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What is statutory/public health insurance?
What is statutory/public health insurance?

In this article, we'll explain what statutory/public health insurance is, and how it is different from private and expat health insurance.

Gabriel avatar
Written by Gabriel
Updated over 2 weeks ago

If you are new in Germany, and the task of signing up for health insurance is still ahead of you, most probably you already heard of the most common insurance options, including statutory/public health insurance.

So let's get started:

Statutory or public health insurance is a solidarity-based government fund. More than 90% of the working people in Germany are insured in it. Members pay according to their earnings, but everyone enjoys the same coverage, regardless of how much they pay into the system. That means that high-earning healthy members pay for the lower earners that need the system. The point behind the system is that life situations can always change. Earnings of any individual can lower, and if they are in need, the system will work in their favor.

Statutory/public health insurance is the central pillar of the German health system, and is the oldest branch of the German social insurance. It originated from the so-called "Insurance scheme for workers" back in 1883, and evolved from there.

These days, we have about 90 different public health insurance providers in Germany (Krankenkassen). Most known are TK, BARMER, and AOK. If you are confused by all the names, no worries: the name is the biggest difference between them. 🙂 These are basically government institutions, which follow the same exact rules. So coverage and contribution is almost identical regardless of which one you choose.

Today, statutory health insurance is split into:

  1. Mandatory insurance: mandatory insured members are employees of a German based company, who earn anywhere between €6.456 and €69.300 gross yearly (2024). If this fits your situation, it means that you need to sign up for statutory health insurance and cannot choose other options. You are also accepted without assessing further eligibility (only people above 55 years of age need to prove that they were not previously privately insured in the EU in order to access the system). Mandatory insured members are automatically insured into the whole social insurance system: health, longterm care, unemployment, and pension insurance. The contribution for all four is about 41% of employees gross salary, split equally between the employee and the employer. Your part (20%) is automatically deducted from your salary each month. This 20% is capped to €5.175, which means that you will never pay more than 20% of €5.175 Euro, regardless of how higher your salary might be.

  2. Voluntary insurance: voluntary insured members are basically the rest: self-employed, job seekers, language school attendees, etc. Voluntary public health insurance is only a continuation of already existing statutory insurance from the EU/EEA, the UK, or Switzerland. Which means, you are only eligible for it if you are currently insured in one of those countries. You can find more info in our article.
    If you do not meet these conditions, check the section about comprehensive private and incoming insurance.

People can also access statutory health insurance as dependents. Members of the system can insure their spouse and kids (who are either not working, or earn up to €538 monthly) completely free of charge.

Regarding the coverage itself, the system needs to provide adequate basic coverage for everyone insured. Since this is a government fund, they decide what basic human need is, and cover it accordingly. They are constantly adjusting the terms as the time and the need of the people change (minor adjustments), but this is generally what you can expect to be covered:

  • All pre-existing conditions (none can be excluded)

  • General doctor visits

  • Specialist visits and treatments (your general doctor always needs to do the assessment, and if they send you to the specialist, it will be covered)

  • 90% of all the prescribed medicines (max you pay out of your pocket is €10)

  • General vaccinations

  • Basic dental coverage

  • Hospital stay and transport

  • Medical aids

  • EU wide coverage for travel purposes

As you can see, it does provide quite a broad scope of coverage, but it is also quite limited in certain areas. Anything that is considered as non-essential by the government will be excluded. Things like:

  • Dental services- public health insurance will cover basics, but if you want to receive high quality material such as ceramic crown or composite filling, you will have to pay the major part out of your pocket. You can take a look into our dental add-on which will provide 90% coverage for all the high-end procedures not covered by your main public policy.

  • Vision care- public health insurance will pay for glasses or contact lenses only for people with highly deteriorated vision (starting at -/+6).

  • Natural health treatment- most providers give a certain, very limited yearly allowance.

  • Worldwide coverage- you are covered for travels within the EU. If you want to travel out of the EU, you might benefit from our travel add-on, starting only at €18 per year.

Statutory health insurance is one of the two health insurance options for people who want to stay in Germany long-term. The second option is comprehensive private health insurance.

Comprehensive private health insurance

If you earn over €69.300 gross yearly as an employee of a German company, or over €25.000 as self employed/from investments, you may be eligible for comprehensive private health insurance. If that fits your situation you can get a personalised quote for our private health insurance, which can provide broader coverage for a lower price than statutory. That will mostly depend on your age and health state, since private health premiums are based only on those two factors. It is important to mention that comprehensive private insurance is legally equally accepted as statutory insurance. It is a no-end date, lifetime policy, same as statutory. It is highly regulated by government and financial authorities.

What about Incoming insurance?

Incoming insurance is a temporary option, valid up to 5 years from your original arrival to Germany, which provides limited coverage. It is a lower tier of insurance, a step down from public or comprehensive private insurance. It is made for people who are not yet eligible for public or comprehensive private health insurance (e.g. self-employed without previous EU coverage earning under €25.000 yearly), or people who are here only temporarily. Incoming insurance, such as our expat health, covers only the health part of the insurance scheme - not pension, long term or unemployment insurance. It is a good option for students over 30, job seekers, and self-employed people who cannot access private or public health insurance at the moment. If you are one of those, you can learn about our expat health in this article.

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