Health insurance

Living in Europe, Working in Europe | Entry conditions/visas, Health insurance, Medical care | Germany

Health insurance ("Krankenversicherung") forms part of the statutory social security contributions. It is regulated in Book V of the German Social Code ("Sozialgesetzbuch"). Pursuant to § 1 SGB V, its purpose is to "maintain, restore and improve the health of the insured".

In Germany, health insurance is compulsory for all employees with annual income lying below the insurance threshold (2018: 59,400 euros; 2017: 57,600 euros) and above this for many other groups (cf. § 5 SGB V). In general, researchers having a working contract as well as their accompanying family members are subject to compulsory health insurance.

In Germany, there are statutory as well as private health insurance companies. As of 1 January 2009, there has been a standard rate for all statutory health insurance companies. There is quite a range of statutory health insurance providers and private insurance companies to choose from. In order to help you get a better overview we have drawn up a list of statutory health insurance providers and private health insurance companies under "Further information".

 


The following information applies to citizens of EU States, as well as citizens of Iceland, Liechtenstein, Norway and Switzerland, who are spending time abroad:

Those who are insured on a voluntary basis or who are covered by statutory insurance may make use of the health services in other EU States, as well as in Iceland, Liechtenstein, Norway and Switzerland, and have the costs reimbursed by their health insurance scheme. Thus, in respect of ambulant treatment, those insured can choose themselves whether they wish to be treated in Germany or in another Member State. If they consult a doctor or use other medical services within the European Union they initially have to pay the costs of the treatment on the spot and then submit the receipts to their insurance scheme in their own country. The costs will then be reimbursed at the same level as they would if they had been incurred for treatment in Germany; any excess costs must be borne by patients themselves.

In the case of hospital treatment in another State, the agreement of the health insurance scheme must be obtained in advance. This may only be refused if the same or equally effective treatment at the same general standard of medical knowledge could be obtained for the patient in good time at a hospital in Germany.

Extended health insurance cover comes into force if someone covered by statutory insurance and his or her family are only staying in another country on a temporary basis - on holiday or business. In case of illness they are eligible for services that are necessary medically, including hospital treatment.

If a contract for employment in Germany has been signed and you are actually working here, you are subject to compulsory health insurance here.

The European Health Insurance Card

To facilitate treatment during temporary visits abroad, every health insurance scheme is obliged to issue its members with a European Health Insurance Card. In case of illness in another EU country, or in Iceland, Liechtenstein, Norway and Switzerland, medical services are provided according to the laws of the host country and reimbursed according to the charges applying there: by presenting the card, patients are eligible both for services which are free of charge in the host country as well as for free medical treatment. Costs for services which usually incur charges in the host country will be covered by the health insurance scheme on presentation of the insurance card.

However, the European Health Insurance Card only has a limited scope. It is valid:

  • for temporary stays abroad
  • for necessary medical services
  • not for trips abroad specifically for the purpose of treatment
  • not for the costs incurred in transporting an invalid home

Extended stays

An extended stay abroad is one that goes beyond a holiday or business trip or a conference visit such as a guest professorship or research trip that lasts a semester or a year. For extended stays abroad within the European Union, as well as in Iceland, Liechtenstein, Norway and Switzerland, instead of the European Health Insurance Card, the following applies:

If you are entitled to statutory health insurance at home, then your domestic health insurance provider will issue Form S1 (formerly E 106) on request. Form S1 entitles you and your family members to register with a German health insurance scheme. The German health insurance scheme will then provide all the services that a German health insurance scheme member is entitled to. The German health insurance scheme will subsequently bill the domestic health insurance provider for their costs.

If you are entitled to statutory health insurance in Germany and some members of your family have remained in your own country then the German health insurance provider will issue Form S1 (formerly E109) on request. Form S1 allows those members of your family who have stayed at home to make use of the services of the statutory health insurance scheme without needing to pay contributions. The domestic health insurance provider will subsequently bill the German health insurance scheme for their costs.

 

Further information

  • Useful forms for social security rights

    These forms are useful for exercising your rights to benefits as an EU national living and/or working in an EU country other than your own - or having done so in the past. The forms are valid if you legally live in an EU country, irrespective of your nationality.

    European Commission


For a research stay in Germany, medical treatment in the event of serious illness and accidents in Germany has to be covered . In case of prior illness, please obtain all necessary medication in your home country, as your private health insurance in Germany generally will not cover this, meaning you will have to bear the costs yourself. In contrast, statutory health insurance providers must assume the full costs for insured persons with a prior illness from the very first day (even for cases of prior illness). We also recommend contacting the health insurance provider before travelling to Germany to clarify all questions in advance and to ensure insurance coverage is provided from the very first day. The responsible Aliens' Registration Office requires proof of such health insurance for the residence permit.

In order to issue a residence permit the local immigration authorities require proof that you are covered by this kind of insurance.

First of all, check whether your insurance at home covers medical and hospital expenses incurred during your stay in Germany. The insurance company must then confirm in writing that insurance cover is valid in Germany, too. If the insurance cover is not adequate, you will have to take out an additional insurance policy.

Travel insurance is not sufficient: this only covers specific health risks when travelling, but does not provide sufficient cover for your time in Germany.

If you are in Germany for more than 6 weeks and are therefore normally resident in Germany, please note: Since 1 January 2009, anyone resident in Germany is required to possess health insurance cover from an insurance provider licensed in Germany, in so far as they are not covered by statutory health insurance or entitled to allowances for members of the civil service. In this case we recommend obtaining health insurance from a German provider. For the duration of the stay in Germany the foreign health insurance cover can be switched to the tariff for the qualifying period.


 

A fellowship to fund a research stay does not normally give you access to statutory health insurance in Germany unless you are also contractually employed by a research institution or university for the duration of your stay (please see the relevant information in the section "Research stay based on an employment contract").

In rare exceptions you may have the option of voluntarily purchasing statutory health insurance as per § 9 SGB V. If in doubt, please enquire about this option with your funding provider or directly with the statutory health insurance providers in Germany before commencing your research stay.

In all other cases we recommend that you purchase private health insurance for the duration of your stay in Germany in advance. Your funding provider can offer recommendations.


 

If you are employed on the basis of an employment contract then as a matter of principle you are subject to compulsory German health insurance.

However, exceptionally, where there is a Social Security Agreement ("Sozialversicherungsabkommen") in place between Germany and your own country the health insurance regulations of that country may continue to be applicable. Your health insurance provider or social security authority at home will confirm this using form number 1 or 101. On the basis of form number 1 or 101 you will continue to be subject to your national health insurance regulations and be exempt from statutory German health insurance, provided that the Social Security Agreement that is in place with your own country applies to health insurance.

As an employed person, if you do not possess form number 1 or 101, you will be subject to statutory German health insurance. Your level of income will determine whether you must obtain private or statutory health insurance.

From 01 January 2018 on, up to a gross salary of 59,400 euros (upper income limit for 2017: 57,600 euros) you must be insured by a statutory health insurance company. The general statutory health insurance rate is a standardised 14.6% of the gross salary. Employer and employee each cover a share of 7.3% of the insurance rate.

However, from 01/01/2015 on, statutory health insurer may charge a supplemental premium if they calculate that they cannot meet their expenses. Nevertheless, non-working spouses and children are still insured at no additional cost by a statutory health insurance.

Health insurer deside themselves on the amount of the supplemental premium. In case your health insurance company first introduces or increases the supplemental premium, you will be entitled to a special right of cancellation of your health insurance contract.

The benefits of statutory health insurance are, for the most part, standardised. There are differences in customer service, additional benefits and optional premiums. You are free to choose your statutory health insurance company. A comparison of the different insurance benefits is therefore still worthwhile.

If your gross annual salary regularly exceeds 59,400 euros (as for 2018), you are free to choose between a statutory health insurance provider and a private health insurance company. This means that you may opt for both a statutory and a private health scheme.

You must inform your employer which health insurance company you have chosen. It is the employer's task to register new employees with the health insurance company. The latter then forwards the registration to the other social security providers. Contributions to health insurance are deducted from the employee's salary at source.

 

 

Further information