FAQ on health insurance

Living in Europe | Health insurance, Medical care | Germany

If you have an employment contract the following obtains: According to Regulation (EC) 883/04 you are obliged to have statutory social security and you must therefore join the statutory health insurance scheme in the country in which you are employed, i.e. Germany. You can only apply to remain in the health insurance scheme in your own country in exceptional cases, such as when the duration of the stay in Germany is restricted and legally-recognised relations exist to an employer at home. This might take the form of leave of absence with the right to return to a job in your own country.

If you have a fellowship you are not required to join the health insurance scheme in Germany. But according to Art. 193, para. 3 of the German Insurance Contract Act ("Versicherungsvertragsgesetz"), as of 1 January 2009, every person residing in Germany is obliged to obtain insurance from a health insurance provider that is authorised in Germany. We therefore recommend that fellowship recipients obtain health insurance cover from a private German health insurance.

European health insurance cards issued by Greek health insurance schemes are only valid for a temporary stay in Germany (holidays, business trip or job search). And they only cover essential medical provision at the doctor, dentist or in hospital and necessary treatment for existing or chronic illnesses. It becomes invalid as soon as you are obliged to pay social security contributions in Germany according to Regulation (EC) 883/04, such as when you are employed by a German research establishment.

When new, private health insurance policies are taken out they usually exclude previously diagnosed prior illness and impose waiting periods for pregnancy treatments, as otherwise their pricing system would break down. In principle this is also the case for temporary health insurance policies for trips abroad that do not require a health check up.

Insofar as the specific circumstances allow, the following possibilities exist for resolving such situations:
  • continuation of the existing private health insurance policy with the addition of an international option
  • continuation of membership in the statutory health insurance scheme in the employee's own country (if the employee is on a posting)
  • joining a statutory health insurance scheme in the host country, whereby this usually presupposes an employment relationship in that country.

Where an existing private or statutory health insurance policy is continued, prior illness or waiting periods are irrelevant, and when taking out a new policy under a host country's statutory health insurance scheme, in most countries cover is available from day one without waiting periods, even in cases of prior illness. However care should be taken in Belgium where even for a statutory health insurance scheme there is usually a waiting period of one year.

As a host university you should make the researcher aware that there is usually no health insurance cover in the case of prior illness or an existing pregnancy. This will help you to avoid any potential liability due to insufficient clarification. It is then up to the researchers themselves whether or not they declare any prior illness.

As soon as the academic resumes her employment in Belgium she will be subject to Belgian social security regulations. Accordingly she will also be entitled to receive Belgian social security benefits, including financial assistance and other services in the case of illness.

However, there is an issue with the waiting times for health insurance benefits in Belgium. During the first year of membership in the Belgian social security insurance scheme you can only make contributions. On principle, health insurance benefits can only be claimed from the beginning of the second year of membership. Time accrued from membership in a German statutory health insurance scheme can be taken into account if it is certified by Form E 104 DE or a "portable document".

However, as the academic only had private health insurance in Germany, Form E 104 DE or a "portable document" will not be issued. We recommend that you confirm with the Belgian health insurance authority how long the waiting period will be upon re-entry into the Belgian social security scheme and, if necessary, obtain private health insurance in Belgium.

The present case involves three different sets of regulations whereby the issues relating to residence permits have priority. The present case deals with:
  • European and German residence law for third-country nationals seeking to take up work as a researcher or scientist at a German university or research institution in the context of the Erasmus Mundus Programme (1);
  • European and German regulations on mandatory health insurance (2);
  • European regulations on the Erasmus Mundus Programme for institutions and persons participating (3).

On (1): Residence law

According to Section 20 AufenthG (German residence law), a foreign national can be given a residence permit for the purpose of conducting research, if s/he has signed a valid hosting agreement with a research institution to conduct a research project. This also includes a requirement to hold valid health insurance. The features of this health insurance coverage must essentially be equivalent to German statutory health insurance (and/or long-term care insurance). Variations in individual benefits are permissible. Health insurance coverage must be unlimited or renew automatically. The "minimum requirement" in the Erasmus Mundus Programme does not pertain here and is thus irrelevant to the Immigration Office in charge.

On (2): Mandatory health insurance

The basic premise of health insurance according to SGB V is that anyone who legally resides in Germany is covered by health insurance and is legally entitled to be accepted by a statutory or private insurance carrier in any event. Which form of insurance is required or may be chosen in each individual case depends on various factors. They are as follows:

  • Current employment according to Section 7 SGB IV yes or no (a);
  • Exceeding the annual salary limit according to Section 6 SGB V (b);
  • An overlapping of international laws according to Article 12 EC, regulation no. 883/2004, an international agreement, or article 5 SGB IV (c).

On (3): European regulations on the Erasmus Mundus Programme for institutions and persons participating

European regulations on the Erasmus Mundus Programme pertain only to the relationship between the European Union, its institutions, the participating universities and research institutions, and the participating persons. They have no effect – neither positive nor negative – on residence law or health insurance legislation.

Therefore, any regulations contained in the "Resolution No 1298/2008/EC of the European Parliament and of the Council of 16 December 2008 establishing the Erasmus Mundus 2009-2013 action programme for the enhancement of quality in higher education and the promotion of intercultural understanding through cooperation with third countries" only abstractly affect the individual prerequisites stipulated (Article 6, paragraph 2 of the document), but not the type or components of health insurance. The "minimum requirements" for health insurance are thus, in the present situation, irrelevant to questions of residence law and German mandatory health insurance coverage. Nonetheless, these regulations (which have primarily been designed for students, but also for scholarship recipients) do, indeed, assume more comprehensive coverage than is provided by domestic health insurance. However, these regulations only apply to participation in the programme, not the acquisition of a residence permit in relation to the necessity for health insurance according to Sections 9c, 20 AufenthG (German residence law).


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