Health insurance

You need health insurance in Germany. Most employees join a statutory health fund, but a Minijob alone does not provide your own cover. Before changing insurance, check which rules apply to you and confirm when your old and new cover start and end.

In short

• Paid employees are generally compulsorily insured under section 5, subject to statutory exceptions. A Minijob alone does not create your own health-insurance cover, even if the employer pays a lump-sum contribution. Arrange cover through another eligible route.
• If your regular annual pay rises above the annual earnings ceiling while you are compulsorily insured, that duty normally ends at the end of the calendar year, and only if your pay also exceeds the next year’s ceiling. Ask the fund to confirm your status and the effective date; do not cancel cover just because of a pay rise.
• Students at state or state-recognised higher-education institutions are generally subject to statutory student insurance under section 5 (1) No. 9 until the end of the semester in which they turn 30. Section 190 (9) sets that end. Above 30, continued student insurance needs a qualifying training, family or personal reason.
• If you are eligible to choose private insurance, compare the options before switching. Its premiums follow the agreed cover, age at entry, and assessed health risk, not income. Section 10 family cover does not apply to a private contract. Sections 6(3) and 6(3a) limit a later return to compulsory statutory insurance.
• A European Health Insurance Card is not a substitute for insuring the stay. Do not assume a visitor’s card covers a job. For a national visa, a separate incoming policy can cover the days before statutory or residence cover starts. It is not that later cover.

What you need to know

A person with a residence in Germany needs health insurance. Section 193(3) of the Insurance Contract Act requires private health-cost insurance unless the person is in the statutory scheme or another exception in that section applies. Statutory and private cover differ in who can join and in what they pay for, and a switch is not always open. For an employee, section 28g of Social Code Book IV lets the employer collect the employee’s share of the social-insurance contribution only by deducting it from pay.

Section 5 of Social Code Book V generally makes paid employees compulsorily insured, subject to the conditions and exceptions in the Act. Section 7 exempts genuine marginal employment from employee health-insurance compulsion; it has separate exceptions for vocational training and the voluntary services it lists.

A Minijob alone therefore does not give you your own health insurance. The Minijob-Zentrale explains that the employer’s lump-sum health contribution does not create personal cover. Depending on your circumstances, cover may instead come from a main job, family insurance, student insurance, voluntary statutory membership or private insurance. Check eligibility with the fund or insurer.

Students enrolled at a state or state-recognised higher-education institution are generally subject to statutory student insurance under section 5 (1) No. 9 until the end of the semester in which they turn 30. Section 190 (9) ends that membership at the close of the semester in which the 30th birthday falls. A recognised extension for training, family, or personal reasons also ends at a semester end. Ask the fund to assess your own route.

Section 6 includes an exemption for employees whose regular annual pay exceeds the annual earnings ceiling, along with other statutory exemptions. The Federal Government fixes the ceiling each year.

Under section 6(4), when pay rises above the ceiling during compulsory insurance, that duty normally ends at the end of that calendar year, and only if the pay also exceeds the ceiling applying from the next year. A new job or another status change needs its own assessment. Ask the fund to confirm the current ceiling, your status, and the date any change takes effect.

From 1 January 2027, section 6 (6), as enacted by the Act of 24 July 2026, adds 3,600 euros to the annual earnings ceiling on top of the 2027 pay-growth calculation. Later years adjust that increased ceiling by pay growth.

Section 6 (8) is the grandfathering rule for employees who on 31 December 2026 were already insurance-free because their pay was above the ceiling then in force and who held substitutive private health insurance. The extra 3,600 euros is not added to their ceiling. Their ceiling follows the pay-growth calculation without that extra increase, including in later years. Ask the fund which ceiling applies to you.

Exceeding the ceiling does not require you to switch to private insurance. Ask the fund whether you can continue as a voluntary member and compare that with private cover if you are eligible. The Federal Ministry of Health states that a private premium depends on the agreed cover, age at entry, and the health risk the insurer assesses, not on income, and that you pay the bill and then claim reimbursement.

Section 19(1) of the General Equal Treatment Act prohibits a disadvantage because of sex in a private insurance contract. Section 20(2) does not allow pregnancy or maternity costs to produce different premiums or benefits, and it does not list sex among the factors that may justify a different premium.

Civil servants, judges, and soldiers who keep their pay and have a Beihilfe or Heilfürsorge claim when ill are exempt from statutory insurance under section 6(1) number 2, with the other people that provision lists. Section 193(3) still requires private health-cost insurance for the share that claim does not cover.

Section 6(3) keeps an exemption under section 6(1) in place if a later job would otherwise be compulsory. After the 55th birthday, section 6(3a) can also block a new compulsory membership when its five-year test is met. Section 10 family cover does not apply to a private contract.

What to do

1. Do not leave a gap in cover. If you will be an employee, ask the fund which date compulsory cover under section 5 starts. If section 193(3) of the Insurance Contract Act applies because you are not in the statutory scheme, take out the private health-cost insurance it requires and confirm the start date in writing.

2. Ask a statutory fund to assess your job and insurance status before work starts. If you are subject to compulsory employee insurance, choose a fund and give the employer its details. If you only have a Minijob, arrange another eligible route to cover; the employer’s Minijob registration is not your health-insurance enrollment. Before changing an existing policy, have the fund or insurer confirm continuous cover and the start and end dates. The GKV-Spitzenverband publishes the list of statutory funds. Ask your fund about contributions and any extras it covers.

3. Bring the elektronische Gesundheitskarte to every appointment once you have it. For a person insured with a statutory fund, the federal portal says the European card is on the back of that card. It covers medically necessary care during a temporary stay in another EU country, in Iceland, Liechtenstein, or Norway, in Switzerland, or in the United Kingdom. It is not a substitute for insuring a move to Germany. Check emergency steps with your fund before you travel.

4. Section 10 can include a spouse, a registered life partner, and children in statutory cover when its conditions are met. The Federal Ministry of Health states that these family-insured relatives pay no contribution of their own. Under section 10 (1) to (3), the family member must have a residence or habitual abode in Germany, must not be full-time self-employed, and must not be insurance-free, exempt from compulsory insurance, or on a compulsory or voluntary route that blocks family cover. Being insurance-free only because of a Minijob does not block it. Regular monthly total income must not exceed one-seventh of the monthly reference amount. For a marginal job, income up to the Minijob limit is allowed: 603 euros a month in 2026 and 633 euros from 1 January 2027. Children are covered until 18, until 23 if they are not employed, and until 25 if they are in school, vocational training, or university, or in a voluntary service the section lists. Section 10 (3) excludes a child when the member’s spouse or life partner is related to the child, is not a statutory member, and has regular monthly total income above one-twelfth of the annual earnings ceiling and regularly higher than the member’s. The fund applies these tests.

   From 1 January 2028, section 242b of the Act of 24 July 2026 charges the member an extra 2.5 percentage points of contributory income for a family-insured spouse or registered life partner. The member pays that surcharge. Children stay free. It is not charged when an exemption in the section applies.

   Those exemptions include a child under 12, or a disabled child who cannot support themselves, living in the family-insured partner’s household. Care of a relative with at least Pflegegrad 2 counts only when the family-insured spouse or partner provides it non-commercially, in the relative’s home, for at least ten hours a week, regularly spread across at least two days. Pflegezeit leave, reaching the regular retirement age, and a degree of disability or an equivalent reduction in earning capacity of at least 60 are further conditions of that spouse or partner. Pflegegrad 3 or higher, a pension for a full reduction in earning capacity, and Grundsicherungsgeld as a non-employable person living with the member in a benefit community are likewise conditions of the family-insured spouse or partner.

   Under section 242b (4), the surcharge is not levied on statutory pensions or covered occupational pensions until 30 June 2028. Ask the fund which test applies. The same surcharge can apply where cover is derived from an international social-security agreement. If you are privately insured, section 10 does not apply. Section 193(3) requires health-cost insurance for a child you legally represent who cannot take out a contract, unless an exception in that section applies.

5. Compulsory members and voluntary members of a statutory fund are insured in social long-term care insurance under section 20(1) and section 20(3) of Social Code Book XI. You do not buy that cover as a second product beside the fund. A person with private health insurance must take out private compulsory long-term care insurance under section 23 of that Book.

When you need care or disability support

Insurance membership is not an application for care benefits. Use long-term care and Pflegegrad for applying, assessment and choosing support. For recognition of participation limitations, GdB and an ID, use disability status. These routes apply separate tests.

Before accepting or changing a job during studies, use student jobs to organise all-job information and obtain the employer/fund assessment; health-cover eligibility remains here and is not decided by the label Werkstudent alone.

Travel and incoming cover are not residence insurance

The European card covers medically necessary care during a temporary stay in the countries named above. BaFin states that using private doctors or hospitals, or treatment beyond the local public standard, needs a separate private travel health policy, or you pay those costs yourself. If you have private German health insurance, ask your insurer what your tariff pays abroad. Check the travel policy’s terms, price and any limit on how long one trip is covered.

For a national visa, the Federal Foreign Office states that a Schengen travel policy is generally not enough for a stay of more than 90 days within 180 days. Where German statutory cover will not start on the day you enter, the Office states that you also need travel or incoming cover for that gap, generally for the first three months, with at least the scope of a Schengen travel policy, and that this policy must still be valid if you take up residence in Germany. A policy limited to emergencies is generally not the private cover the Office describes for study, a language course, the opportunity card, and the other purposes on its page. The mission applies the purpose you are applying under. People who do not need that visa should ask the German fund or insurer which date cover starts, rather than treat a visitor policy as residence insurance. If you are still on that incoming policy when you see a doctor, take its details and say so at the desk.

For a relative’s short visit, use visitor visas to distinguish visitor insurance requirements from the residence cover discussed here.

When your job, family cover or income changes

Tell your fund promptly about a job ending, self-employment, changes to family-cover eligibility or a move abroad. Ask who pays the contributions and which cover starts next. Under section 188(4), compulsory or family cover often continues automatically as voluntary membership, subject to statutory exceptions. A job ending does not by itself end every insurance bill. You may leave that automatic continuation by declaring withdrawal within two weeks after the fund’s notice of how to leave. The withdrawal takes effect only with proof of alternative cover. Ask the fund before cancelling anything.

Answer a fund’s request for evidence of your contributory income and keep the submission receipt. Section 240(1) assesses a voluntary member, for each calendar day, on one-thirtieth of the monthly contribution ceiling for as long as the member does not provide that evidence when the fund asks. Within twelve months after the fund announces that assessment, the member can ask for a reassessment for the periods covered by evidence of the income actually received.

For income from self-employment, section 240(4a) sets contributions provisionally from the latest tax assessment, or from evidenced expected income when the work starts, and finally from the tax assessment for that year. If you do not prove the actual income within three years after the end of that year when the fund asks, the fund generally makes a final assessment at the contribution ceiling. There is an important exception while you are still waiting for the tax assessment: provide a Finanzamt statement or other proof that no income-tax assessment for that year has yet been notified. The fund must then hold off that final ceiling assessment for twelve months from the date of that proof and withdraw one it has already made. Separately, within twelve months after the fund notifies you of a final ceiling assessment, you can request reassessment for the year for which you prove actual income with the tax assessment. Ask your fund which evidence it needs and request a written assessment when your income falls. Keep contribution decisions, income records and proof of replacement cover. For departure, use the separate health-insurance checklist in Close contracts before you leave.

Your electronic patient record (ePA) and your right to object

A statutory fund provides an electronic patient record, the ePA, when you do not object within six weeks after the prior information the fund gives you. Section 344(1) sets that period. If you do not object in time, the fund provides the record.

You can object after the record has been provided. Use your own fund’s channel: tell the fund, or use the user interface of a suitable device, including the fund’s ePA app. The national health portal names those same routes. Section 344(3) requires the fund to tell you that this objection deletes the record and the data stored in it, and that the data cannot be restored if a record is created again. The provider then deletes the record in full and without delay. You can later ask the fund for a new record under section 344(5). The deleted data are not restored with it.

Section 344 is the statutory fund’s rule. A private insurer follows the contract.

Common mistakes

• Treating the EHIC as German insurance from the day you register an address and start work. The federal portal separates care during a temporary stay from treatment after you move your residence to Germany.
• Using a Schengen travel policy as the health insurance for a stay of more than 90 days within 180 days. The Foreign Office says that policy is generally not enough for a national visa, and that an emergency-only policy is generally not the private cover for the longer purposes it lists.
• Assuming a non-working spouse is covered without telling the fund. Family cover under section 10 is real, and it is the fund that enrols them. From 2028, section 242b adds the surcharge above unless an exemption applies. A private contract does not include that family cover.
• Switching to private insurance for a lower premium at 30 and later finding that sections 6(3) and 6(3a) narrow the way back. The health ministry says the private premium depends on age at entry.
• Expecting every statutory fund to pay the same extras. Sections 11 and 27 include outpatient and inpatient treatment, dental care, medicines and aids, medically necessary rehabilitation, and care in pregnancy and maternity. Section 11(6) lets a fund add further benefits in its statutes, so extras differ. Ask the fund you joined.