When choosing health insurance in Germany, you’re often not just choosing for yourself — you’re choosing for the family members that depend on you.
Health insurance is a requirement in Germany, but there is plenty of choice: statutory health insurance or private health insurance, of which there are dozens of providers. To qualify for private health insurance, however, you must earn over €57,600 per year or be self-employed, as well as submit to a health check — which, if you have a pre-existing condition, may disqualify you.
Although expats in Germany may think private health insurance automatically means better health insurance, they are often surprised that sometimes it’s the other way around.
How family insurance works in Germany
To ensure that everyone is equally covered, the German health care system includes stipulations for family insurance, in which dependent family members such as spouses and children may enrol at no cost with the statutory health insurance provider with whom one family member is already enrolled.
Also called family co-insurance, this is offered to a number of spouses or registered partners and children under certain conditions:
- They must live in Germany
- They are not exempt from insurance (e.g. they are a civil servant, a profession which offers insurance exemption)
- They are not enrolled with any health insurance provider
- They have no income or income that does not exceed EUR 425 per month (or EUR 450 per month if they fall under so-called marginal employment, or a minor part-time job) as of 2017
Children are generally insured up to the age of 18, but this limit may be extended. Children may be insured to the following ages, provided they meet additional conditions:
- Up to 23 years old if they are unemployed or not independent
- Up to 25 years old if they are in school, vocational training, or participating in one of the voluntary work programmes, including the Voluntary Social Year or Voluntary Ecological Year, with some additional requirements
- Over 25 years old if education was interrupted by military or civilian service, lasting as long as the service itself.
Stepchildren and grandchildren are also eligible, provided they are dependents of the enrolee; foster children are also eligible, provided you are not caring for them as a professional. Children who are permanently disabled and must be cared for by the parents are also eligible.
This family health insurance regulation ensures that families are equally covered, and that health insurance remains affordable for all — especially if one half of the couple earns far less or does not have an income at all. Expats that have arrived in Germany due to an overseas assignment often bring their spouses — the trailing spouse — and nearly half of those spouses remain unemployed. One spouse, of course, may earn a salary above the threshold for private health insurance — but enrolling in private health insurance may be a mistake, especially considering that once you enrol with one, you cannot return to statutory health insurance unless you fall under the income threshold and are older than 55.
Statutory vs. private health insurance for families
The family insurance regulation does not apply to private health insurance providers — they are free to charge contributions for spouses and children, regardless of how much they earn (or, rather, do not earn). For families with younger children or those who wish to expand their families, private health insurance may be far more expensive than statutory health insurance.
Child sickness benefits, in which parents receive their wages if they must stay home with a sick child, do not apply in private health insurance. In addition, with private health insurance, the enrolled spouse must always pay contributions — which is especially important if one parent must take parental leave. In this case, even when wages are reduced or non-existent, the partner taking leave must pay the same contribution — which is not determined based on salary, as in statutory health insurance, but health.
For example, with private health insurance, an employed father may pay EUR 380 per month with a private health insurance provider; adding an unemployed wife and two children would require an additional monthly contribution of approximately EUR 320 and EUR 150 per child.
Statutory health insurance provides may also provide “extras” for family members – with some companies, enrolled members receive reimbursement for selected additional pregnancy check-ups and an allowance for midwide on-call services, as well as antenatal classes. Children also receive full range of preventive check-ups from birth until 17 years of age; and some companies cover the costs of the U10, U11 and the J2 preventive check-ups if conducted by contract physicians — check-ups that are generally not covered under other providers – and provides two complementary covered yearly dental check-ups for children aged three to six.
But each family is different — that’s why some health insurance companies offer personal consultants for each of its members, a perk you may not get with private health insurance providers.
When moving to Germany as a family, health insurance is often one of the first things to settle. Although you may qualify for private health insurance, it may not be the best option in the long-term — especially if you have a trailing spouse or young children.
Private health insurance in Germany
If you do want to look into private health insurance in Germany and compare plans, the following companies provide expat coverage packages: