Opting Out of Germany’s Public Health Insurance explained
You will notice that we use original German terms like "Befreiung von der Versicherungspflicht" throughout this guide. We do this because German bureaucracy rarely translates its forms. When you apply for your visa, register at your university, or receive official letters, these are the exact words you will see on paper. Knowing the German terms will help you match this guide with your paperwork and avoid misunderstandings.
Health insurance is a must in Germany as well as in most of Europe
In Germany and many other European countries, health insurance is mandatory. This means that anyone entering Germany or Europe must have health insurance.
More specifically, this refers to the "Sozialversicherungspflicht" (obligation to have social insurance): every person living in Germany must have social insurance coverage. This applies not only to health insurance but also to pension insurance. Both are collectively referred to as the "Sozialversicherungspflicht". But since the pension insurance requirement applies only to people who will receive a pension in Germany, we will focus here on the health insurance requirement.
For people from other European countries, the requirement to have health insurance is not a problem, as their health insurance is generally valid throughout Europe, including Germany. However, if you come from a “third country” (that is, a country that is not part of the EU or the Schengen Area), you need health insurance that is recognized in Europe. Without this health insurance, you will not be granted a visa and will not be allowed to enter the country.
Public and private health insurance
In Germany, there are two types of health insurance: statutory and private. Most Germans are enrolled in statutory health insurance ("Gesetzliche Krankenversicherung", in short GKV). Although the GKV is not directly administered by the German government, it is similar to public health insurance systems in other countries. All members contribute to a common fund, which is used to pay the medical bills for all members.
However, you don’t have to be a member of GKV. You can also take out private health insurance ( “Private Krankenversicherung”, in short PKV). You can find the pros and cons of GKV and PKV here.
To be eligible for private health insurance (PKV), you must obtain permission from the statutory health insurance provider (GKV). In German insurance terminology, this process is called “Befreiung von der Versicherungspflicht”. This term literally translates to “exemption from mandatory insurance”, but it's a little misleading, since in Germany, you can not be exempted from health insurance. What it means is that you are exempted from statutory (public) health insurance.
Your Insurance Status
Whether you are required to have public health insurance during your stay in Germany—and are therefore eligible to join a statutory health insurance plan (GKV)—depends on what you are doing in Germany. In insurance terminology, this is referred to as your “status.” For example, if you have a permanent job in Germany, your status is “employee.” If you begin a degree program in Germany, you will be classified as a “student.”
If you are granted “student” status, you become part of the German social security system and a member of a statutory health insurance plan, unless you choose to get private health insurance. To do so, you must apply for opting out of Germany’s public health insurance.
How do you opt out of German public health insurance?
What do you need to do as a student from a non-EU country if you want to study in Germany? Step 1: Apply for a spot at a German university. If your application is successful, the university will send you a letter of admission. You can then choose whether you want to have public or private health insurance during your studies.
In case you decide to enroll in public health insurance
There are many different statutory health insurance providers in Germany, known as “Krankenkassen.” You choose one of them and apply for membership. To do so, you will need:
- Your letter of admission from the university
- A copy of your passport
- A passport photo for your membership card
Once these documents are received, the health insurance provider will review the application and send the confirmation directly to the university. This is known as the "M10-Meldung" (M10 notification). You don't need to do anything else.
Why is it called an “M10 notification”? It's an abbreviation that the health insurance providers use in their communication with the universities. “M” stands for “notification,” and the number indicates the type of notification. 10 refers to the student’s health insurance status (public or private) and also confirms that you are properly insured. Other examples: M11 is a notification of a change in insurance, and M12 is a notification of a delay in premium payments.
Speaking of premium payments
You must make sure you have sufficient funds in your account so that your insurance premiums are paid on time. Even a single late payment can result in your being removed from the university’s rolls. And that’s not all: if the university expels you, you will lose your residence permit and will have to leave the country.
If you find yourself in financial difficulty during your studies and are unable to pay your premiums on time, contact your health insurance provider immediately. You have a good chance arranging to pay in installments or defer your payment.
In case you decide to get private health insurance
As a student, you are not required to be a member of a public health insurance plan. You have the right to enroll in private health insurance. In that case, the registration process works a little differently. After you receive your letter of admission from the university, you should contact any Krankenkasse, but instead of applying for membership, you should request opting out ("Befreiung von der Versicherungspflicht"). It’s important to know that German health insurance providers aren’t just insurance companies that pay medical bills. They also serve as official regulatory authorities and decide whether you are eligible for private health insurance or not.
For the application for Befreiung von der Versicherungspflicht you need the following:
- Letter of admission from the university
- Copy of your passport
- Confirmation of private health insurance
Make sure the insurance confirmation includes the following information:
- Exact policy description
- Policy start date
- Certificate for submission to government agencies (this is a summary of the key points so that officials do not have to read through pages of insurance contracts).
Beware of the irreversibility trap!
We mentioned earlier that it is the Krankenkasse’s duty to verify whether you are insured. What only few people know is that the Krankenkasse has no obligation to provide advice in this regard! What does that mean? Simply put: the Krankenkasse doesn’t care at all about the quality of your private health insurance. When you opt out, the Krankenkasse only checks whether you have health insurance valid in Germany and Europe. The Krankenkasse does not check whether this insurance actually pays out in the event of illness.
So if you choose private health insurance just because it’s very cheap, you could fall into the “irreversibility trap.” You need to know this: If you opt out of GKV as a student, you can’t go back. At least not as long as you’re a student. The decision is therefore irrevocable. So if you choose a cheap insurance plan that pays nothing or very little when you get sick, and you have to cover most of the costs yourself, you cannot switch to the GKV. Then you’re stuck with an insurance plan that costs you money every month but provides hardly any benefits.
In a situation like this, switching to a better private health insurance plan would make sense and is also possible. But there’s a huge problem here too: pre-existing conditions. If you want to switch private insurance providers, the new insurer might reject you because of health issues you had before the switch, or it might contractually exclude coverage for them. For example, if you need regular treatment for asthma, allergies, back pain, etc., the costs for these treatments and medications won’t be covered by the insurer.
Here are our tips:
- Even though GKV may not seem like the cheapest option at first glance, it is the safest and more cost-effective in the long run. What good is a cheap insurance plan that costs less per month than GKV, but leaves you barely able to pay for treatments and medications due to deductibles and coverage limits?
- Above all, GKV is future-proof: Private health insurance for students usually has a maximum term, typically ranging from 2 to 5 years. What if your studies take longer? What if you decide to stay in Germany? In that case, GKV is the better option, because it has no maximum term.
- Of course, private health insurance can still be the better choice. For students over 30, it’s actually the only option, since the affordable student rate offered by GKV is only available to people under 30. But as we said: under no circumstances should you choose the cheapest offer!
When choosing private health insurance, you should keep the following points in mind:
- No coverage limits: The plan must not include any maximum limits (e.g., “up to 30,000 euros per year”) for hospital treatment.
- Comprehensive coverage: Psychotherapy, prenatal care, dental prosthetics, and chronic conditions must not be excluded in the fine print.
- Unlimited term: The contract must cover the entire expected duration of study and may not automatically expire after 12 or 24 months.
What's better for me? Public health insurance or private health insurance?
That depends on a number of factors, which we can't cover in full here due to space constraints. Try our insurance finder or our chatbot—you'll find it in the bottom right corner. If neither of those helps, please contact us!
Is it true that people with private health insurance can never switch back to GKV?
You may have read online that many insurance advisors warn against choosing PKV over GKV because, once you have private insurance, you can no longer switch back to GKV. In principle, this is correct—unless your status changes in the way we explained above. For example, if your status changes from “student” to “employee” because you take a job in Germany after finishing your studies, you automatically become subject to the social security system again and are enrolled in the GKV.
So don’t be misled: if you plan to live and work in Germany after graduation, you don’t need to worry that you’ll never be able to enroll in public health insurance again. As soon as your student status ends, you can enroll in the GKV, even if you had private insurance during your studies.
Our insurance plans
We offer a variety of insurance plans for international students:
1. Provisit Student TK, the statutory student health insurance
Recommended for students under 28 or students with families
from
€141.16per month
- Students under 28
- Exchange students
- Graduate students
2. Provisit Study Secure: Private Comprehensive Health Insurance
Recommended for students between the ages of 28 and 38
from
€125.86per month
- Students from 28 to 38
- Exchange students
- Graduate students
3. Provisit Student: Private Comprehensive Health Insurance
Recommended for students aged 38 and older
from
€129.00per month
- Students from 38 up
- Exchange students
- Graduate students
Please read the details of our student insurance plans carefully, and if you have any questions, use our insurance finder, our chatbot (bottom right), or contact us!
