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statutory health insurance
Statutory Health Insurance: Your Guide to Contributions, Benefits, and Optimization Potential
Statutory health insurance is a pillar of the German healthcare system, but do you know all its details? Many insured individuals pay hundreds of euros monthly without fully utilising their options. This article explores how you can understand and improve your coverage.
The topic in brief and concise terms
The statutory health insurance is based on the principle of solidarity: contributions are income-based, and benefits are the same for everyone.
The contribution amount is determined by the general contribution rate, the fund-specific additional contribution, and the contribution assessment ceiling.
Family members can often be co-insured without additional contributions, which saves significant costs.
Understanding the Basics: Core Principles of the SHI at a Glance
Statutory health insurance (GKV) has been a cornerstone of the German social insurance system since its introduction in 1883. Today, more than seventy million people in Germany are insured under it. The central principle is solidarity: contributions are based on economic capacity, while entitlement to benefits is the same for everyone. Employees, pensioners, students, and, under certain conditions, self-employed individuals are insured through it. The GKV has a legal mandate to maintain or restore the health of the insured. This fundamentally distinguishes it from private providers, where risk assessment and the scope of benefits vary individually. Understanding this foundation is the first step towards optimising your protection.
Calculating Contributions: How Your GKV Costs Are Composed
Contributions to statutory health insurance are calculated as a percentage of gross income. The general contribution rate is fourteen point six percent, with employees and employers each contributing half, i.e., seven point three percent. In addition, there is an individual supplementary contribution by the funds, which will average about one point seven percent in 2025. For income above the contribution assessment ceiling, which in 2025 is 66,150 Euros annually (5,512.50 Euros monthly), no higher contributions are due. Self-employed individuals generally pay their contributions in full but may potentially pay a reduced rate for income up to the minimum assessment threshold of 1,248.33 Euros (as of 2025). Having a precise understanding of these figures assists in financial planning.
Use the service catalogue: This basic provision is guaranteed
The range of services offered by statutory health insurance is extensive and is defined by law in the Fifth Book of the Social Code (SGB V). The core services, which make up about ninety-five percent of the services and are the same for all insurers, include:
Medical and dental treatment, including psychotherapy.
Provision of medicines, bandages, remedial and auxiliary aids.
Hospital treatment, both inpatient and partial inpatient.
Medical preventive services and rehabilitation.
Sick pay during work incapacity for more than six weeks.
For many services, statutory co-payments are required, such as ten euros per day of hospital stay for a maximum of 28 days per year. The costs for glasses in the statutory health insurance are only covered in exceptional cases. Understanding these basic services is crucial for identifying gaps in coverage.
Secure your family: The benefits of free co-insurance
One major advantage of statutory health insurance is the opportunity for free family insurance. Spouses, registered partners, and children can be co-insured at no additional cost, provided certain conditions are met. This includes the requirement that family members reside in Germany and their total monthly income does not exceed a specific limit (2025: 535 Euros or 556 Euros for a mini-job). Children are generally insured until the age of 18; during schooling or vocational training, this is extended up to the age of 25. For children's health insurance, this is an important option. Family insurance can save hundreds of Euros in contributions each year. This regulation underlines the solidarity principle of statutory health insurance and offers families significant financial relief.
Deepen expert knowledge: Important paragraphs and regulations in the SGB V
The Fifth Book of the Social Code (SGB V) is the central legal foundation of statutory health insurance. Some paragraphs are particularly relevant to insured individuals. §1 SGB V defines the tasks of health insurance, namely to maintain, restore, or improve health. §3 SGB V enshrines the principle of solidarity-based financing through income-dependent contributions. The conditions for non-contributory family insurance are regulated in §10 SGB V. §226 SGB V specifies which income is subject to contributions. Current court decisions, for instance, regarding the coverage of certain therapies, can influence the interpretation of these paragraphs. It is advisable to refer to these foundations or seek expert advice, such as our voluntary health insurance consultation, when faced with complex questions or rejections of benefits. A basic understanding of the legal framework strengthens your position.
Handling Special Cases: Statutory Health Insurance for Self-Employed Individuals, Students, and Mini Jobbers
Certain groups are subject to special regulations within the statutory health insurance (GKV). Self-employed individuals can voluntarily opt for statutory insurance if they meet specific previous insurance periods or transition directly from a compulsory insurance to self-employment. Their contributions are based on their total income, but at least on an assessment threshold of 1,248.33 Euros (as of 2025). Students pay a reduced contribution up to the age of 30 or until their 14th semester, which was approximately 110-120 Euros in 2023. In the case of a mini-job and health insurance, mini-jobbers are often covered through a main employment or family insurance if their income does not exceed 556 Euros. Our expert tip: Clarify your individual situation early with your health insurance provider to avoid disadvantages. These specific regulations highlight the flexibility, but also the complexity of the system.
Unlock potential for optimisation: Personalised advice for your health protection
The statutory health insurance provides a solid basic protection for over seventy million people in Germany. By choosing the right health insurance company, using bonus programmes, and being aware of potential additional services, coverage can often be improved and premiums optimised. Especially when life circumstances change, such as the start of self-employment or planning for children, it is sensible to review your own situation. Finding affordable health insurance for the self-employed requires, for example, a thorough analysis. nextsure supports you in analysing your individual situation and finding suitable solutions. A sound consultation can help you get the most out of your statutory health insurance and close any gaps in coverage. Take the opportunity to actively shape your coverage.
More useful links
Wikipedia provides a comprehensive overview of statutory health insurance in Germany.
The Federal Ministry of Health offers an online guide to health insurance.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) provides information on the financing of statutory health insurance.
Destatis, the Federal Statistical Office, offers data on health expenditures in Germany.
The Federal Office for Social Security provides an overview of health insurance.
The Federal Ministry of Health presents figures and facts on the financial results of health insurance.
The Federal Ministry of Labour and Social Affairs (BMAS) provides information on social security in Germany.
The National Association of Statutory Health Insurance Physicians (KBV) offers health data.
FAQ
Was ist das Solidaritätsprinzip in der GKV?
Das Solidaritätsprinzip bedeutet, dass die Beiträge einkommensabhängig sind (wer mehr verdient, zahlt mehr), aber alle Versicherten Anspruch auf die gleichen medizinischen Leistungen haben, unabhängig von der Höhe ihrer Beiträge oder ihrem Gesundheitszustand.
What is the contribution assessment ceiling?
The contribution assessment ceiling is the maximum income up to which contributions to the statutory health insurance are calculated. For income parts above this, no further contributions are due. In 2025, it is set at 66,150 euros annually.
Which costs are not fully covered by the GKV?
The GKV does not cover all costs fully. Co-payments are required for medications, hospital stays, and aids, for example. Certain services, such as some vision aids or individual health services (IGeL), are often not covered at all or only partially.
How do I find the best health insurance for me?
Compare the amount of the additional contribution, the additional services offered (e.g. dental cleaning, alternative medicine), bonus programs, and customer service. Use independent comparison portals and advisory services.
What happens to my health insurance if I become unemployed?
Recipients of unemployment benefit I or Bürgergeld are usually mandatorily insured under statutory health insurance. The contributions are covered by the Federal Employment Agency or the Job Centre. [-ä,]
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