Health insurance in Germany: Things you should know
Anyone coming to Germany from abroad must prove that they are insured with a health insurance company. For short stays, EU citizens are usually covered by their country of origin’s health insurance with the European Health Insurance Card (EHIC). If they stay longer or move their place of residence to Germany, they must take out statutory or private insurance. Different rules apply to non-EU citizens.
Important: In Germany, a basic distinction is made between private health insurance and public health insurance.
The health insurance regulations for foreigners coming to Germany vary depending on two key factors: Country of origin and occupational group.
Country of origin: European Union, Iceland, Liechtenstein, Switzerland or Norway
As a general rule, if you come from another EU country, such as Spain, Italy or France, you can apply for the European Health Insurance Card through your health insurance company. However, this is often already printed on your current insurance card. The foreign health insurance is then recognised in Germany.
- Exception: United Kingdom
During the transition period until 31 December 2020, British people will be covered by their health insurance with the EHIC as usual. How it will work thereafter is still under negotiation.
Through the so-called EHIC, foreigners in this country are entitled to medically necessary treatment. However, if anything could be postponed until they return home, the costs will not be covered. In general, foreigners are entitled to all the benefits that people with statutory health insurance (SHI) receive in Germany, for example:
- Doctors & dentists
Costs can only be covered for "panel” doctors/dentists, i.e. those affiliated with a statutory health insurance fund. Apart from a few co-payments, the treatment is free of charge.
A doctor's referral is required. Every medical service within the scope of the SHI benefits catalogue is covered.
€10/day for an inpatient hospital stay; likewise €10 for prescriptions plus 10 percent of the costs; €5 to €10 for medication.
Important: Only emergency treatment costs are covered. However, you can extend the benefits of your European Health Insurance Card. To do this, ask your home country’s health insurance company to fill out the EU form S1 and present it to a German health insurance company. Then you will also be covered for routine examinations or planned treatments.
How long is the EHIC valid for?
It is often thought that European Health Card coverage is only valid for up to three months. In fact, the EHIC is valid for the duration of the entire temporary stay. When a stay stops being ‘temporary’ depends on the individual case. Factors such as the employment situation, family circumstances, housing situation and, in the case of foreign students, income are considered.
Country of origin: Outside the EU – health insurance for foreign guests
Foreign health insurance from countries with which Germany has concluded a social security agreement is also recognised here. Turkey is one of these states.
If you need a visa to enter the country, for example from Russia, you must prove that you have health insurance. Special travel insurance or incoming insurance policies are available for this which are valid for up to five years. After that, private health insurance for foreigners is required.
Even if someone is only staying for a short time on a visitor visa, they will need health insurance for foreign guests. It must be valid throughout the Schengen area and have a minimum cover of €30,000. Certain deadlines apply, depending on the provider.
- With which countries does Germany have a social security agreement?
Bosnia-Herzegovina, Israel, Morocco, Macedonia, Montenegro, Serbia, Turkey, Tunisia.
Anyone who works in Germany or moves their residence here must be insured with a German health insurance company. Whether they should take out statutory health insurance (SHI) or private health insurance (PHI) depends on their occupational group.
They are subject to compulsory insurance and must be insured with a statutory health insurance company. The employer is responsible for registration with the health insurance company. Exceptions apply to seasonal workers and posted workers, who should be covered by their country of origin’s insurance through the EHIC.
They must take out statutory or private insurance based on how they were insured previously. If they were not insured at all in the past, they must take out private health insurance. If they had statutory insurance, they may become a voluntary member of Germany’s statutory health insurance system.
Students who are not insured in their home country and are therefore covered by the EHIC must opt for statutory health insurance or an incoming health insurance.
As a rule, they are covered by the health insurance of their country of origin.
Migrant jobseekers: They are subject to compulsory insurance, which means they must take out statutory health insurance. This applies regardless of whether they receive unemployment benefit II (Hartz 4).
Unemployed people may, under certain circumstances, also take out voluntary insurance with a statutory health insurance scheme. However, they must provide proof of previous insurance periods with their previous health insurance company. For EU citizens, forms SED S040 and SED S041 are available here.
Attention: As a rule, people coming to Germany from outside the EU must take out private health insurance.
Tip: Family members without income can be insured in the statutory health insurance through the free family insurance. This applies both to the spouse and to children up to at least 18 years of age.
Taking out health insurance in Germany: Foreigners require these documents
To register for health insurance in Germany, the following documents are key:
- Contract of employment
- Copy of passport or identity card
- Copy of residence permit
You must choose a health insurance plan within three months. Bear in mind that the contributions are levied retroactively. If you do not register until the third month, you still have to pay the contributions for the first two months.
Basic differences in health insurance for foreigners
If you have the choice of statutory or private insurance, it’s worth comparing both types of health insurance.
|Public health insurance for foreigners||Private health insurance for foreigners|
|Costs: The contribution amount depends on income and is 14.6 percent. There is also the additional contribution, which varies depending on the plan. For employees, the employer pays half of the contribution. For self-employed persons, the minimum contribution is around €149 and the maximum contribution is €736 per month.||Costs: The contribution amount depends on the agreed benefits, the applicant’s age when the policy was taken out and their state of health. Unlike the SHI system, income plays no role.|
|Benefits: These are for the most part identical across health insurance companies and only differ in a few additional benefits. The details of what the health insurance covers is described in the SHI benefits catalogue.||Benefits: Insured persons determine the scope of benefits themselves. In the hospital, for example, they can arrange for treatment by the senior consultant as well as a single room. Foreigners with private health insurance often benefit from shorter waiting times. Moreover, innovative treatment methods are available to them more quickly than in the SHI system.|
|Prepayment: Treatment costs are paid directly by the health insurance company, so insured persons do not have to pay in advance. Exceptions to this rule are co-payments, for example for medicines, for which insured persons generally pay themselves.||Prepayment: Privately insured persons pay their medical bills themselves and then submit them to their private health insurance company, which then reimburses the costs. In the case of hospitalisation, the insurer also settles directly with the clinic.|
|Deductibles: The statutory health insurance schemes do not provide for any deductibles for foreigners. However, you can opt for an optional deductible tariff, which allows you to save on contributions in return.||Deductibles: With private health insurance, foreigners are free to choose the deductible amount. The higher it is, the cheaper the contribution.|
|Pre-existing conditions: If foreigners meet the requirements for statutory health insurance, they cannot refuse health insurance. Pre-existing conditions have no effect on the level of contributions.||Pre-existing conditions: These can lead to a higher PHI contribution. In addition, insurers may reject the applicant on the basis of their state of health. Only the PHI basic tariff is then available to those affected. Here the benefits are at SHI level and the costs are capped at the SHI maximum.|