Health insurance in Germany: how to choose your Krankenkasse

The system in two minutes

Health insurance is compulsory in Germany. For anyone working as an employee below a certain income threshold, joining the public system (gesetzliche Krankenversicherung, GKV) is automatic. Above that threshold you can choose between the public system and private insurance (private Krankenversicherung, PKV).

For most people arriving from Italy or Bulgaria the real question is: which public Krankenkasse. The basic benefits are set by the legislator and are practically identical; what differs is the Zusatzbeitrag (each insurer's supplementary contribution) and the extra services.

Who is insured how

• Employees: compulsory insurance in the GKV; your employer registers your employment with the insurer you chose.
• University students: student insurance at reduced rates, with the same insurer you choose.
• Family members: a spouse and children without their own income can join your family cover, free of charge.
• Freelancers and the self-employed: can choose between voluntary GKV and PKV, each with its own rules.
• Jobseekers: the Federal Employment Agency covers contributions in certain cases.

What you need to enrol

Step by step

1. Work out which category you fall into. Employee, student, family member or self-employed: your costs and procedure follow from that.
2. Compare 2–3 Krankenkassen. The large insurers (for example TK, AOK, Barmer, DAK) offer similar services; look at the Zusatzbeitrag, extra services and whether the office has your language.
3. Submit your enrolment request. Online or in person, with the required documents. You receive a confirmation that your employer needs.
4. Tell your employer your choice. Give them the insurer's name and your insurance number.
5. Receive your card (Gesundheitskarte). It normally arrives by post within a few weeks. With the card you can see a doctor.

What the public system covers

The basic catalogue includes doctor visits, hospital treatment, medicines at reduced co-payment, pregnancy and childbirth, recommended vaccinations, basic dental care and rehabilitation. Some services require a referral (Überweisung) or prior authorisation.

The German system has no mandatory family doctor, but many insurers offer coordinated care programmes (hausarztzentrierte Versorgung). For specialists, book well in advance; for out-of-hours emergencies call 116117.

Numbers and deadlines worth remembering

• 116117: out-of-hours medical service for non-serious urgent cases.
• 112: real emergencies.
• Notifying your employer: as soon as you've chosen an insurer, usually within your first working week.
• Changing insurer: possible with two months' notice; there is a minimum membership period (Bindungsfrist).

Common mistakes

• Not choosing an insurer. If you don't decide, your employer picks one for you: you'll lose the chance to compare Zusatzbeitrag and services.
• Confusing GKV and PKV. Private cover only makes sense in specific cases: it isn't a decision to rush.
• Forgetting family cover. If you have children or a spouse without income, activate it immediately: it's a significant saving.
• Not crediting contributions paid abroad. Insurance periods in Italy or Bulgaria can count: keep your S1/A1 forms and the certificates.