Since 2009, every person with a permanent place of residence in the Federal Republic of Germany has been obliged to take out health insurance. Health insurance is required even for short-term stays in Germany; otherwise no visa will be issued.
Particularities of the German health insurance system
German health insurance is characterised by a dual system consisting of statutory health insurance (SHI) and private health insurance (PHI). While SHI is accessible to everyone, certain conditions apply to private health insurance.
Citizens from countries of the European Economic Area¹ (EEA) and foreign nationals from countries with which Germany has a social security agreement² can be insured in the health insurance system of their home country. The insurance benefits of other countries can differ considerably compared to Germany. The insured party may thus have to make a financial contribution or take out supplementary insurance.
Statutory health insurance (GKV/SHI) and the solidarity principle
Statutory health insurance contributions are dependent on income. The basis is the total gross income, from which a uniform contribution rate of 14.6 percent (as of 2018) is levied. This is divided equally between the insured party and the employer, i.e. 7.3 percent each. Each health insurance company also levies a different amount of additional contribution, which is paid only by the employee. If the contribution assessment ceiling (2018: € 4.425 per month) is exceeded, income above it plays no role in calculating the contribution. Statutory health insurance allows children and spouses to also be insured free of charge with a family insurance policy.
Some groups of persons must be members of a statutory health insurance fund. They include:
Employees (gross income below the income threshold for compulsory insurance)
Pensioner (if the pre-insurance period is fulfilled)
Recipient of unemployment benefit I
Individual benefits in private health insurance (PKV/PHI)
Membership in a private health insurance (PHI) scheme is not possible for everyone. Employees can be insured in the PHI scheme if their gross income is above the income threshold for compulsory insurance (2018: € 4.950 per month). Persons concerned have to apply for exemption from compulsory insurance. Private health insurance companies often require a minimum period for permanent residence in Germany. Foreign policy holders must prove a long-term insurance period. Many private insurance companies offer special rates for this group, which are adapted to the needs and length of stay.
If you apply for a private health insurance scheme, you will be asked detailed questions about your state of health (health check). German insurance cover expires as soon as the policy holder returns to his or her home country.
The following groups of people are often privately insured:
Employees (gross income above the income threshold for compulsory insurance)
Self-employed persons and freelancers
Health insurance for foreign students in Germany
All foreign students who begin studies for a specialist degree at a German college or university must have health insurance coverage. No enrolment takes place without proof of health insurance coverage.
Working in Germany –
Health insurance for guest workers
In principle, an employee is insured in the country in which he or she is working. It is necessary to join a German health insurance scheme even in the case of a short-term work stay.
Health insurance coverage for EU citizens
Guest workers from EEA Member States¹ and from countries that have signed a social security agreement with Germany² need health insurance in Germany regardless of whether they are employees or self-employed. This also applies if the employed person resides in another Member State or the employer is domiciled in another Member State. There are only two exceptions:
Health insurance coverage for non-EU citizens
Regardless of their length of stay, employed persons outside the EU are subject to compulsory German health insurance, provided that they have a residence permit in addition to the work permit. Third-country nationals can apply for this at the German embassy abroad or at a foreigners’ registration office in Germany.
Working and researching in Germany –
Health insurance for guest workers and guest scientists
Regulations for guest scientists
Health insurance is also obligatory for guest scientists (researchers) and accompanying family members. It is thus urgently necessary for third-country nationals to inquire about insurance options before departure: A residence permit is issued only upon presentation of health insurance. Legal regulations at a glance:
|Origin/type of stay||Health insurance regulations|
|Guest scientists from EEA countries¹ and countries with social security agreements²||Health insurance in the home country is also valid in Germany (European Health Insurance Card). Form number 1 or 101 from your home country’s health insurance fund or social security office is required|
|Foreign scientists resident in Germany (for longer stays)||Compulsory health insurance with an insurance company licensed in Germany|
Existing health insurance from the home country can be converted to entitlement tariff for the duration of the stay in Germany
|Guest scientists with employment contract||Compulsory German health insurance required for statutory or private health insurance|
|Guest scientists with fellowship||Only private health insurance possible|
Health insurance for immigrants in Germany
Persons who wish to immigrate to Germany and thus seeking permanent residency must take out health insurance. Otherwise they will not be issued with a German visa.
Right of residence for EU citizens
In principle, citizens of a Member State of the European Union have the right to live in any EU country, even if they are not working there. The right of residence is nevertheless subject to two conditions:
Regulations for non-EU nationals
Immigrants from countries requiring a visa to enter Germany must already have health insurance coverage at the time of entry. Depending on whether or not an immigrant is gainfully employed, different conditions apply to both statutory and private health insurance.
German health insurance for students, apprentices and au pairs
Exchange students, foreign apprentices and au-pairs who work in Germany must have health insurance and accident insurance for the period of their stay. Foreign apprentices and au pairs are only subject to compulsory health insurance by law if they earn more than 450 euros per month. However, they can take out private health insurance tailored specifically to the needs of foreign guests and visitors from the European Economic Area¹ as well as countries with a social security agreement².
Health insurance from the home country or in Germany?
Visitors from EEA¹ Member States can receive health care in Germany with the European Health Insurance Card (EHIC). If the home country has concluded a social security agreement² with Germany, including health insurance regulations, under certain circumstances benefits may be claimed in Germany. The range of the benefits is determined by the respective agreement. If the country of origin is not in the EEA¹ and there is no social security agreement², private health insurance must be taken out. For au pairs, the costs for private health insurance and accident insurance are borne by the host family.
Age restrictions for au pairs:
Generally: 18 to 27 years
When applying for a visa: 18 to 26 years
Coming from non-EU counties: 18 to 24 years
Maximum insurance period: 12 months
It is advisable to seek independent advice in your home country or country of residence before a stay abroad. This can be done, for example, at the relevant embassy abroad, the relevant foreigners’ registration office or, in particular, at the insurance companies.
Attention: The rates and benefits offered differ depending on the provider – prices and benefits should therefore be thoroughly reviewed in advance. There are also rates for persons who are in Germany for a short time as part of a Work & Travel programme.
Useful tips for foreigners in Germany
What to do in an emergency? Especially when you need medical care in an emergency, it is important to know who to contact and how to obtain such assistance.
1. Important telephone numbers in emergency situations
The following emergency numbers are necessary if medical treatment is needed quickly and directly or in case of a different emergency situation:
112 → Ambulance and/or fire brigade (applies throughout Europe)
110 → Police
(All emergency numbers can be reached free of charge.)
2. Medical on-call service
Ways to receive medical care outside of office hours:
- 116117 → Medical on-call service by the Association of Statutory Health Insurance Physicians
- Emergency department of the municipal hospital or the local university hospital
3. Medicines and pharmacies
Medicines are usually obtained through pharmacies; Germany has a very dense network of pharmacies. They are indicated by a large, red “A” symbol. Medicines are also commonly ordered via internet pharmacies today. The following categories exist nevertheless:
over-the-counter medicines ⇢ available without a doctor’s prescription
prescription medicines (e.g. antibiotics) ⇢ prior medical examination and doctor’s prescription as well as additional payment required
A pharmacy emergency service is set up in Germany for emergencies. The address of the relevant local pharmacies (“Apotheke vom Dienst”) can be found in the latest newspaper or on the notice board of any pharmacy.
4. Advice and assistance – Useful links
|Federal Foreign Office||www.auswaertiges-amt.de|
|Federal Office for Migration and Refugees||www.bamf.de|
|Federal Commissioner for Foreigners||www.bundesauslaenderbeauftragte.de|
|The National Refugee Councils||www.fluechtlingsrat.de|
|German Academic Exchange Service (DAAD)||www.daad.de|
|Association of German Student Services (DSW)||www.internationale-studierende.de|
|Foundation for the Promotion of the Rectors’ Conference||www.hochschulkompass.de|
|Secretary of the Standing Conference of the Ministers of Education and Cultural Affairs of the Länder|
Central Office for Foreign Education
|Society for Academic Study Preparation|
and Test Development
|Federal Ministry of Education and Research||www.bmbf.de|
|Federal Social Insurance Authority||www.bundesversicherungsamt.de|
|Federal Agency for Civic Education (bpb)||www.bpb.de|
|German Liaison Office for Health Insurance Abroad (DVKA)||www.dvka.de|
|Health care facilities||Address|
|Federal Ministry of Health (BMG)||www.bundesgesundheitsministerium.de|
|Federal Centre for Health Education (BZgA)||www.bzga.de|
|Federal Association for Prevention and Health Promotion (BVPG)||www.bvpraevention.de|
|Independent Patient Counselling Germany (UPD)||www.patientenberatung.de/de|
|German Red Cross (DRK)||www.drk.de|
|Federal Association of Non-statutory Welfare (BAGFW)||www.bagfw.de|
|German AIDS Service Organisation||www.aidshilfe.de|
|German Centre for Addiction Issues (DHS)||www.dhs.de|
|German STI Society – Society for the Promotion of Sexual Health||www.dstig.de|
|German Nutrition Society||www.dge.de|
|The Healthy Cities Network||www.gesunde-staedte-netzwerk.de|
¹ EU /EAA countries: EU Member States and Liechtenstein, Norway, Iceland + Switzerland
² Countries that have signed a social security agreement with Germany: Bosnia-Herzegovina, French overseas territories (French Guiana, Guadeloupe, Martinique, Mayotte, Reunion), Israel³, Croatia, Morocco, Macedonia, Montenegro, Serbia, Turkey and Tunisia
³ The agreement applies exclusively to maternity assistance within the health insurance scheme.