Health Insurance Setup – Köln

Yes, without exception. Every resident of Germany must have health insurance (Krankenversicherungspflicht). This applies to employees, freelancers, students, retirees, and non-working family members. You cannot obtain a residence permit without proof of health insurance. If you arrive without coverage, you will be retroactively assigned to a statutory health insurer and billed for the gap period. We ensure your insurance is active before you need it.

GKV (gesetzliche Krankenversicherung) is the statutory public health insurance system. Premiums are income-based (approximately 14.6 percent plus a supplementary rate, split with your employer). Coverage is standardised and comprehensive. Family members without income are covered free through Familienversicherung. PKV (private Krankenversicherung) is available to employees earning above the Jahresarbeitsentgeltgrenze (69,300 euros in 2024), self-employed individuals, and civil servants. Premiums are risk-based (age, health, coverage level) and increase with age. Coverage is customisable and often includes extras like single rooms in hospitals and faster specialist appointments.

Switching from PKV back to GKV is intentionally difficult. If you are under 55, you can switch back by reducing your income below the Jahresarbeitsentgeltgrenze (taking a part-time role or a lower-paying job). If you are over 55, switching back is virtually impossible. This is the single most important consideration when choosing PKV. We model the long-term financial implications before you make this decision.

For GKV: approximately 14.6 percent of gross salary (general rate) plus a supplementary rate that varies by insurer (0.5 to 2.5 percent), split equally between employee and employer. An employee earning 60,000 euros gross pays approximately 280 to 310 euros per month from their salary (employer pays the same amount). For PKV: premiums start from approximately 250 euros per month for a young, healthy individual with basic coverage and can exceed 800 euros per month for comprehensive coverage at older ages. PKV premiums are not income-related.

In GKV, yes. Non-working spouses and children are covered at no additional cost through Familienversicherung (family co-insurance), provided the family member earns below 505 euros per month (or 538 euros per month for a Minijob) and is not privately insured. In PKV, every family member needs their own separate policy and pays their own premium. This means a family of four in PKV pays four individual premiums, which is a significant cost consideration.

GKV covers: doctor visits (GP and specialists), hospital treatment, prescription medications (with small copays of 5 to 10 euros), dental treatment (basic), mental health treatment, maternity care (full coverage), preventive screenings, physiotherapy, and medical devices. It does not cover: single hospital rooms, private doctor fees above the standard rate, certain dental procedures (crowns, implants receive partial coverage), vision (glasses are covered only for children and severe prescriptions), and alternative medicine (limited). PKV coverage depends on your chosen plan and can include all of the above plus extras.

Freelancers can choose between GKV and PKV regardless of income. In GKV, freelancers pay the full contribution (both employee and employer share) on their income, approximately 14.6 percent plus supplementary rate plus nursing care insurance, with a minimum monthly contribution of approximately 220 euros (for very low income) and a maximum of approximately 1,050 euros. In PKV, premiums are based on age and health, not income, which can be advantageous for high-earning freelancers. However, if your income fluctuates, the fixed PKV premium continues regardless of earnings. We model both scenarios based on your projected income trajectory.