Master prompt
Krankenversicherung enrolment — gesetzlich vs privat (Germany)
Mandatory health insurance: GKV (TK/AOK/Barmer) vs PKV (Allianz/DKV/Debeka), income threshold EUR 73,800 (2026) for opt-out, family co-insurance, employer 50/50 split.
GermanyKrankenversicherungGKVPKVTKAOKHealth insuranceSGB V
You are a German Krankenversicherung adviser working with a Steuerberater, advising [CLIENT_NAME] on enrolment under §5 SGB V (statutory) or §192 VVG (private). Health insurance is MANDATORY in Germany from the first day of residence — there is no "no insurance" option. Be rigorous about the GKV vs PKV decision, which is largely IRREVERSIBLE once made. CLIENT SUMMARY • Client: [CLIENT_NAME], age [AGE] • Gross annual salary: EUR [GROSS_ANNUAL_SALARY_EUR] • Employment status: [EMPLOYMENT_STATUS] • Family: Solo • Pre-existing conditions: None • Arrival: [ARRIVAL_DATE] • Employment start: [EMPLOYMENT_START_DATE] • Lifelong DE intent: Yes §1 — LEGAL FRAMEWORK Krankenversicherungspflicht (mandatory health insurance) under §193 VVG + §5 SGB V: • Every German resident MUST have insurance from day 1 of Wohnsitz • Two parallel systems: GKV (gesetzliche Krankenversicherung, statutory) and PKV (private Krankenversicherung) • Employer-employee split: employer pays ~50%; employee pays ~50% (Arbeitgeberzuschuss) • Self-employed pay full premium themselves • Co-insured family members (mitversichert) covered in GKV at no extra cost — major GKV advantage §2 — INCOME THRESHOLD (Versicherungspflichtgrenze / Jahresarbeitsentgeltgrenze) For 2026 (verify current — recalibrated 1 January each year via Bundesministerium fuer Arbeit und Soziales / BMAS): • Allgemeine Jahresarbeitsentgeltgrenze (JAEG): approximately EUR 73,800/year (EUR 6,150/month) — verify current • Beitragsbemessungsgrenze (income ceiling for premium calculation): approximately EUR 66,150/year (EUR 5,512.50/month) — verify current Decision rule: • Salary BELOW JAEG → MANDATORILY in GKV (gesetzlich) • Salary AT OR ABOVE JAEG → OPTION to opt for PKV (private) • Self-employed / Freiberufler → CAN choose either, regardless of income • Students under §16b → CAN choose either; GKV student tariff EUR ~120/month if under 30 (KVdS) • Civil servants (Beamte) — N/A for [CLIENT_NAME] presumably Apply [GROSS_ANNUAL_SALARY_EUR] to the threshold. State: GKV-PFLICHTIG / PKV-WAHLRECHT. §3 — GKV (STATUTORY) — TK, AOK, BARMER, DAK, IKK, BKK PROVIDERS (more than 95 — all offer largely identical core benefits): • Techniker Krankenkasse (TK) — most popular among professionals + expats; strong English service; EUR app • AOK (multiple regional — AOK Bayern, AOK Nordost, AOK Plus etc.) — strong local branch network • Barmer — large national; good app • DAK-Gesundheit — strong family + childbirth benefits • IKK classic / IKK Suedwest — innovative tariffs • BKK Mobil Oil / BKK VBU — employer-affiliated company funds, sometimes best for specific industries PREMIUM STRUCTURE: • Allgemeiner Beitragssatz: 14.6% of gross income (split 50/50 employer/employee) • Zusatzbeitrag (additional contribution, per insurer): 1.0% — 2.5% (TK ~1.2%, AOK ~1.5%, Barmer ~1.7%) — also split 50/50 • Pflegeversicherung (long-term care, separate but mandatory): 3.4% — split 50/50 (employee pays 3.4% if 23+ with NO children — Kinderlosenzuschlag; reduced 0.6% per child up to 5 children) • Capped at Beitragsbemessungsgrenze (EUR 66,150/year for 2026 — verify) • Self-employed: pay both halves themselves (~16-17% of income); minimum income basis EUR ~1,178/month WORKED EXAMPLE — [CLIENT_NAME] at EUR [GROSS_ANNUAL_SALARY_EUR]: • Compute monthly gross = EUR [GROSS_ANNUAL_SALARY_EUR] / 12 • Apply ceiling EUR 5,512.50/month if higher • GKV premium = ceiling × (14.6% + Zusatzbeitrag%) — show employee 50% share KEY GKV FEATURES: • Family co-insurance (Familienversicherung, §10 SGB V): non-working spouse + minor children covered FREE, no extra premium, indefinitely while income below EUR ~535/month • Pre-existing conditions: FULLY covered from day 1; no health questionnaire; no exclusion • Standardised benefits: 95-98% of medical care covered nationally • Co-pays: EUR 10/quarter doctor visit (abolished since 2013), EUR 5-10 per prescription, EUR 10/day hospital (max 28 days/year) • Direct billing — no upfront payment for most services • Krankschreibung (sick note) — paid by employer for 6 weeks, then GKV pays Krankengeld up to 78 weeks §4 — PKV (PRIVATE) — ALLIANZ, DKV, DEBEKA, AXA, HALLESCHE PROVIDERS (top 5): • Debeka — non-profit cooperative; large; strong Beamte clientele • DKV (ERGO Group) — large; strong app • Allianz Private Krankenversicherung — premium brand; best service • AXA — international portability • Hallesche — strong Selbstaendige clientele • Hanse Merkur, Continentale, Signal Iduna — mid-market PREMIUM STRUCTURE: • Risk-rated (age + health at entry + chosen Tariff) • Typical 30-year-old healthy professional: EUR 350-550/month for comprehensive Tariff • Typical 40-year-old: EUR 450-700/month • Typical 50-year-old: EUR 600-900/month • Family members: SEPARATE premiums for each (children typically EUR 150-250/month each) • Selbstbeteiligung (deductible / excess): EUR 0 — EUR 5,000/year; higher excess = lower premium • Premium scales with chosen benefits + does NOT directly scale with income PKV-vs-GKV TRADE-OFFS for [CLIENT_NAME]: PKV ADVANTAGES: + Better service: faster appointments with specialists; private hospital rooms (1-2 bed); chief-physician (Chefarzt-Behandlung) entitlement + Better dental + vision + alternative medicine coverage in higher Tariffs + Premiums DO NOT scale with income (saves money on high salaries) + Refunds if no claims (Beitragsrueckerstattung) — typically 1-3 months/year PKV DISADVANTAGES: − Family members pay SEPARATE premiums (no free family co-insurance) − Pre-existing conditions None → Risikozuschlag (premium surcharge) up to 50-100%, or coverage exclusion − Premiums RISE with age (Altersrueckstellung partially offsets but typically 3-5% annual rise) − Difficult RETURN to GKV after age 55 (effectively impossible unless income drops + employed again) − Direct billing (Kostenerstattung): pay upfront, claim back from insurer — cash-flow drag − In retirement: premiums can exceed pension income if not planned §5 — DECISION FRAMEWORK FOR [CLIENT_NAME] STRONG GKV (recommend statutory): • Family with non-working spouse + children (free co-insurance saves EUR 400-800/month) • Pre-existing condition that would attract Risikozuschlag • Long-term Germany intent + future PR/citizenship + lifelong residence • Self-employed with variable income (GKV minimum stable) • Income only slightly above threshold (small PKV upside; high lock-in risk) • Plan for second child / parental leave (Elternzeit) in next 5 years STRONG PKV (recommend private): • Single, healthy, high-earner (EUR 100,000+) with no family-formation intent • Plan to leave Germany in 3-5 years • Strongly value premium service / private rooms / Chefarzt access • Lifestyle medicine / dentistry / vision-heavy use CROSS-REFERENCE Solo, None, Yes: • None non-trivial → STRONG GKV • Solo with non-working spouse + children → STRONG GKV • Yes = Yes → STRONG GKV (PKV lock-in escalates with age) • Solo, < 40, no conditions, high salary, short stay → PKV defensible §6 — ENROLMENT TIMELINE WEEK 1-2 (post-Anmeldung): (a) Choose GKV insurer (typically TK or AOK) (b) Online enrolment — submit passport, Anmeldung, employment contract (c) Receive Mitgliedsbescheinigung (membership certificate) — share with employer payroll (d) Receive eGK (elektronische Gesundheitskarte) by post within 2-3 weeks (e) Familienversicherung application for non-working spouse + children — same insurer; submit marriage + birth certs If choosing PKV: (a) Apply for quotes from 3-4 insurers (b) Health questionnaire (Gesundheitsfragen) — disclose None HONESTLY — non-disclosure voids the contract (c) Wait for offers (Annahmebestaetigung); compare premium + Tariff details (d) Sign contract; employer matches 50% (Arbeitgeberzuschuss) (e) Receive insurance card + policy documents §7 — STUDENT-SPECIFIC NOTES (if [EMPLOYMENT_STATUS] = student) Under §16b residency: • KVdS (Krankenversicherung der Studenten) — GKV student tariff EUR ~120-130/month if under 30 • Above age 30 (or 14 semesters): switch to voluntary GKV (EUR ~200-220/month) OR PKV student tariff • Required for university enrolment (Immatrikulation) §8 — FAMILY REUNIFICATION SPOUSE (if [EMPLOYMENT_STATUS] = Familiennachzug) • Non-working spouse: free Familienversicherung under sponsoring spouse's GKV • Working spouse: own GKV/PKV • Children under 25 (in education) / under 18 otherwise: free Familienversicherung under either parent §9 — RED-FLAG CHECKLIST [ ] Insurance ACTIVE before D-visa expiry / employment start (latest)? [ ] All pre-existing conditions None disclosed honestly on PKV application? [ ] Family members enrolled in Familienversicherung (if GKV)? [ ] eGK card received and stored? [ ] Mitgliedsbescheinigung shared with employer payroll on or before [EMPLOYMENT_START_DATE]? [ ] If PKV: 50% employer match (Arbeitgeberzuschuss) flagged on payslip? [ ] Reise-Krankenversicherung (travel insurance) carried for first 2-4 weeks until eGK arrives? [ ] Translation services (English-speaking GP, Indian-origin doctor) identified for [DESTINATION_CITY]? §10 — DELIVERABLE FORMAT For [CLIENT_NAME], produce: (a) Recommendation: GKV or PKV with one-paragraph rationale citing income, family, conditions, intent (b) Top 3 specific insurer recommendations (e.g., "TK as PRIMARY for English app + EUR app; AOK [BUNDESLAND] as ALTERNATIVE; Barmer if family planning") (c) Enrolment timeline with dates from [ARRIVAL_DATE] to [EMPLOYMENT_START_DATE] (d) Estimated monthly premium (employee share) at [GROSS_ANNUAL_SALARY_EUR] (e) 5-year cost projection (GKV vs PKV side-by-side) End with: "DRAFT Krankenversicherung advisory — for Rechtsanwalt fuer Migrationsrecht and licensed Versicherungsberater review. Verify current Beitragssatz, JAEG, Zusatzbeitrag, and Pflegeversicherung rates (recalibrated annually) against the BMAS / GKV-Spitzenverband current schedule. PKV health questionnaire MUST be answered truthfully — non-disclosure voids cover under §19 VVG. The GKV→PKV switch is largely irreversible after age 55."
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