International health insurance in Germany

Germany requires every resident to hold health insurance that meets statutory standards, and many international plans do not. IPMIEMEA explains the public and private systems, where international health insurance fits for expats, and what to check before you rely on a plan.

How healthcare works for expats in Germany

Germany has one of the best-resourced health systems in Europe, and it is built around insurance rather than a tax-funded service. There are two pillars. Statutory health insurance covers most residents through non-profit sickness funds, with contributions based on income. Private health insurance covers a minority who are allowed to opt out of the statutory system, such as higher-earning employees, many self-employed people and civil servants, and who choose to.

Expats are allocated in the same way as everyone else. If you are employed in Germany, you will normally be enrolled in the statutory system unless you qualify to opt out. If you are self-employed, a freelancer or not working, the position is more complicated and depends on your circumstances. Either way, the point to understand is that being insured is not optional, and the type of insurance you hold must satisfy German rules.

International private medical insurance (IPMI) is a different kind of product. It is designed to cover people across borders, under contract terms set by the insurer, and it is not built around German regulation. That creates the central question for expats in Germany, which the next section addresses.

The insurance requirement, in general terms

In general terms, everyone resident in Germany must hold health insurance, and private insurance only satisfies the requirement if it meets statutory standards. Those standards concern the structure of the cover and the insurer, not just the benefit level. Many international plans do not meet them, however generous the benefits, because they are not written or regulated in the way the rule expects.

What this means in practice:

• Do not assume an international plan is enough. Residence permit applications generally require proof of adequate health insurance, and the authority decides what counts. An international plan that is not recognised may be rejected, leaving you uninsured in the eyes of the state.
• Some insurers offer a compliant version. A few international insurers write a German-compliant policy or a variant designed to meet the requirement. Ask specifically whether the plan is accepted as substitutive cover in Germany, and get the answer in writing.
• Employment usually settles it. If you are employed and in the statutory system, the requirement is met. An international plan then adds to it rather than replacing it.

Confirm your own position with your employer, the insurer and the relevant authority before you rely on any plan. This page describes the pattern, not your case.

Where international cover fits for expats in Germany

Given the requirement, international cover in Germany is usually one of three things.

• A top-up to statutory cover. Statutory insurance is comprehensive but public. Expats add an international plan for private hospital rooms, choice of consultant, shorter waits and, above all, cover outside Germany when they travel or work abroad.
• Cover for people outside the statutory system. Some expats are not eligible for statutory insurance, or are in Germany on terms where a compliant international plan is the accepted route. For them the plan must meet the requirement, and the choice narrows to insurers who can confirm that it does.
• Cover that will outlast Germany. Many expats are in Germany for a few years. An international plan taken out now, and kept, means no new underwriting when they move to the Gulf, to Switzerland or home.

Travel insurance covers none of these needs. Our guide to international health insurance in EMEA explains the difference, and our Europe-only versus worldwide cover guide helps with the area decision.

The decisions that change your cover

Once the compliance question is settled, the usual decisions apply. Make them before you compare prices.

Our guide to inpatient versus outpatient cover explains what each module adds.

Pre-existing conditions and underwriting

Statutory insurance in Germany does not underwrite: everyone eligible is accepted on the same terms. Private insurance, German or international, does. Your history determines what is covered, and the routes are the familiar ones: full medical underwriting with a written decision, or a moratorium that excludes recent conditions automatically for a period.

This difference is one reason to think carefully before leaving the statutory system if you are eligible to do so. It can be difficult to return, and a private insurer may exclude a condition that the statutory system would simply have covered. Take advice on that question; it is a German regulatory matter, not an insurance comparison.

If you already hold an international plan, ask whether a new insurer will continue its terms. Our guide to pre-existing conditions explains the options.

Insurers worth reading about first

Nomi quotes the insurers on our insurer pages for residents of Germany where the insurer offers cover there. Useful first reads:

• Bupa Global, whose limits are published in pounds sterling, for British expats who expect to return to the UK. Choose an area that includes Europe.
• AXA Global Healthcare, with five cover levels, the choice of including or excluding the USA and a per-person excess.
• Cigna Global and Allianz Care, modular plans that suit a top-up role. Our Cigna versus Allianz page compares them.

Whatever you shortlist, ask the single most important question first: is this plan accepted as meeting the German insurance requirement for someone in my situation? If the answer is no or unclear, treat the plan as a top-up only.

How to prepare a comparison

1. Your status in Germany: employed and in the statutory system, privately insured, self-employed, student, or not yet resident.
2. Whether a residence permit application depends on the policy.
3. Who is to be covered, with dates of birth and nationalities.
4. Where you travel and whether you expect to leave Germany within a few years.
5. Your medical history and your preference on excess.

Our cost guide explains the premium drivers, and the HealthiNomad Premium Index publishes a country table for context.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to a regulated broker.