Health system in Germany
In Germany there is a general compulsory health insurance policy. For non-EU foreigners this means: The embassy gives you no visa and the immigration authorities no residence permitif you do not have sufficient insurance.
Employer pays half: If you are an employee with statutory health insurance (GKV), you share the costs. The contribution is automatically deducted from the gross salary.
Family insurance (GKV): In statutory health insurance, your spouse (without their own income) and your children are usually insured free of charge.
Travel insurance is not enough in the long term: Simple travel health insurance (incoming insurance) is often no longer accepted by the immigration authorities for the final residence permit.
No job start without a certificate: Your employer needs a membership certificate (or your social security number) on your first day of work, otherwise you won't be allowed to start.
The system
The German healthcare system consists of two pillars. As a foreign specialist or student you have to know which system you belong to - you can often make the wrong choice later very difficult to undo.
Where do you have to (or are you allowed) to get insurance?
The GKV (e.g. Techniker Krankenkasse, AOK, Barmer) is the standard for most immigrants. The contribution depends on your salary (approx. 14.6% + additional contribution). If you earn more, you pay more. If you earn less, you pay less.
You can only switch to private health insurance if you meet certain requirements. The post is directed here not based on salary, but based on your age, your state of health when you join and the scope of services you want.
| feature | GKV (legal) | PKV (private) |
|---|---|---|
| Contribution amount | Depending on salary | Depending on age & health |
| family members | Insured free of charge | Everyone needs their own contract |
| Choice of doctor | Statutory health insurance physicians | Free choice of doctor (including private doctors) |
| Pre-existing conditions | Don't matter | Can lead to rejection |
The route to entry
This is where the biggest misunderstanding arises for many expats: The German embassy requires proof of insurance for the visa, before you entered. But real statutory health insurance companies will only accept you once you are in Germany.
How to close the gap before starting work
You are in your home country and apply for the visa. The message says: "Show us your health insurance." You call a German GKV (e.g. TK). The GKV says: "We can only insure you from the first day of your employment contract/study. And we need your German address."
What do you do in the weeks between your arrival at the airport and your first day at work?
You must have one for the period from the day you enter the country until the official start of your employment or study relationship private travel health insurance (incoming insurance) complete (e.g. at Educare24, Mawista, Care Concept). This usually costs around €30-50 per month and can easily be booked from abroad.
Step by step
Take out travel health insurance online that is valid from your planned flight date. You print out the certificate and take it with you to your appointment at the German mission abroad (embassy/consulate).
Choose a German health insurance company (e.g. TK, AOK, Barmer). Fill out the membership application online. You will usually need your employment contract, your passport and (if you already have one) your German registration address.
The health insurance company will send you a “membership certificate to present to your employer” (or send it electronically). You must tell your employer (HR department) which fund you are with before your first day of work so that they can log you into the system and pay your contribution.
Since this is your first job in Germany, your new health insurance company will automatically apply for your German one Social security number (SV number / pension insurance number). You will receive the ID card in the mail a few weeks later. Keep this safe, it will last a lifetime!
You will be asked to upload a passport photo to the health insurance company's app. A short time later you will receive your plastic card (electronic health card) in the mail. From now on you will show this every time you visit a doctor in Germany. The doctor then bills the insurance company directly – you don't have to pay anything on site.
GKV, PKV or incoming insurance? The German system is confusing at the beginning.
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As of: May 2026. Lalmano checks content editorially and is based on official information, including from Foreign Office, BAMF and Make it in Germany. The content does not replace individual legal advice.