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General health insurance

What is health insurance? 

Health insurance in general provides financial security against the risks of illness or injury, while also promoting preventive care. The Fifth Social Code (SGB V) serves as the legal basis for health insurance. 

Since 01.01.2009, health insurance is mandatory for all residents of Germany according to § 5 SGB V. 

What types of health insurance are there?

The German social security system distinguishes between three types of health insurance. Under certain circumstances, you can even choose between them: 

• Compulsory statutory health insurance
• Voluntary statutory health insurance 
• Private health insurance 

You will find out which requirements must be met for each type of health insurance in the further course of this article. 

Note
A basic requirement is the so-called annual income limit which is set annually by the legislator. This specifies the point in time from which an employee is no longer subject to compulsory health insurance according to § 6 SGB V.

The social contribution key 

Contribution groups have been introduced for the purpose of transmitting the total social insurance contributions. The position and number indicate the classes of insurance for which employees are subject to mandatory insurance. The first digit represents the health insurance type: 

Contribution Group	Number
No contribution	0XXX
General contribution to health insurance (with entitlement to sick pay)	1XXX
Reduced health insurance contribution (no entitlement to sick pay)	3XXX
Contribution to agricultural health insurance	4XXX
Employer contribution to agricultural health insurance	5XXX
Flat-rate contribution for marginal employees	6XXX
Contribution to voluntary health insurance	9XXX

You can find further information on social contribution keys in our article on the topic.

Statutory health insurance 

Contribution rates and contribution assessment ceilings for 2024

Insurance groups	Contribution rate
General contribution rate (with entitlement to sick pay)	14.6%
Reduced contribution rate (without entitlement to sick pay)	14.0%
Contribution rate from pensions	14.6%
Average additional contribution	1.7%

 

KV / PV contribution assessment ceiling 2024
Monthly contribution assessment ceiling	€5,175.00
Annual contribution assessment ceiling	€62,100.00

Contributions to statutory health insurance

The statutory health insurance (Gesetzliche Krankenversicherung [GKV]) is financed by federal subsidies and contributions from the insured members and their employers. Contributions are calculated as a percentage based on eligible income. For both voluntarily and compulsorily insured employees, your contributions will be taken into account up to the contribution assessment limit. 

In 2024, the general GKV contribution rate is 14.6% of all income that is subject to contributions. 
The reduced contribution rate is 14.0%. This applies to all members who are not entitled to sick pay. This includes, for example: 

• Pension recipients who receive a full retirement or disability pension and are still employed.
• Employees who are receiving early retirement benefits. 

The contribution rate and the additional contribution are divided equally between the employee and the employer.

Note 
Since 01.01.2019, the additional contribution has also been paid equally by the employee and the employer. 

 

The additional contribution

To cover financial needs, health insurance companies charge an additional contribution according to § 242 SGB V that is on top of the general or reduced contribution rate.  This is based on the average additional contribution for statutory health insurance according to § 242a SGB V which the Federal Ministry of Health (Bundesministerium für Gesundheit) publishes one year in advance. However, it can be set individually by each health insurance company and may vary accordingly. 

Note
According to § 175 (4) Sentence 6 SGB V , members have a special right of termination if a health insurance company increases the additional contribution. 

The average additional contribution (2024: 1.7%) is generally applied for certain groups. These include:

• Trainees in youth welfare institutions
• Persons who receive Bürgergeld
• Employees with low salaries
• Trainees who receive a salary up to a maximum of €352.00

Compulsory statutory health insurance

According to § 5 SGB V, members of the compulsory statutory health insurance system are all employees, whose gross income subject to social insurance contributions is between the marginal income limit (2024: €538.00 monthly) and the annual income threshold (2024: €69,300.00 yearly). In addition to general employees, the following groups are also required by law to be insured: 

• Trainees and students enrolled at a state or state-recognized university, as well as interns who are completing an internship without pay in line with their study or examination regulations 
• Persons who receive unemployment benefit or maintenance allowance in accordance with SGB III or, under certain conditions,
• Persons receiving a pension, provided that certain pre-insurance periods have been fulfilled
• Artists and publicists 
• Persons who receive an orphan's pension or survivors' benefits from a professional pension fund 
• Agricultural and forestry companies, their working family members and farmers who have handed over their businesses to the next generation and, for example, receive maintenance support ("Altersteiler")
• Persons with a disability who work in a recognized workshop, nursing home or similar institution
• Persons who are not otherwise entitled to coverage in the event of illness, and who were most recently insured in or are subject to statutory health insurance 

Exceptions

According to § 6 SGB V, some groups are not subject to mandatory health insurance and are therefore free to decide to take out either statutory or private health insurance voluntarily. The following, for example, are exempt from insurance: 

• Employees who exceed the annual earning threshold (2024: €69,300.00 per year) 
• Civil servants, judges, and temporary soldiers
• Self-employed or freelance workers 
• Persons who have reached the age of 55 and have completed a certain preliminary insurance period in private health insurance

Note 
Under certain circumstances, employees can ask to be exempt from mandatory insurance. You can find more information about this on the Federal Portal website.

Voluntary statutory health insurance

Employees whose salary exceeds the annual income threshold under certain circumstances pursuant to § 6 (1) (1) SGB V are no longer subject to mandatory insurance under § 5 SGB V. There are two options for them to protect themselves against the risk of illness: They can either switch to private insurance or remain in the statutory health insurance system as a voluntary member. 

The health insurance company is obliged to provide information about the end of compulsory insurance and the existing possibility of continued insurance or withdrawal and thus switching to private health insurance. If no termination is submitted within the period, the membership is automatically continued according to § 188 (4) SGB V. 

According to § 9 SGB V, the following groups of people may voluntarily take out statutory health insurance: 

• Employees whose regular gross annual salary exceeds the annual income threshold (2024: €69,300.00)
• Freelancers
• Self-employed people
• Employees who within two months of their return from abroad take up an employment that does not result in compulsory insurance
• Former temporary soldiers (SaZ) can voluntarily join the GKV within three months of the end of their service 

Note 
Employees with voluntary health insurance are entitled to a contribution subsidy from their employer. This is non-contributory as long as it is limited to the maximum allowable contribution. 

Employer contribution subsidy for voluntary statutory health insurance

Social insurance group key	Employer subsidy
Persons who are insured voluntarily and are entitled to sick pay	€377.78 (plus half the individual additional contribution of the respective health insurer)
Persons with voluntary insurance who are not entitled to sick pay	€362.25 (plus half the individual additional contribution of the respective health insurer)

Right to choose your health insurer

Pursuant to § 173 SGB V, members of the statutory health insurance system who are subject to mandatory insurance and are voluntary members of the statutory health insurance system have the right to choose a health insurance company from the following: 

• Allgemeine Ortskrankenkassen (AOK) (General local health insurance funds)
• Any substitute health insurer, including those whose name refers to a specific occupational group
• Betriebskrankenkassen (BKK) (Company health insurance funds)
• Betriebs- or Innungskrankenkassen (IKK) (Health insurance of guilds)
• Deutsche Rentenversicherung Knappschaft-Bahn-See (KBS): German pension insurance for miners, railway workers, and seafarers

Note:
Some health insurers are tied to the insured person's place of residence, place of employment or company. This applies in particular to the AOK, BKK and IKK. 

Otherwise, they can choose their spouse's health insurer. They also have the right to choose the health insurer with which they were insured as a member or family member prior to becoming subject to or eligible for insurance. 

The only exemption from the right to choose their health insurer applies to members of agricultural health insurance companies. 

Changing the insurer

In principle, it is always possible to switch to another health insurer. However, the statutory minimum commitment period of the respective health insurance company must be taken into account. Pursuant to § 175 (4) SGB V, this period is at least 12 months. 

Since 01.01.2021, insured persons are no longer required to submit a termination notice to their existing health insurer, in accordance with § 175 (2) SGB V. The newly selected health insurer will inform them of the switch. Termination is, however, required if the change is to another insurance system (e.g. to private health insurance). 

Under certain circumstances, the minimum 12 months of a compulsory insurance are not required:

• Termination by a voluntarily insured member who meets the requirements for non-contributory family insurance. 
• Termination because they need to be covered in the event of illness outside of the statutory health insurance system (for example, in private health insurance).
• If the insurer's statutes provide that the minimum commitment period does not apply when changing to a health insurer of the same type.

A special right of termination may also apply if

• There is an increase in the supplementary contribution in accordance with § 175 (4a) SGB V. The information must be provided at least one month in advance and with a note that if the average additional contribution is exceeded, it is possible to change the insurer. 
• The same right shall apply where several health insurance companies merge, if this results in an increase in the additional contribution.

If a health insurer finds itself in the position of insolvency, it is also obliged to inform its members immediately. In this case, there is also the possibility of changing your health insurer, which, in accordance with § 175 (3a) SGB V, must be done within six weeks of the start of the insolvency proceedings. If a previous health insurer is insolvent, rejection by another health insurer is excluded. 

Changing to statutory health insurance

If the employee's income falls below the annual income threshold, they become subject to mandatory insurance again. In this case, an automatic change takes place from private to statutory health insurance. This can also take place within a calendar year.

The following groups are exempt from this rule: 

• Privately insured persons who have reached the age of 55.
• Privately insured persons who have not had statutory health insurance within the last five years. 
• Privately insured persons who were exempt from paying social security contributions, not required to have statutory health insurance, or who were primarily self-employed for at least half of that period.

Private health insurance 

What is private health insurance? 

Persons who do not meet the requirements for mandatory insurance according to § 5 SGB V can either choose to take out voluntary insurance with a statutory health insurance provider or switch to a private health insurer. 

These are companies that are organized by the private sector and aim to make a gain from the insurance they offer. They work according to the so-called equivalence principle, in which the premiums are calculated based on the insured person's individual insurance risk. The age at entry and existing illnesses also play a role in the calculation. 

In contrast to statutory health insurance, private health insurance not only offers the benefits required by law. The insured can combine benefits according to their personal preferences, which in turn affects the amount of the premium.  

Who can take out private health insurance?

Private health insurance is an option for persons who are not subject to mandatory health insurance according to § 5 SGB V. This includes the following groups of people: 

• Employees whose regular gross annual income is above the annual income threshold (2024: €69,300.00)
• The self-employed and freelance workers
• Persons with civil servant status (for example, judges, soldiers and federal employees)

Private health insurance contributions 

In contrast to the income-related contributions of statutory health insurance, private health insurance premiums are determined by the insured person's age at entry and risk of illness, as well as the scope of the insurance benefits. 

Private health insurers are entitled to adjust premiums at any time if the actual benefits differ from those calculated for the insured group. Improvements in performance due to medical progress and longer life expectancy may also play a role here. 

That means that young, healthy policyholders often have to pay a lower basic premium.  As the policyholder ages, their risk of illness and basic premium increase. 

Part of the premium is used to set up an age provision to cover medical costs that increase with age. 

The employer's contribution subsidy for private health insurance

Employees with private health insurance may be entitled to a contribution subsidy for health insurance from their employer.

The maximum subsidy for 2024 is calculated as follows:

Employer contribution subsidy per month = contribution assessment ceiling per month x (statutory health insurance contribution rate + average additional contribution)/2 

= €5,175.00 * (14.6% + 1.7%) / 2

= €421.76

If the employee is in the release phase of partial retirement and then retires from working life, for example, due to the statutory pension, they will no longer be entitled to sick pay from the statutory pension insurance. For this reason, the reduced contribution rate of 14.0% is used for the calculation. 

The maximum subsidy for 2024 is calculated as follows:

Employer contribution subsidy per month = contribution assessment ceiling per month x (statutory health insurance contribution rate + average additional contribution)/2 

= €5,175.00 * (14.6% + 1.7%) / 2

= €406.21

The following overview shows the maximum contribution subsidy amount for 2024:

Group	Monthly salary	Employer subsidy
Persons with private health insurance who are entitled to sick pay	to €5,175.00	50% of the contributions paid, however, a maximum of €421.76 per month for private health insurance
Persons with private health insurance who are not entitled to sick pay	to €5,175.00	50% of the contributions paid, but a maximum of €406.24 per month for private health insurance
Trainees and volunteers (low-income earners)	up to €325.00	100% of the contributions incl. average additional health insurance contribution

Note 
Contributions up to the current, legally specified maximum of €421.76, or €406.24 during the release phase, are not subject to tax and social security contributions. However, an employer may allow a higher subsidy. The excess amount will then be subject to tax and social security contributions.

Calculation of the contribution subsidy 

Contribution payments are divided equally between employers and employees where half the total contribution is not greater than the maximum contribution subsidy.

Example: Half the total contribution is less than the maximum contribution subsidy

Total private health insurance contribution: €500.00
Employer health insurance subsidy (50% of the total contribution): €250.00

Example: Half the total contribution is greater than the maximum contribution subsidy

Total private health insurance contribution: €900.00
Employer health insurance subsidy: €421.76

Payment of social security contributions 

According to § 23 (1) SGB XI, employees are required to take out insurance to cover the risk of illness and need for care. The employee usually pays their own contributions for health and long-term care insurance. Pension and unemployment insurance contributions are paid by their employer to the last relevant statutory health insurer.

Example: The employee previously had statutory health insurance

Marina is 25 years old. Up to 30 November 2021, her annual salary was €30,000.00, and she had statutory health insurance with health insurer XY. From 1 December 2021, she received an annual salary of €75,000.00. As her annual income exceeded the annual income limit (JAEG) from that point on, she decided to switch to private health insurance.

• Health and long-term care insurance contributions: Marina is a self-payer and receives a statutory subsidy for private health and long-term care insurance from her employer.
• Pension and unemployment insurance contributions: Are paid by her employer to the last relevant statutory health insurer, in this case health insurer XY.

Example: The employee never had statutory health insurance

Moritz is 22 years old. He has just started his first full-time job. Until this point, he was covered by his family's private health insurance. His annual salary is €75,000.00, he still has private health insurance and he did not previously have statutory health insurance.

• Health and long-term care insurance contributions: Moritz is a self-payer and receives a statutory subsidy for private health and long-term care insurance from his employer.
• Pension and unemployment insurance contributions: Are paid by his employer to a statutory health insurer of his choosing.

Tip
It usually makes sense to pay the contributions to a health insurer that other employees in your company are already insured with.