Health insurance options and social security obligation regulations for foreigners in Germany 2021


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It’s vital to understand the health insurance options that are currently the law of the land in Germany. Even Expats living in Germany are subject to social security contributions. This also applies to employees from abroad. With them, however, some special regulations must also be observed.

Compulsory insurance for foreigners

health insurance options

Employment usually leads to compulsory social insurance. If an employer hires an employee, he has to check his insurance status. The question of whether there is compulsory or exemption from social insurance is of central importance. This depends on whether you are entitled to benefits, whether contributions are due and whether notifications are to be made.

Foreign employees who

  • were posted to Germany by their employer or
  • are employed or self-employed in several countries or 
  • are subject to an exceptional agreement with another state.

Registration rights and social security card for foreigners

health insurance options

The social security agencies receive data on the processing of the respective insurance through reports. The employer reports every person who is insured in health, long-term care, pension and / or unemployment insurance to the responsible health insurance company. He reports marginally employed persons to the mini-job center.

In order for the social security agencies to be able to correctly assign the personal data of the insured person, the correct information on the pension insurance number is required. It is on the employee’s social security card.

If there is no valid insurance number when registering an employee, for example because he has never worked in Germany before, the employer adds the following information when registering the employee:

  • Surname
  • Birth name if it differs from the family name
  • place of birth
  • Date of birth
  • Gender (key)
  • Citizenship (key)

The collection point (health insurance company) then informs the employer of the pension insurance number as soon as this has been assigned to the employee by the pension insurance.

If a non-German citizen of the European Economic Area (EEA) takes up employment in Germany for the first time, the country of birth and the insurance number assigned there must be specified, provided they are known.

Family insurance for relatives of foreign employees

In Germany, spouses or registered partners and children can be insured through the member free of charge (Section 10 SGB V). The prerequisite for family insurance for foreigners is that the relatives have their place of residence or habitual abode in Germany. They are also allowed to

  • do not have your own insurance
  • do not have an income over 470 euros per month,
  • do not have a full-time self-employed activity.

In addition, spouses can only be insured with the family if they can prove a legal marriage to the member. Age limits apply to co-insured children.

Health insurance options

Employees who are subject to health insurance and those who do not have health insurance can freely choose their health insurance company. A distinction is made as to whether the employee has an immediate right to choose when he or she becomes compulsory or entitled to insurance, or whether he or she changes health insurance during an existing membership.

Health insurance options

Employees are free to choose their health insurance company. Deadlines must be observed so that the choice of health insurance company becomes legally effective. From January 1, 2021, the commitment period is only twelve months.

The right to choose health insurance for employees

People who are subject to health insurance and those who do not have health insurance can freely choose their health insurance from various providers of statutory health insurance. Deadlines must be observed so that the choice of health insurance company becomes legally effective. A distinction is made here between

  • whether there is a compulsory health insurance or an insurance entitlement as a voluntary member or
  • whether the member opts for a new health insurance company from an existing membership.

New health insurance options 2021

Since January 1, 2021, it has been easier for employees to change health insurance. The commitment period is reduced to twelve months. If you change employer, you can immediately choose a new fund (exception: multiple employment). There are also simplifications for employers.

Family members

Co-insured family members do not have their own choice of health insurance. They depend on the choice of the family member through whom they are insured. This can be, for example, the spouse, a same-sex partner or a parent.

Selectable health insurance companies

Employees can choose a health insurance from various providers of statutory health insurance – for example the AOK of the place of residence or the place of employment.

Selection from the statutory health insurances

From the statutory health insurance options, there are various providers to choose from for changing health insurance. There are several options, for example:

  • the AOK of the place of residence or employment (for students: AOK of the place of study)
  • any substitute fund
  • a company health insurance fund, if an occupation is carried out in a company for which it was established
  • a company or guild health insurance fund, if the statutes of the company or guild health insurance fund provide for this
  • the miners
  • the last responsible health insurance company
  • the spouse’s health insurance

So workers have a lot of choice. Before you decide, you should take your time to check:

  • Which health insurance company has the best benefits?
  • Which health insurance is right  for me?

Commitment period with the health insurance company

If an employee opts for a health insurance company and thus uses the health insurance options in a legally effective way, membership of the chosen health insurance company is established.

When you start membership in a new health insurance company, there is a commitment period. As a rule, it is twelve months and describes the period for which the member is at least bound to the health insurer of his choice. At the earliest at the end of the commitment period, the insured person can change health insurance with uninterrupted membership. In addition, there are special binding periods of one year to three years for members who use an optional tariff with their health insurance company.

Exercise of the right to choose from a health insurance company

If a person subject to health insurance chooses a health insurance company for the first time or wants to change his previous health insurance company, binding and notice periods apply.

Entry of compulsory health insurance

If health insurance is compulsory, for example at the start of training or when starting a new job, the person subject to insurance has the right to choose health insurance. He can choose a health insurance provider up to two weeks after the compulsory insurance has become mandatory. For this he submits a membership declaration at the cash register of his choice.

The selected health insurance company confirms the membership to the member. In this confirmation, the member is also informed of his obligation to notify the employer. The employee informs his employer informally about the choice of health insurance company.

The training company or employer then registers the trainee or employee with the named health insurance company. As part of the DEUEV process, the employer then receives an electronic notification from the health insurance company about the existence of membership. The commitment period is usually twelve months.

Change of health insurance

If there is already a membership with a health insurance company and the member would like to change his insurance company, the following steps are necessary:

  • File application
  • Check deadline
  • Exchange between health nsurance companies

Change health insurance without notice

Upon termination of membership and re-entry of compulsory insurance, there is an immediate right to choose health insurance. This is the case, for example, when a job ends and the new job is started the following day or after a short break. In this case, binding and notice periods do not apply.

No exercise of the right to choose health insurance providers

If a member does not exercise his or her right to choose a health insurance company or does not exercise it in good time, the health insurance company with which membership or family insurance last existed is responsible.

If a statutory health insurance fund has never been responsible, for example because the employee has come to Germany from abroad, the employer selects an optional health insurance company and informs the employee about it. In this case, if the employee has not made his / her own choice of fund, no commitment period begins.

Before creating the registration, employers should contact their local AOK contact person and discuss the best possible further course of action in each individual case. In this way, it may be possible to avoid the need for a reversal of the health insurance and a retroactive accounting and reporting correction by the employer.

Expaturm aims to help educate Expats in Germany on key issues that they will have to deal with while living in Germany by providing everything you need to know about Banking, Healthcare, Lifestyle, and Housing in Germany


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