No health insurance in Germany: what to do and how to get back into cover

Compulsory health insurance in Germany

Health insurance is compulsory in Germany: in statutory health insurance (gesetzliche Krankenversicherung, GKV) since 2007 and in private health insurance (PKV) since 2009 (section 5(1) no. 13 SGB V, section 193(3) VVG).

The upside: you have a right to be insured again. If you were last in the GKV, your former fund must take you back regardless of your health, according to the consumer advice centres (Verbraucherzentrale).

Statutory or private: where do you belong?

It mainly depends on how you were last insured. Simplified, and with exceptions:

• Last in the GKV: generally back to the GKV, usually your last fund (Krankenkasse) or its successor.
• Last insured privately: generally back to the PKV.
• Never insured: employees usually GKV, the mainly self-employed and freelancers usually PKV.
• Not sure: ask a statutory fund first – it can check who is responsible.

Back into statutory insurance: contributions

Membership applies retroactively from the first day without other cover (section 186(11) SGB V), so back contributions may be due. If you report late, the fund should reduce them appropriately and must waive late-payment surcharges (section 256a SGB V) – usually provided you did not use benefits in that period or waive them. Voluntary members do not qualify.

Claims usually become time-barred four years after the end of the year they fell due. Instalments may be possible, but there is no legal right to them.

Back into private insurance: surcharge and basic tariff

If you belong in the PKV and apply more than a month late, a one-off surcharge applies (section 193(4) VVG): one monthly premium per further month without cover, one sixth from the sixth month. If the period is unknown, the law assumes at least five years, so documents matter. Deferral may be possible.

Private insurers must offer people assigned to the PKV at least the basic tariff (Basistarif, section 193(5) VVG): benefits comparable to the GKV, a premium capped at the GKV maximum and no surcharges or exclusions for pre-existing conditions. In financial need, the premium can be halved.

Arrears: suspended benefits and emergency tariff

Arrears do not leave you without any protection. In the GKV, benefits can be suspended after two months' arrears and a reminder (section 16(3a) SGB V), but acute illness, pain, pregnancy, maternity and early-detection check-ups stay covered. Paying or keeping to an agreed instalment plan ends the suspension.

In the PKV, two unpaid monthly premiums trigger a reminder and a surcharge of 1 per cent of the arrears per month. If they remain after a second reminder, you move to the emergency tariff (Notlagentarif, section 193(6) and (7) VVG), which mainly covers acute illness, pain, pregnancy and maternity, until everything is paid and your old tariff resumes. People in need of assistance under SGB II or XII are not moved to it.

Step by step: what to do now

Do not wait until you are ill:

• Gather documents: old insurance cards, letters, employment contracts, payslips or your pension insurance record.
• Ask your last fund or insurer to readmit you, ideally in writing.
• Ask about a reduction, deferral or instalments.
• Get advice: the Independent Patient Advice Service (UPD) helps free of charge on 0800 011 77 22, including people without insurance; the Verbraucherzentralen also advise, sometimes for a fee.

Special cases: worth asking

Some situations have their own rules, and this article is not legal advice. Ask directly, for example:

• Students: ask a statutory health insurance fund.
• Self-employed people: your last insurance counts; if never insured, usually the PKV.
• Returning from abroad: the same rules apply, based on your last insurance in Germany.
• Support from the Jobcenter or social welfare office (Sozialamt): ask them and your fund.