or notice period is possible in the following cases — it must take place within 14 days of the occurrence of the respective event:

• Your earnings from employment exceed or fall below the compulsory insurance threshold. If you switch from mandatory to voluntary insurance, immediate termination is also possible if you switch to private health insurance.
• You become self-employed as your primary occupation.
• The requirements for non-contributory co-insurance are no longer met.
• You have registered as unemployed.

How to choose the right insurance provider

Before deciding on a particular statutory health insurance scheme, you should always compare several providers. The additional contributions of public health insurance providers can vary considerably. In addition, the insurance companies offer various additional benefits, each with its focus. These may include, for example, cost coverage or subsidies for alternative treatments, professional dental cleanings, vaccinations, nutritional advice, and health courses.

Of course, you can also get help from professionals when selecting your insurance. The FinTech insurer Feather especially offers support to expats who are taking out public health insurance in Germany. The company works with Techniker Krankenkasse, Barmer, DAK, and AOK. You benefit from personal advice and an exceptionally straightforward online process.

Conclusion

Statutory health insurance in Germany is based on solidarity. All insured people receive the same benefits. Contributions depend on income — those who earn more must pay more as long as the compulsory insurance threshold is not reached. Under certain conditions, family members can be insured free of charge. For employees, the employer pays half of the health insurance contribution.

The contributions and additional benefits of the 95 public health insurance funds differ. By comparing providers and selecting your health insurance company wisely, you can optimize your contributions and healthcare within the public healthcare system.

Frequently Asked Questions — FAQ