German health insurance for foreigners
Health insurance in Germany is obligatory for all residents, including researchers and scientists coming from abroad. To help you before you arrive, here’s how the German health insurance system works and how to get insured.
- The German health insurance system
- Health insurance in Germany – who needs it?
- Public health coverage in Germany - how to get it
- Public health insurance – how much does it cost?
- Public health insurance – what does it cover?
- Private health insurance in Germany – who can get it?
- Private health insurance – where to get it
- Private vs public health insurance in Germany – key differences
- Supplementary private insurance
- Health insurance in Germany – when should I get it?
- Health insurance for researchers and scientists
- European Health Insurance Card in Germany
The German health insurance system
Since 2007, everybody who is a resident in Germany is legally required to have health insurance. Under the law, you must have a policy with an insurance provider (called a Krankenkasse in German) that offers at least the minimum level of coverage allowed.
There are three options for health insurance while living in Germany: the government-regulated public health insurance system (Gesetzliche Krankenversicherung, GKV) private health insurance from a German or international insurance company (Private Krankenversicherung, PKV) or a combination of the two that supplements coverage not included in your public health insurance policy.
Health insurance in Germany – who needs it?
The public health insurance in Germany is known as Gesetzliche Krankenversicherung (GKV), which actually translates as ‘statutory health insurance’, and covers the vast majority of people – around 90 per cent. In 2018, if your gross salary is less than €59,400 per year, or €4,950 per month, it is compulsory to be insured under a public, statutory health insurance scheme, and you must choose an insurance provider.
Public health coverage in Germany - how to get it
If you already have a job offer, the first step to take is to talk to your employer about getting registered, although you have the right to choose your insurer yourself and do not have to go with its suggested provider.
Three of the largest providers of health insurance in Germany are AOK, Barmer GEK and TK. While there are over 100 (a complete list – in German – is available here), these companies offer good English language websites.
Providers can offer slightly different rates and different incentives, such as cash back if you quit smoking or are involved in regular fitness activities, so it is worth researching and seeing what your options are. This German-language website has a comparison tool that enables you to explore the different policies available.
Once you are registered with an insurance provider, it will issue you an insurance card, called a Gesundheitskarte in German. The insurance card has a chip to store your personal data and must be presented the first time you visit a doctor each quarter.
Public health insurance – how much does it cost?
All public health insurance providers in Germany charge the same basic premium of 14.6 per cent of your gross income, plus a supplemental charge that is an average 0.9 per cent of your gross income, to a maximum monthly income of €4,425.
If you earn more than this, you will not pay a higher insurance premium. The basic premium is split equally between you and your employer: 7.3 per cent each. From January 1, 2019, employers will pay half the supplemental charge as well.
You and your dependents must also become members of Germany’s long-term nursing care scheme (Pflegepflichtversicherung). This covers some of the cost of meeting personal nursing needs, including the bathing and feeding of those who become substantially disabled.
The nursing care scheme cost is either 2.55 per cent or 2.8 per cent of your gross salary (with a maximum of €123 per month if you have no children), of which your employer pays a maximum of €56.
Public health insurance – what does it cover?
The minimum threshold all health insurance coverage in Germany has to meet includes:
- in-patient (hospital) care as a ward patient
- out-patient care from a general practitioner or medical specialist (such as a cardiologist)
- prescription drugs
- pregnancy care
- basic dental care
- employee sick note
- Statutory Sick Pay when the employer’s duty to pay it is over (up to 90 per cent of your net salary)
In addition, all non-working dependents – spouse, civil partner and children (up to a specified age) – living at your address in Germany will be covered under your plan at no additional cost. They simply need to be registered with the same health insurance provider as the paying member.
Although the medical provision provided by public healthcare insurance in Germany is fairly extensive, additional care may require additional payment – so make sure you know what your coverage includes. For example, while basic dental care is covered, aesthetic teeth cleaning may incur an additional fee.
Private health insurance in Germany – who can get it?
Germany does offer the opportunity to opt for private health insurance (private Krankenversicherung or PKV for short), but only if:
- you earn more than a fixed amount (€59,400 per year in 2018), or;
- you are self-employed, or;
- you are a student, in which case you can choose private health insurance for the duration of your studies
However, even if you meet one of these criteria, you are not obliged to choose private healthcare, and can still opt with public health coverage.
Private health insurance – where to get it
A complete list of all private health insurance providers is available on this German-language website. However, given the differences in premiums and scope of coverage available, it is worth using a commercial price comparison website like Check24, Krankenkassen Deutschland and PKV-Gesundheit.
Private vs public health insurance in Germany – key differences
Although you will have access to all health institutions for doctor’s appointments and medical treatment with both types of policy, it is worth knowing the differences. For example, public health insurance does not cover you things such as dental implants, glasses or contact lenses or private rooms in hospitals, but a private insurance policy might cover several or all of these.
- While the basic premium rate you are charged for public health insurance is the same (14.6 per cent) for all German citizens and residents, regardless of their income, private health insurance charges higher premiums that vary according to your earnings, your likely state of health (i.e. the risk you pose to them) and the risks you are willing to take with regards to what your policy covers.
- Although pre-existing conditions are not an issue with public health insurance policies, your premiums may be higher if you have known conditions when you sign up for private coverage. However, because private health insurance providers in Germany are legally obliged to accept anyone, you cannot be denied health insurance because of a pre-existing condition.
- German private health insurance adopts the same style of system that you find in any general insurance policy. Every month you will pay a monthly premium and choose a level of excess (or deductible) on top of that. For example, a €400 excess will mean you have to pay the first €400 of healthcare costs yourself before your insurer starts paying.
- If you have public health insurance then you have to pay 10 percent of the cost of any prescription medicine, to a maximum of 10 euros and a minimum of 5 euros per prescription. With private healthcare you will pay the full charge for your prescription up front, but the receipt can then be sent to your provider, who will cover the full cost.
- It is important to note that while public health insurance policies also cover your family members, this isn’t always the case with private health insurance. So if you opt to go private, check the policy details as you may need to organise separate provision for your dependents.
Supplementary private insurance
If you have to have public health insurance in Germany but want further coverage options, you can opt to supplement it with private insurance, but not instead of it. While this will incur extra costs, it could come in useful if you want to be covered for things not included in your public health insurance policy, such as additional dental care or treatment in a private hospital.
Health insurance in Germany – when should I get it?
Ideally, those coming to work in Germany from another country in the EU should get their health insurance as soon as they arrive and are registered as a German resident. Don’t panic though: Germany offers a brief grace period from your registration date, and your employer will be able to guide you through the process.
If you are coming from a country outside the EU, you will need proof of valid German health insurance to get a residency visa. In this case, you must have your insurance policy in place in good time before you arrive in Germany.
Health insurance for researchers and scientists
Even if you are coming to Germany to work as a guest researcher or scientist, you are still legally required to have health insurance. Universities can accept your proof of a health insurance policy you already have in your home country if the extent of coverage is equivalent to the coverage provided by a German statutory health insurance. Don’t forget that if your family joins you, they need to have health insurance for their stay in Germany, too.
Germany has social insurance agreements with several countries, including the member states of the European Union and those in the European Economic Area. If either of these applies to your home country, the statutory health insurance of your home country is valid in Germany as well.
If you are from a non-EU country and you’re planning to stay in Germany for a longer period of time, you will need to get the compulsory health insurance from licensed insurance companies in Germany. It is possible to purchase a policy tailored for guest scientists and researchers, such as EDUCARE24, IHC-COMPANY’s International Science Healthcare Plan and MAWISTA Science.
European Health Insurance Card in Germany
Citizens of other EU countries, countries in the EEA and of Switzerland who have a European Health Insurance Card are eligible for free access to some health treatments while visiting Germany on a temporary basis. This might be useful if you are a jobseeker coming to the country to explore the possibility of living and working there. However, this isn’t a substitute for German health insurance, and as soon as you take up residence and are no longer unemployed, you must ensure you have a proper policy coverage.
