Health / Health insurance

Health / Health insurance

If you are an EU citizen and reside in Germany, it depends on your residence situation whether you are still insured through health insurance in your country of origin or whether you are subject to the regulations of the health insurance system in Germany.  

1. Temporary stay in Germany

If you are only staying in Germany temporarily, for example as a tourist, as a posted worker or as a seasonal worker mainly employed in the country of origin, you will remain covered by the health insurance in your country of origin. For treatment at the doctors or in a hospital you need your European health insurance card ( EHIC - European Health Insurance Card) and proof of identity (ID card or passport). The EHIC is issued by your health insurance company in your country of origin free of charge. If you do not have an EHIC, for example because it would take too long to issue it before departure or because you are already on your way, you can also request from your health insurance company a provisional replacement certificate (PEB) . This can also be sent to you by fax or electronically.

Note: Information about country-specific features of the EHIC and PEB – also where you can request EHIC and PEB, can be found here.

Sample photo of a European Health Insurance Card (EHIC)

Sample photo of a European Health Insurance Card (EHIC)

Photo: AOK Homepage

With the EHIC or PEB you can get medical treatment in Germany if this becomes necessary during your stay, i.e. you cannot wait until you return to your country of origin. This also includes benefits in kind in connection with chronic or existing illnesses as well as pregnancy and childbirth. Benefits in kind include medical treatment, hospital treatment and the supply of medicines. The principle of benefits in kind ensures that you receive medical services without having to make any advance payments yourself. The treatment costs will be reimbursed by your health insurance company in the country of origin. Return transport to your country of origin is however not covered by the EHIC/PEB !

Please note: The EHIC/PEB is only recognised by doctors and hospitals that are part of the statutory health insurance system (e.g. note “Statutory health insurance doctor” or “all health insurance companies” at medical practices). Private health care is not covered. These are, for example, medical practices that are designated as “private practices”.

In the medical practice or at the hospital you have to fill out the form “Patient Declaration of European Health Insurance “. It will be given to you in the language of your choice in the practice or at the hospital. In the form you must also specify any German health insurance company, e.g. a health insurance at your place of residence. The treatment costs are charged via the German health insurance company.

Note: The leaflet “With the EHIC in Germany” contains the most important information. In addition to German, it is available in five other languages.

2. For longer stays in Germany

If your stay goes beyond a short stay, you should secure your benefit claim using the S1 form.

[Sample form S1] PDF, 583 KB, not barrier-free

It is issued by your health insurance company in your country of origin. In addition to medically necessary treatments, planned treatments and routine examinations are also possible. You can find more information about the S1 form here:

[Information on form S1 and its use] PDF, 120 KB, not barrier-free

This applies, for example, to posted workers, cross-border workers and their family members or pensioners who have been in Germany for a longer period of time.

If you come to Germany to receive targeted medical treatment here, i.e. to have planned treatment carried out, you need proof of entitlement issued by your health insurance company in your country of origin - the so-called “ Portable document S2”.

A checklist gives an overview of what you have to consider during a planned treatment.

3. Residence in Germany

If you are a resident and have therefore moved your usual place of residence to Germany, as a rule you have to be insured in case of illness. This also applies to your family members if they live here. In Germany the general compulsory health insurance applies!

Please note: If you as a pensioner receive a pension from an EU member state, your country of origin, but move your place of residence to Germany, you will remain insured in your country of origin!

In Germany, health insurance is possible by means of two different systems:

  • the Statutory health insurance (GKV) and
  • the Private health insurance (PKV).

As a member of Statutory health insurance (GKV) you automatically are covered by care insurance. The benefits that people in need of care receive from the insurance depend on the length of time they are in need of care, the level of care and the type of care. It is not a fully comprehensive insurance. Supplementary long-term care insurance must be taken out for full coverage. If you have private health insurance, you must also take out private long-term care insurance when you conclude your health insurance contract.

Please note: The compulsory insurance in the statutory health insurance (GKV) takes effect automatically and also retrospectively! If your registration for membership in a (freely chosen) health insurance company is delayed, this will result in premium debts. This is the case even if you did not know about the occurrence of compulsory insurance. If you have any premium debts, be sure to visit an Advice centre: Premium debts can be reduced or waived under certain circumstances. The start of compulsory insurance can possibly also be postponed.

§ 5 paragraph 1 of the Social Code V lists for whom the compulsory insurance in the Statutory health insurance (GKV) applies. This also includes employees up to a certain income. The income limit for 2021 is 64.350 Euro. Above this limit, you can choose whether you want to be insured with private health insurance (PKV) or voluntarily with statutory health insurance (GKV). You have to choose one of these two variants. It is not possible to forego health insurance cover entirely!

If your spouse lives in Germany and does not work, you can also insure them in the Statutory health insurance (GKV). There are no additional costs for doing so. The same applies to your children (Family insurance according to § 10 of the Social Code V).  For family members whose entitlement to family insurance ends in the country of origin or for whom family insurance is excluded, voluntary insurance in the Statutory health insurance (GKV) (according to § 9 Social Code V) comes into consideration. The voluntary insurance must be reported to a health insurance company within three months of the expiry of the insurance cover.

Please note: As an EU citizen who is employed as an employee in Germany, you should ensure that you are a member of a health insurance company in good time before starting work. Contact a health insurance company and register for membership. You can find a list of statutory health insurance companies here.

You are a marginally employed employee (keyword “mini-job” ), you do not earn more than an average of € 450 per month and you are not self-employed. This does not mean that you are not obliged to take out insurance as an employee. You still have to make sure you have health insurance!

This can be done via the family insurance in the statutory health insurance (GKV), e.g. as a spouse, or through the job centre, if you also receive unemployment benefit II. Voluntary insurance in the statutory health insurance (GKV) can also be considered as a follow-up insurance to any expiring insurance protection (according to § 9 Social Code V). The voluntary insurance must be reported to a health insurance company within three months of the expiry of the insurance cover.

Finally, you are subject to the automatic compulsory insurance in the “Mandatory recourse insurance” according to § 5 para. 1 No. 13 Social Code V)! You can fulfil this compulsory insurance with a statutory health insurance company of your choice. Anyone who was privately insured in their country of origin must also look for private health insurance in Germany.  

For job seekers, it depends on: As long as the main part of your life is still in your country of origin, i.e. if you have not yet relocated to Germany, you will continue to be covered by health insurance in your country of origin. You must then continue to pay the contributions to your health insurance in your country of origin. Determining where to move in Germany can sometimes be difficult. The decisive criteria are: Duration and continuity of the stay in Germany, family circumstances and living situation - the time of reporting to the registration office can, but does not have to be decisive.

Please note: If you stay in Germany for more than three months, you are in all cases subject to the obligation to register with the local registration office. Information on the right of residence can be found here.

If, as a jobseeker, you have already established your residence in Germany, you must take out health insurance here. There is an automatically occurring insurance obligation (“Mandatory recourse insurance” according to § 5 paragraph 1 no. 13 Social Code V)! You can take out statutory insurance with a health insurance company of your choice. Anyone who was privately insured in their country of origin must also look for private health insurance in Germany.

Note:: For people not in remunerated employment there is the possibility to take out voluntary statutory insurance in Germany after their health insurance cover expires in their country of origin (§ 9 Social Code V). The voluntary insurance must be reported in writing to a health insurance company within three months. There is no gap in insurance coverage, as health insurance in Germany follows immediately. Have the health insurance company confirm receipt of your written notification!

Even if you are self-employed or have been until now, you must have health insurance in Germany. You cannot go without insurance cover! As a rule, you need to take out private health insurance. These often differ greatly in their premiums and services. Find out more and always compare several offers. Advice centres can help you with this.

In the case of being unemployed, after having previously worked in Germany, you are automatically obliged to continue to be insured. Most of the time, the health insurance remains with the previous health insurance company. However, the health insurance company must be informed about the unemployment. The contributions are paid by the Employment Agency (unemployment benefit I) or the job centre (unemployment benefit II/”Hartz IV”).

Even if you receive Social assistance according to the Social Code XII, you usually remain insured in the statutory health insurance (GKV). According to § 32 para. 1 Social Code XII, the contributions to the statutory health insurance (GKV) are paid by the social welfare agency (municipal social welfare office). If you were insured with private health insurance when you became in need of assistance, appropriate insurance contributions will be paid by the social assistance provider (§ 32 para. 5 Social Code XII).

If you are in need of help but are without insurance cover because, for example, your health insurance no longer exists in your country of origin or you were unable to take out health insurance in Germany, depending on the legal residence situation, health assistance according to Social Code XII may be considered (§ 23 Social Code XII). If you are not entitled to these benefits due to your residence status, for example as a jobseeker, only health benefits for the treatment of acute illnesses and painful conditions as well as pregnancy and childbirth for up to one month within two years are possible; in individual cases over a longer period of time.

Note: Further information for EU citizens and their family members on the subject of access to the health system can be found in the brochure “Access to the health system for EU citizens, members of the EEA and Switzerland” PDF, 2 MB, not barrier-free from the Federal Association of Independent Welfare Services and the EU Equal Treatment Office.

If you have difficulties joining a health insurance company, contact an Advice centre. It is imperative that you avoid not being insured! In all cases, that would lead to problems for you.

Note: The Advice centres include so-called clearing locations that can check for you whether and to what extent you are entitled to benefits in the German health system. Clearing locations can also help you get health insurance.

[List of the clearing locations in Germany] PDF, 123 KB, not barrier-free

4. Health insured in Germany: Medical treatment

As a member of the statutory health insurance (GKV) in Germany you will receive a health insurance card . You present the health insurance card every time you visit a doctor. The costs for the medical treatment are settled directly with the health insurance company. You do not have to pay anything.

Please note: Sometimes the doctor recommends treatments that are not included in basic health insurance (IGeL - Individual Health Services). You can decide whether you want to take advantage of this at an additional cost. Your doctor must explain to you the advantages and disadvantages of such additional treatment and the costs.

If you work in Germany but live in another country (residence outside the insurance country), you can also receive medical treatment in your country of residence. However, you should register with your health insurance company in your country of residence. You need the S1 form to register in your country of residence. You can apply for the form at your health insurance company in Germany.

5. Accident insurance

All employees in Germany are compulsorily insured in the statutory accident insurance. A special registration is not required for this. The insurance is free of charge for you; contributions are paid by the employer alone.

The accident insurance serves the prevention and protection against the consequences of accidents at work and occupational diseases. Its services include in particular

  • treatment and medical rehabilitation services,
  • services for participation in working life (vocational rehabilitation),
  • services for participation in life in society (social rehabilitation),
  • wage compensation during incapacity for work and
  • pensions to injured and surviving dependents.

In the event of an accident at work, your employer will report the accident; if an occupational disease is suspected, your doctor will report it. The accident insurance company will then automatically check your claims. You do not need to submit an application or report.

Note: General information on the benefits of German social insurance in the event of illness, accidents at work and occupational diseases are available on the websites of the GKV-Central association and the German Statutory Accident Insurance .