A Guide To Health Insurance in Germany

Expath helps navigate ex-pats through the labyrinth of the German healthcare system..

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Health insurance in Germany can be painful for your pocket, but mistakes can be even more costly. Expath‘s Tia Robinson and independent insurance broker Keith Tanner have compiled a helpful list of insurance FAQs below…

How do I know if I should enroll in the public or private system? 

Unlike in many other countries, in Germany there are two systems working in parallel. Very generally speaking, in most cases employees, their dependents, and students or trainees (Azubis) can join the public system.  The self-employed/freelancers or government employees usually join the private system.

Public insurance payments are income-based and deducted from your paycheck by your employer – and your dependents (spouse or children) will be covered for free. Public insurance is also ideal for those with pre-existing conditions, who cannot be declined entry based on their medical condition.

Private insurance, on the other hand, is based on your age and personal risk factors, so if you’re young and healthy this may be a cheaper option (though it’ll become more expensive as you age). Two important possible disadvantages: coverage for dependent spouse or children requires additional payment, and those with pre-existing conditions may be declined coverage.

But I’m from the EU – do I really have to get German health insurance?

As a resident of Berlin (i.e. you’ve completed the ‘Anmeldung’ process at the ‘Bürgeramt,’ which you should do within 14 days of arrival) you’re obliged to have health insurance that will fully cover you in Germany, no matter where you are from.

If you come directly from another EU country, you may be entitled to join public insurance even if you are self-employed or a freelancer.  You should apply within 3 months of your Anmeldung.  (There are some exceptions where EU citizens may be able to continue to pay into your home country’s social system, but this depends on which country you come from and should be researched carefully, as it may be a good short-term but not long-term solution).

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Even if I’m from England where we have free coverage through the NHS?

Absolutely. Think about it this way – if you’re in a serious accident you won’t have time to take a plane back home to receive free treatment.  In the worst case scenario you’ll be treated at a German hospital, ‘assigned’ to a German insurer, and given a hefty bill for back payments for the years you’ve lived in Germany without paying into the system.

What’s the ‘EHIC card’ and what does it cover?

The European Health Insurance Card (EHIC) covers EU citizens who are travelling abroad as tourists (3 months or less). As it’s primarily for emergency travel coverage, it isn’t a good long-term substitute for healthcare in Germany. Important: you’ll have to get this card before leaving your home country!

I’ve got a full-time job offer in Germany – I’ll automatically get insurance from my company, right?  

That’s right – as an employee in Germany your company will deduct insurance payments from your paycheck as well as making an employer contribution. Unless you make over 4350€ per month (for 2013) you’ll automatically go into the public system, where how much you pay is based on how much you earn. All you have to do is tell your employer which health insurance company you want to use and they’ll register you.

So how do I choose the best insurance company for me?  

There are a great deal of public and private insurance companies in Germany – and choosing ‘the best’ depends on what criteria you value – price, coverage, family planning, preventative care, access to specialty treatment etc.

For the best personal solution(s) available, the ideal solution is to contact an independent insurance broker who is registered in Germany. Independent insurance brokers will meet with you for free and present the best option(s) based on your job situation, personal profile and short- or long-term needs. Insurance brokers can also inform you about other types of insurances, including pension (Rentenversicherung), personal liability insurance (Haftpflichtversicherung), property insurance (Hausratversicherung), disability insurance (Berufsunfähigkeitsversicherung) etc.

I’ve heard European private insurance is cheaper than German private insurance – is that an option for me?

‘International insurance’ has been at the heart of an exciting legal battle in Germany for the past several years, existing in a legal grey zone. Thanks to Patrick Ott, an insurance broker based in Munich, the German financial regulatory authority BaFin provided an official statement confirming that international health insurance that is registered in Germany is legal under German law.

However, the German private health insurance consortium (Verband der Privatenkrankenversicherung) disagrees that international insurance is ‘good enough’ and is still trying to fight against international insurance in Germany. German companies also disapprove of the lack of coverage for long-term nursing care, or Pflegepflichtversicherung (which German insurance companies must cover), although this can now be added as separate coverage.

Expath recommends talking to an independent insurance broker to decide whether international private insurance is a smart possible solution for you. Recommended companies include Chambervelt, Rooselain & Cie in Berlin, Munich and Stuttgart, John Gunn in Hamburg, Mike Woodiwiss in Nordrhein-Westfalen and Anke Lübben in Berlin.


I’m not from the EU and need insurance coverage to apply for a freelance work permit – but I heard that Germany companies won’t insure me without a freelance work permit.  Huh?

It’s true that some German insurance companies can be hesistant to take on new international clients. This lovely Catch-22 has a few workarounds. The first possibility is to secure international private insurance, which you can often get without first having a work permit. Make sure your plan includes coverage for pregnancy, as the Ausländerbehörde requires this. Ask your insurance broker to provide written confirmation (in German) of coverage to take with you to your Ausländerbehörde appointment.

The alternative option is to get a concrete offer for health insurance from a German company, and have them fill out a paper called the “Bescheinigung fur die Erteilung/Verlängerung von Aufenthaltstiteln über einen Krankenversicherungsschutz“ to take with you to the Ausländerbehörde.

I’m an artist – what’s the KSK and do I qualify for insurance there?

The Künstler Sozialkasse (KSK) is a government-subsidized program that helps professional artists by paying contributions to the health, pension, and unemployment insurance system, acting as an employer would.  This typically makes health insurance more affordable, as well as gives artists similar social benefits to employees. However, you must apply and be able to prove that you are a professional artist (education and work background) and that art is your main source of income.  They will do an audit of your qualifications and art-related income and this may take some time. For more information on whether you may qualify, visit the KSK website here. (German only)

Anything else I should know?

Dental coverage is optional under international private insurance plans. We can recommend from personal (painful) experience that it is an excellent idea to purchase this coverage separately.

In conclusion…

As with any financial commitments, it definitely pays off to do your research, compare options and weigh pros and cons before you choose which insurance is right for you.


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