Krankenversicherung: German health insurance, explained

Health insurance in Germany is mandatory. You cannot legally live here without it. You cannot get a residence permit without it. You cannot change jobs or enrol at a university without it. Your Anmeldung triggers the requirement; your insurance start date usually matches your move in date.

The system splits into two halves: gesetzliche Krankenversicherung (GKV, public) and private Krankenversicherung (PKV, private). Most Indians arriving on a work visa go public. Here is why, and what to actually pick.

Public (GKV) vs private (PKV)

Public (GKV) is a fixed percentage of your gross salary (currently about 14.6% base rate plus a provider-specific Zusatzbeitrag of roughly 1.6 to 3.4%), capped at a monthly income ceiling (Beitragsbemessungsgrenze, around €5,812.50/month in 2026). Half is paid by you, half by your employer. Your spouse and children under 25 are covered for free on your plan (Familienversicherung). Covered services are identical across all GKV providers because the scope is federally defined.

Private (PKV) charges based on your age, health, and chosen coverage. It can be cheaper than GKV when you are young and healthy, and notably more expensive as you age. It covers your family only if you pay separately for each person. You cannot easily switch back to GKV once you leave it.

You can only choose PKV if:

• You are a salaried employee earning above the Versicherungspflichtgrenze (approximately €77,400 gross per year in 2026), OR
• You are self-employed or a freelancer, OR
• You are a civil servant (Beamter)

Below that salary threshold, GKV is mandatory.

Which GKV provider to pick

All GKV providers cover the same things. They compete on customer service, app quality, extra perks, and the Zusatzbeitrag (the supplemental top-up).

GKV Zusatzbeitrag comparison 2026

The Zusatzbeitrag is an additional percentage on top of the 14.6% base rate. You and your employer split it equally. Rates shift every calendar year and vary by provider.

These figures are approximate. Rates are published at the start of each year. For the most current rates across all statutory providers, check GKV-Spitzenverband.de.

For most Indians arriving in Germany, TK is a safe pick. The English-language customer service and international-friendly processes matter when you are new to the system. You can switch provider after 12 months if you dislike them.

Student tip: if you are opening a Sperrkonto (blocked account) for your student visa, Expatrio bundles TK health insurance enrollment directly into the Sperrkonto setup process. One signup handles both your blocked account and your TK membership — one less form to file after landing.

If you want to compare Zusatzbeitrag rates and extra benefits across all providers, Verivox* shows a side-by-side comparison filtered by your situation (employed, student, self-employed).

The PKV trap for Indians

PKV is worth understanding in detail because some Indians are lured in by the lower premiums in their 30s and regret it in their 50s.

Who can enter PKV: only employees earning above the Versicherungspflichtgrenze (approximately €77,400/year gross in 2026), self-employed people, and civil servants. Below that threshold, you are legally required to be in GKV.

The premium trajectory: premiums in PKV are calculated based on your age at entry and your health status. At age 30, a solid PKV plan costs approximately €400–600/month. By age 50, the same plan typically runs €700–1,200/month. PKV insurers must legally maintain Alterungsrückstellungen (aging reserves), but these reserves do not fully offset real-world premium growth. Premiums rise faster than GKV contributions for most people past middle age.

Leaving PKV is very difficult: once you voluntarily move from GKV to PKV, you can only return to GKV if two conditions are simultaneously true: your gross salary drops below the Versicherungspflichtgrenze AND you begin a new employment relationship. If you are 55 or older, returning to GKV is effectively impossible — the law presumes that you will stay in PKV for the rest of your working life. People who made the switch at 35 and now face premiums of €1,400/month in their late 50s with no realistic exit route are common.

No free family coverage: this is the most frequently overlooked PKV fact. In GKV, your spouse and children are covered at no extra cost (Familienversicherung). In PKV, each family member requires their own policy. A family of four in PKV can easily pay €1,500–2,500/month in combined premiums. GKV for the same family might cost €600–900/month total.

PKV does not travel with you: the policy is a German contract. If you return to India, move to another EU country, or relocate to a third country, your PKV policy is worthless there. You would need to either suspend it (paying a reduced Anwartschaft premium to keep your spot) or cancel it entirely and restart from scratch if you ever return to Germany. GKV has the same limitation, but the costs of leaving and rejoining GKV are lower.

The safe default for most Indians: stay in GKV. The exception would be someone who has very high income, no plans to have a family in Germany, intends to remain in Germany permanently, and has modelled the long-term premium trajectory. Even then, get independent advice (not from a PKV broker, who earns commission from PKV signups).

Familienversicherung in detail

Familienversicherung is one of the genuine advantages of the GKV system: your spouse and children can be added to your plan for free, provided certain conditions are met.

Who qualifies:

• Spouse (married, not civil partnership in some older interpretations — check with your provider)
• Children under 25 who are in education or vocational training
• Children under 18, regardless of employment status

Income limits for spouses: the free coverage applies only if the family member earns no more than €505/month (2026 threshold). Mini-job (Minijob) income has a slightly higher limit of €538/month. If your spouse earns between €505 and approximately €2,300/month (the rough GKV mandatory threshold for voluntary membership), they must take out their own GKV as a voluntarily insured member. They pay both halves of the contribution, which typically comes to €400–600/month depending on their income level.

Children over 25: once a child turns 25, the free Familienversicherung ends. At that point, if they are still a student, they move to the student GKV rate (around €120/month). After completing education, they get their own employment-based or voluntary GKV membership.

Children born in Germany: automatically covered under your plan from birth. Notify your GKV provider and register the child; the Gesundheitskarte for the child follows later.

Spouse joining you on a family reunion visa: register them with your GKV provider immediately on arrival. Bring the new residence permit and marriage certificate. Coverage starts from the registration date.

What to do on day one in Germany

Getting health insurance set up quickly matters because your employer's first payroll run requires a membership certificate. Here is the sequence:

1. Choose a provider before you arrive or within the first day or two. TK is the recommended default for new arrivals due to English support.
2. Apply online or by phone. TK and Barmer both have English-language online applications. You do not need to visit an office.
3. Submit your documents: passport, proof of German address (your Anmeldung confirmation helps but some providers accept a rental contract or employer confirmation as an interim address proof), and your employment confirmation letter or contract.
4. Receive your Mitgliedsbescheinigung (membership certificate). This is a one-page document the provider emails or mails to you, usually within 1 to 3 business days. Forward it to your HR or payroll team the same day you receive it.
5. Your Gesundheitskarte (health card) arrives by post within 1 to 3 weeks.
6. Until the card arrives: the Mitgliedsbescheinigung is sufficient to see a doctor. Bring it to any appointment and the practice will process it.

What happens if you become unemployed

This section covers a gap that most newcomer guides ignore.

Immediate grace period: when your employment contract ends, your former employer's GKV contribution arrangement continues for approximately one month. You are still covered as an insured member.

Voluntary continuation (freiwillige Versicherung): after the grace period, if you are not yet receiving unemployment benefits, you must continue your GKV membership voluntarily. You pay both halves of the contribution yourself. This comes to roughly €450–900/month depending on your last income, because contributions are calculated on your last known income. This is the expensive but legally mandatory route if you have savings and are job-searching without benefits.

If you receive ALG I (Arbeitslosengeld I): the unemployment insurance (Arbeitsagentur) pays your GKV contributions on your behalf. You are automatically covered. You do not need to do anything special; the Arbeitsagentur handles the transfer to your GKV provider.

If you receive ALG II or Bürgergeld: the Jobcenter handles your health insurance. You will be assigned GKV coverage and the Jobcenter pays for it.

No gap is legally permitted: the GKV system is built so that you cannot fall through. Your GKV provider is legally obligated to continue your membership even if you temporarily cannot pay. If you fall behind on voluntary contributions, the debt accumulates but you remain covered for medically necessary treatment. Sort out any payment issues as soon as possible — the debt does not disappear.

How to sign up

Your employer's HR team will ask you which provider you chose before your first payroll run. Call or email the provider, give them your passport, Anmeldung, and employment contract. They send you a membership certificate (Mitgliedsbescheinigung) which you forward to your employer.

Your Gesundheitskarte (health card) arrives by post in 1 to 3 weeks. Carry it to every doctor visit.

What it actually covers

• Unlimited GP (Hausarzt) visits, no co-pay
• Specialist visits (Facharzt), need a referral (Überweisung) in some cases
• Hospitalisation (€10/day co-pay, max €280/year)
• Prescription medication (€5 to €10 co-pay per item)
• Mental health (therapy with long waiting lists — see section below)
• Dental basics (cleanings cost extra; implants not covered — see section below)
• Vision basics (glasses mostly not covered — see section below)

For anything cosmetic or elective, you pay out of pocket.

Dental coverage in detail

GKV covers the basics, but the gap between what GKV pays and what you actually owe for major dental work is substantial.

What is covered: one annual checkup (Prophylaxe) is fully covered. Simple fillings (Amalgam-level) are covered. These go into your Bonusheft (bonus booklet) — keeping this booklet up to date over years improves the GKV subsidy on more expensive treatments.

What is only partially covered: crowns, bridges, and implants fall into a system of Festzuschüsse (fixed subsidies). GKV pays a defined reference amount regardless of what treatment you actually need. The reference amount typically covers roughly 50–60% of a standard treatment plan; you pay the rest. An implant that costs €2,000–3,500 in Germany might receive a GKV subsidy of €300–600. You fund the difference.

Zahnzusatzversicherung (dental supplemental insurance): this is worth considering. Standalone dental top-up plans cost approximately €10–30/month and cover 70–90% of implants, crowns, and orthodontics above the GKV base payment. If you have existing dental issues or expect major work in the next few years, buy one early — most policies have a waiting period of 3–6 months before they pay out.

Vision coverage in detail

GKV does not cover glasses or contact lenses for adults under the general scheme.

Exceptions: if you have a diagnosed medical eye condition that requires corrective lenses (strabismus, keratoconus, or very high prescriptions above a threshold), GKV may contribute. Your ophthalmologist (Augenarzt) would need to document the medical necessity.

The practical reality: most Germans pay for glasses out of pocket. Frames cost €50–300+, lenses €50–200+ depending on prescription strength. Budget optical chains (Fielmann, Apollo Optik) make this manageable. For contact lenses, you typically pay the full cost.

Optical supplemental insurance (Brillenzusatzversicherung): available as an add-on with most providers for approximately €5–15/month. These plans typically reimburse €100–200 every two years toward frames and lenses. The maths rarely favour the insurance unless your prescription is strong or your taste in frames is expensive.

Mental health coverage

Mental health treatment is fully covered by GKV, but access is constrained by supply.

Waitlists: the primary obstacle. Outpatient psychotherapy (Psychotherapie) waitlists run 3–9 months at most practices. This is a structural problem with the German healthcare system, not specific to any provider.

Acute crisis support: if you are in crisis, call 0800 111 0 111 (free, available 24 hours, anonymous, Telefonseelsorge). English-speaking staff are available on request.

Probatorik sessions: before entering a formal therapy course, practices offer up to 5 initial assessment sessions (Probatorische Sitzungen) that can be arranged faster than a full therapy slot. These are covered by GKV and let you and the therapist assess fit. If your situation is not acute but you need to start somewhere, ask explicitly for Probatorische Sitzungen rather than waiting for a full therapy course opening.

Online therapy platforms: HelloBetter and Selfapy are digital mental health programmes that are partially or fully covered by an increasing number of GKV providers (particularly TK and Barmer). Check directly with your provider whether a specific platform is on their approved list (Digitale Gesundheitsanwendungen, DiGA). Prescriptions can be issued by a GP.

Finding a therapist: the Kassenärztliche Vereinigung (KV) of your state operates a matching service at 116 117 that can help you find a therapy place faster than cold-calling practices. Worth calling if you have waited more than a few weeks without success.

Specific scenarios for Indians

Student visa: you must enrol in GKV. Student rate is around €120 per month across all providers. This is heavily subsidised.

Blue Card holders: your employer handles it. Go with TK or Barmer unless HR recommends otherwise.

Freelancers and self-employed: you can choose either GKV (voluntary membership, you pay both halves so around €400 to €900/month depending on income) or PKV. Most freelancers eventually regret PKV because premiums rise sharply with age. See the PKV section above.

Family members in India visiting: they need travel insurance, not your German policy. Your policy does not cover them while they are abroad.

Spouse joining you on a family reunion visa: immediately register them on your Familienversicherung (free) if their income is below the €505/month threshold. See the Familienversicherung section above.

Children born in Germany: automatically covered under your plan.

Finding a Hausarzt

Call around. Many GPs are not accepting new patients, especially in Berlin. Try doctolib.de for availability filtered by language (Hindi, Urdu, Punjabi, and Tamil speaking doctors exist in most major cities).

Once you find a Hausarzt, stick with them. They become the gatekeeper for referrals to specialists.

Switching providers

You can switch after 12 months of continuous membership, with 2 months notice. The process is paperwork-light: the new provider handles most of it.

Things nobody warns you about

• Waiting times for specialists can be 6 to 12 weeks. Therapy waiting lists are often 3 to 9 months.
• Your GP will test less than an Indian GP would. Routine bloodwork is not automatic. If you want a specific test, ask for it by name.
• Prescriptions expire fast. The pink slip (Kassenrezept) is valid for 28 days only.
• Your Gesundheitskarte must be physically presented or the clinic may bill you privately.
• Dental work costs are not what you expect. GKV pays a reference amount, not the actual bill. Always ask for a Heil- und Kostenplan (treatment and cost plan) before any major dental procedure.
• PKV premiums are not stable. If a PKV broker tells you otherwise, get a second opinion from an independent fee-based insurance advisor (Honorarberater).

Enrolling as a student? Open Expatrio to set up your Sperrkonto and TK enrollment together →

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Related guides on this site

• Finding a Hausarzt in Germany
• First 30 days in Germany: the Indian arrival checklist
• Freelancer life in Germany: health insurance for the self-employed
• Family Reunion Visa: bringing your spouse and children to Germany