In addition, you will usually not get a residency permit without proof of adequate insurance. Health insurance is also mandatory for all employees and students in Germany, so you will not be able to start working or studying without it.
In 2007, there were some 200.000 persons living in Germany without health insurance coverage. With the health insurance reform of 2007, the German government has now implemented a new insurance law which makes insurance mandatory for everybody living in Germany. When living in Germany, this law will also apply to you.
There is an EU agreement which guarantees free medical treatment for EU citizens in Germany. Since the 1st June 2004, European citizens who are travelling within the European Economic Area are given a European Health Insurance Card, which simplifies the procedure when receiving medical assistance during their stay in a Member State. The European Health Insurance Card replaces forms E111 and E111B, E110, E128 and E119. However, if you wish to take up long-term residence in Germany you must exchange the card for a local health insurance scheme.
Health insurance contributions are split 50-50 between employers and employees, independent on whether you opt for a statutory or private insurance schemes. Students are offered special student insurance schemes with favorable rates. Note that health insurance in Germany is part of the social security system. More information about this system can be found in our chapter on social security.
In Germany, there are two parallel health insurance systems:
(a) State health insurance is run by German government. Most foreigners (and Germans as well) are obliged to take out state health insurance.
(b) Private health insurance can be chosen in some specific cases. It generally offers more extensive cover, but is not automatically an advantage for all cases.
Almost everyone can join the state insurance scheme, but only a few people are allowed to leave this system for a private insurance. To work out which insurance scheme fits is best for you, follow these steps:
(a) Find out whether you can choose between private and public insurance. If you're obliged to join the state system, it is irrelevant to compare it with private insurance. To find out whether the state system is mandatory for you, have look at our information below.
(b) IF you are allowed to take a private health insurance, you should compare the advantages and disadvantages of both systems before making a final decision.
Although this is complicated, take the time to analyze your situation in order to make the right decision. Our health insurance guide will lead you step by step through this decision process.
As of 2007, state health insurance was compulsory for the following groups:
You can within a period of three months join a state health insurance scheme voluntarily if you:
Students from countries with which Germany has concluded a social security agreement which includes an insurance clause can continue to be covered by their home insurance company while they are in Germany. For information, enquire at your institution's International Office. In such cases, you will be required to present proof of insurance cover to the health insurance company in Germany.
The Federal Ministry for Health and Social Security offers detailed information on statutory insurance in different languages at www.bmgs.bund.de.
In theory, everybody not in the categories above can choose a private insurance scheme. However, once you've opted out of the state insurance scheme, it can be very difficult to go back. Before you make this decision, you should therefore carefully compare the advantages and disadvantages of the two systems.
If you opt out of statutory health insurance and cannot go back, the private insurance companies will be forced to offer you a basic tariff with the same fees as the statutory insurance from 2009.
There is no simple answer to this question, as it depends heavily on your personal circumstances. To help, we have listed below some of the advantages and disadvantages:
Contributions: To understand the main differences between the two systems, you should bear in mind that state and private insurance work on completely different contribution models:
Note that contributions are always equally split between employer and employee, independent of whether you are in a private or public scheme.
Payment of medicines and treatments: If you're insured through the state system, you only pay a nominal fee for treatments and medicines as these are directly paid for by your insurance company. If privately insured, you pay doctor's fees and medicine costs and send receipts to your insurance company for reimbursement. Although this makes no difference in the long run, it might be important if you're short on cash.
Private health insurances: Private health insurance schemes provide more extensive cover, including the option of private/semi-private hospitals, alternative therapies such as acupuncture and herbal treatments, glasses and contact lenses and other treatment that may not be available under the state scheme. In recent years, some statutory insurance companies have also extended their coverage of alternative treatments, but it’s still not as wide as the coverage of private insurances.
At the doctor, you will often be treated preferentially compared to state insured patients, as you are generally more profitable. Some doctors even restrict their practices only to private patients. Another advantage is that private insurances don't expect you to pay any additional co-payments ( Zusatzzahlungen) for medicines and treatment as in the state scheme (see below for more information).
However, some private insurance policies offer you the option of a ( Selbstbehalt), which means that for each case of illness part of the cost is paid by you up to a certain amount per year. On the upside, the insurance company will lower your contributions if you go for this option.
Statutory insurance: Despite the constant complaints of Germans, the state health insurance scheme also offers some advantage compared to private schemes. The biggest one is that it also insures your family at no extra charge! YYour spouse or civil partner and, up to a certain age, your children are covered by your insurance, provided among other things that their collective income does not exceed € 345 a month and they do not have their own insurance (figures for 2005).
However, you should bear in mind that the state insurance system has come under serious pressure during the last decade. As the government tries to cut the cost of health care, co-payment (i.e. the portion of costs the patient has to pay himself) has been increasing for all kinds of medical treatment and medicines and is likely to increase even further in the future. In areas such as dental/orthodontic treatment and glasses, state health insurance only covers a fraction of the cost.
Statutory health insurance is provided by a network of non-profit making companies working with the state to administer the national health program ( Gesetzliche Krankenkassen). Some of the most popular ones include the TK, AOK and BEK. Since 1996, anyone is free to choose the fund they wish to be insured with. Even though benefits are similar across all companies, it is often worth comparing contributions since these can vary significantly.
Your insurance company will issue you a health insurance card, which you have to take with you whenever you visit a doctor, dentist or specialist.
Note that benefits of statutory health insurance change often. Some of the treatments covered are (as of 2007):
If you have children, you can claim a range of additional benefits. The Federal Ministry for Health and Social Security offers detailed and up-to-date information on benefits at www.bmgs.bund.de.
In the following cases, you will have to an additional contribution to treatments and medicines (as of 2007):
If your income is below a certain level, you can be exempted from these additional payments.