Pathways to Healthcare for German Citizens
Since 2009, there has been a general health insurance obligation in Germany, meaning there is mandatory insurance, and all individuals must be insured!
The following groups of people have statutory health insurance entitlement by law, which lasts for a maximum of one month after the end of membership:
Mini-jobs and employment contracts below the threshold for marginal employment are generally exempt from insurance!
If you are insured through your employer in Germany but reside in another EU country and wish to receive medical treatment there, you can use the so-called “portable Document” to prove your insurance coverage. The costs will then be covered by the insurance in Germany. Here you can find more information about this.
Private health insurance in Germany is obligated to insure the following groups of people:
After the age of 55, a switch from private to statutory health insurance is no longer possible! Exceptions include switching to family health insurance (if there is no main self-employment) or taking up employment.
Premiums for private health insurance may be higher than those for statutory health insurance. However, there is a basic tariff for private health insurance whose scope of benefits matches that of statutory health insurance in terms of type, extent, and amount. The premium amount depends on the average maximum contribution rate in statutory health insurance, and there must be officially certified neediness. Refusal by private health insurance is only possible in the case of threat, fraudulent deception, or withdrawal due to intentional violation of pre-contractual disclosure obligations, for example, if the health questionnaire is not submitted. The entitlement exists without a risk assessment. Another disadvantage of private health insurance is that privately insured individuals must advance payments, meaning they must initially pay bills themselves and then reclaim the money from the health insurance fund.
Insurance of spouses and children through family health insurance (FamKV)
If you are an active member of statutory health insurance, it is possible to insure your spouse and children. The requirement is that their residence or habitual residence is in Germany or the EU, and identity documents of those to be insured are necessary (e.g., birth certificate, birth announcement, hospital document with paternity recognition, determination of child benefit entitlement, etc.), as well as a completed and signed family questionnaire and the signed declaration of family insurance. Foreign marriages are also recognized if they correspond to local form. In polygamous marriages, only the first wife is eligible for family health insurance. Here you can find more information about family health insurance.
Information for individuals without health insurance
Individuals who left health insurance between April 1, 2007, and July 31, 2013, are legally regulated to be in a backup insurance since 2009. This means that the last health insurance that insured the person must take them back! Those to be insured have no choice and an obligation to provide information and cooperate! Health insurances require an application from the person to be insured! The backup insurance applies to individuals who have no entitlement to other coverage in case of illness and were last insured under statutory health insurance or have never been insured anywhere but can be assigned to statutory health insurance.
For all individuals who left health insurance after August 1, 2013, there is mandatory continuation insurance. This starts after the insured person leaves compulsory or family health insurance. It takes precedence over backup insurance, meaning no pre-insurance and no declaration of intent is required, as it simply continues with the conditions of voluntary health insurance from the last health insurance. These regulations affect the following groups of people:
Exiting backup insurance or mandatory continuation insurance is only possible by providing evidence of re-entry into another health insurance!
Additional information for uninsured individuals who were previously privately insured:
Private health insurances are subject to a compulsory acceptance into the basic tariff (§125 VVG). This means that those to be insured must be accepted without waiting times, unless it is a case of fraudulent deception. To do this, the medical questionnaire (preferably completed with a doctor) must be fully filled out. This questionnaire has no legal relevance regarding whether one is admitted to health insurance. Acceptance of a complete application must occur within 1-2 weeks; otherwise, a complaint should be filed with the private health insurance association. The benefits of the basic tariff of private health insurance correspond to the benefits of statutory health insurance. Co-payments are possible up to the limit of burden. Payment exemption works as with statutory health insurance.
To be admitted to the basic tariff, there must also be an officially proven neediness according to SGB2/12, and current decisions must be regularly submitted. Despite a protected amount of €10,000, one is still considered in need. The treatment of property is regulated locally. Debts (including to the health insurance) and debt repayment are not included in neediness. However, if paying the contribution to private health insurance alone would result in neediness, this must be certified by the JobCenter or social welfare office, and subsequently, the neediness must be reported. The report can initially be informal via fax. Neediness is considered a special hardship, leading to the interest-bearing deferral of accrued premium surcharges.
Admission to the basic tariff is possible with and without a deductible. Under certain circumstances, people can switch to the regular tariff later.
Insurance debts/contribution debts
If you have contribution debts with a health insurance fund, you should immediately seek debt counseling and have the debts broken down.
If you are insured with private health insurance, the debts should always be repaid as the entire amount. However, if there is a special hardship (e.g., declared neediness), you can request a deferral in writing from the private health insurance. If the insured person was already in need at the beginning of the insurance or would have become in need by paying the maximum contribution, the private health insurance can also calculate only half the contributions for the past. If contribution debts have arisen because the JobCenter has not fulfilled its duty to provide advice and information and has not provided sufficient information about private health insurance, you should file an objection and inform the JobCenter that the debts must be paid.
In the case of non-payment of ongoing contributions, the emergency tariff according to §206 VVG comes into effect after two months, resulting in a suspension of insurance. Excluded from this are individuals with officially proven neediness. In statutory health insurance, this emergency tariff is called “suspension of benefits.” These tariffs have existed since 2013. Those who fell out of health insurance before 2013 were/are not insured in the meantime.
Here you can find a strategic roadmap for (re-)acquiring health insurance coverage. It provides an overview of the documents you need and which institutions are responsible. If you want to come to us for advice on this matter, it’s best to bring this document and the documents listed there already filled out.
Pathways to Healthcare for EU Citizens in Germany
How EU citizens can access the healthcare system in Germany depends primarily on their employment status and the nature of their residence status.
Generally, EU citizens have the right to stay in Germany for up to 3 months without conditions (§2 Abs. 5 FreizügG/EU). If you are self-employed, employed, or looking for a job, you are entitled to a residence permit after 3 months. However, you must also prove that you are not staying in Germany solely for job seeking purposes, but also, for example, to live with family members.
EU citizens must obtain insurance within 3 months of coming to Germany. Initially, they must try to obtain coverage from statutory health insurance; if rejected, they must turn to private health insurance. However, private health insurance may also refuse coverage if there is no income or financial means.
EU Citizens Employed in Germany
As employed individuals, if you are legally employed, you are covered by statutory health insurance in Germany. This coverage also extends to your family members, regardless of whether they live in Germany or another EU country. If family members of the person employed in Germany seek medical services in their home country, the German statutory health insurance covers the costs.
The possible insurances are:
or upon exceeding the annual income limit: 2. Voluntary insurance in statutory health insurance or
Self-Employed EU Citizens in Germany
EU citizens who are self-employed in Germany can either:
EU Citizens Whose Right as Employees Persists According to §2 Abs. 3 FreizügG/EU
EU citizens whose right as employees persists are either:
EU Citizens Seeking Employment/Without Material Residence Right/Freedom of Movement Entitled as Non-Employed or in the First 3 Months of Stay
EU citizens in Germany seeking employment/without material residence right/freedom of movement entitled as non-employed or in the first 3 months of their stay can either:
Lack of Health Insurance Coverage
If there is no statutory health insurance coverage in Germany and health insurance cannot be “brought along” from the home country, there are various ways to still get insured in Germany.
For people engaged in irregular employment in Germany (working “under the table”), it is helpful to consider how work can be legalized to ensure access to statutory insurance. Additionally, there is the option to voluntarily enroll in statutory or private health insurance. The prerequisite for entry into the state insurance system is proof that you were already insured through statutory health insurance in your home country. If you were previously privately insured in another EU country, you must also take out private health insurance in Germany. Furthermore, in some cases, there is the possibility of being insured through the receipt of social benefits in Germany.
You can find a Strategic Roadmap for (Re-)Acquiring Health Insurance Coverage here. It provides an overview of the documents you need and which institutions are responsible. If you want to come to us for advice on this matter, it’s best to bring this document and the documents listed there already filled out.
Right to Medical Care Even Without Documents
In principle, every person residing in Germany has the right to medical care, regardless of gender, ethnic background, religion, or residence status, according to § 1 I No. 5 in conjunction with § 4 AslybLG (Asylum Seekers Benefits Act). In emergencies, doctors and hospitals are obligated to examine and treat you, even in the absence of documents and uncertainty about the cost bearer, and failing to do so constitutes a criminal offense (§ 323 c German Criminal Code)!
Reporting Obligation for Persons Without Valid Residence Status
To assert your right to regular medical care (i.e., all treatments beyond emergency care), you would need to present yourself to the social welfare office, which is obligated to report you to the immigration office as a public entity.
For this reason, in addition to open.med Berlin, there are other facilities providing anonymous and mostly free medical care for people without health insurance.
The Clearingstelle of the Berliner Stadtmission has been working since mid-January 2019 on issuing anonymized medical certificates (AK). This allows people without legal status access to health care according to general standards of statutory health insurance. After examination, the Clearingstelle issues treatment certificates that can be redeemed with specific doctors. This process is anonymous and free of charge!
Nationwide Overview: Medical Assistance for Migrants Without Healthcare
List of Doctors with Language Proficiency, sorted by specialty and districts in Berlin
Application form from the State Office for Refugee Affairs Berlin for cost coverage for language mediation within the scope of healthcare
Take Care Project EU – Phrasebook and self-learning material on health topics for migrants
Pregnancy with an unresolved residence status/no documents: Tolerance arrangement for pregnancy and childbirth
To officially assert your right to prenatal and postnatal medical care, you can visit the Berlin Foreigners’ Office three months before and three months after childbirth. During this period, potential deportation is suspended, meaning you cannot be expelled. However, if you were undocumented before, the Foreigners’ Office will be informed about your stay afterward.
The birth of a child is considered an emergency, and a pregnant woman must not be rejected for childbirth in the hospital. However, the ten recommended prenatal check-ups are part of regular medical services, making them challenging for uninsured women to access.
Family planning, sexual health, abortion
If you decide against a pregnancy, you can seek anonymous and free advice. Unfortunately, the coverage of costs for the abortion itself is often not possible without a regulated residence. The costs of abortion vary depending on the chosen method. During a consultation on abortion, you can weigh potential risks and options for your decision.
The following organizations can provide specialized advice and support on pregnancy-related matters:
Center for Sexual Health and Family Planning Berlin – multiple locations in different districts, offering advice on pregnancy (including unwanted pregnancies), gynecological consultation, coverage of contraceptive costs, sexual health, psychological counseling, and couples counseling, multilingual flyer.
Berlin Midwives Association e.V – Multilingual information for expectant parents.
AWO Berlin e.V. – Information on pregnancy counseling, abortion, also available in multiple languages and simple language.
The Maltese also provide nationwide prenatal care.
XENION – Psychotherapeutic Counseling and Treatment Center for Traumatized Refugees and Survivors of Torture
TransVer – Psychosocial Support for People with Migration Background
International Psychosocial Organisation gGmbH (Account must be created) – Psychosocial Online Counseling for Refugees
Zentrum Überleben – Help and Treatment Center for Individuals with Torture Experience, Psychosocial Support, Reintegration, etc.
DaMigra – Consulting and Empowerment Projects by and for Women* with Migration Background
LARA e.V. – Specialized Center Against Sexualized Violence on Women* and Support in Crises
SOLWODI – Psychosocial Counseling and Trauma Counseling for Women
S.U.S.I. Intercultural Women’s Center – Multilingual Social and Legal Advice, Psychological Counseling
List of other counseling centers for migrant women, sorted alphabetically
Contact and Counseling Center for Refugees and Migrants – Consultation on Residence and Asylum, Support for Psychological and Social Issues
Amnesty International Asylum Group Berlin-Brandenburg District – Consultation on Residence and Asylum, Preparation for Asylum Hearings
Refugee Law Clinic Berlin – Legal Advice for Refugees and Migrants
AL Muntada Plus – Consultation on Residence, Asylum, and Migration Law for Refugees from the Arabic Region
Asylum Erstberatung of AWO Kreisverband Berlin-Mitte e.V. – Consultation on Residence and Asylum, Family Reunification (English, Somali, Tigrinya, Russian, Farsi, Kurdish)
Sportbunt – Search Engine for Sports Offerings (German, Arabic, English, Farsi)
Overview of current healthcare regulations for refugees in Berlin:
The electronic health card
In 2016, the electronic health card for asylum seekers was introduced in Berlin, eliminating the use of green certificates since 2017. The four health insurance companies AOK Nordost, DAK, BKK Siemens, and BKK VBU are involved in the process, with asylum seekers randomly assigned to them.
For newly arriving individuals in Berlin seeking asylum, the first stop is the Arrival Center at Oranienburger Straße 285 in Reinickendorf.
There, a transitional accommodation and a registration area are available. You will undergo initial medical examinations and vaccinations. While the registration process is ongoing, you will be accommodated in the Arrival Center for a few days.
For more information, visit the State Office for Refugee Affairs website.
Information about Medical Care under the Asylum Seekers’ Benefits Act can be found on the Berlin Senate Administration’s website.
Validity and Entitlements
Newly arriving refugees are registered for the electronic health card by the LAF. Upon registration, they receive a copy of the registration letter to the health insurance company. The card is issued by the health insurance company and sent to the individuals’ accommodation. During the transitional period until the eGk is sent, the copy of the registration letter serves as proof of insurance coverage.
Even after the introduction of the eGK, the scope of services still adheres to the provisions of §4 and §6 of the Asylum Seekers’ Benefits Act.
According to §4 of the Asylum Seekers’ Benefits Act (AsylbLG), there is a right to treatment if an illness is either acute or painful. This also applies to chronic illnesses, if the omission of treatment could lead to the illness becoming acute and endanger the individual (e.g., hypertension, diabetes).
There is entitlement to all officially recommended vaccinations and all medically necessary preventive examinations, such as dental care, child examinations, cancer screenings, etc. (§4 Abs. 1 Satz 2 AsylbLG). During pregnancy and childbirth, there is entitlement to all services, including midwifery assistance and preventive examinations.
We especially recommend checking and, if necessary, completing the vaccination status.
Pregnant women have the same entitlements as those insured under statutory health insurance (all preventive examinations, childbirth, midwifery assistance, etc.).
The documents gathered here for printing are intended to assist you in organizing and conducting volunteer consultations effectively when needed. We draw on several years of experience in our work in shelters as well as collaboration with medical practices and clinics.
Organization of the Consultation:
Information; Organization of Consultation – Procedures
Information; Organization of Consultation – Lists
Medical Supplies – On-Site Consultation
Treatment and Findings:
Anamnesis Forms in Multiple Languages
Medical Report Form – Psychological
Medications:
Information; Prescription of Medications
Medication List for Pediatric Consultations
Medication Intake –
ME (English)
ME (Français)
ME (Arabic)
ME (Dari)
ME (Persian)
ME (Serbo-Croatian)
MedGuide Edition Welcome – Medical Phrasebook: 500 Questions and Answers (German-Arabic-Farsi or German-Russian-Turkish)
Take Care Project EU – Phrasebook and Self-Learning Material on Health Topics for Migrants and Doctors
Senate Department for Health and Social Affairs – FAQ: Psychosocial Care for Refugees
Brochure by the German Medical Association – Patients without Legal Residency Status in Hospitals and Practices
Brochure by the Office for Medical Refugee Aid Berlin, ProAsyl, and IPPNW Germany – Possibilities and Limits of Medical Care for Patients without Legal Residency Status
Health for Refugees: Information Portal by Medibüros / Medinetzen – The Model of the Anonymous Health Insurance Card
Effective communication between healthcare professionals and patients is crucial in healthcare. However, language assistance in the healthcare sector is not considered a healthcare service and, unfortunately, is not reimbursed by health insurance. Therefore, the costs can be covered by the relevant authority responsible for the individual. To initiate this, a request for cost coverage must be submitted by the healthcare professionals or the hospital.
If other authorities are responsible for patients, please direct the application there. Costs for language assistance can be requested in advance from the social welfare office or, in the case of receiving benefits from the job center. The following legal regulations may apply:
> 18 Months Residence & Receipt of Benefits according to § 3 AsylbLG
< 18 Months Residence & Receipt of Benefits according to § 3 AsylbLG:
Further information on the topic: www.bundestag.de
Lengthy Processing Times by Authorities
After 6 months, an action for failure to act can be filed. In cases of urgent medical necessity for patients and the resulting need for interpreters, an expedited application can be submitted.
Question of Responsibility for Refugees
It must be clarified in advance who is responsible for the individual (LAF, job center, social/welfare office).
Shortage of Interpreters
Interpreters are mostly internally employed, and there are few freelance, mobile interpreters who are increasingly in demand. Therefore, expect long waiting times and/or the absence of the desired language for interpretation. Many interpreters are not trained for specialized language assistance. The fees for language assistance are sometimes too low, and precarious working conditions for this professional group make the field unattractive for newcomers.
The application for language assistance costs is often very time-consuming. The processing time is often several months, and applications are frequently rejected.
Telephone Interpreting:
Triaphon
A non-profit organization offering 24-hour telephone translation services for hospitals and medical practices. Convenient for brief translations in medical emergencies—call the number and select the language by pressing a key.
Language Mediation Pool Berlin UG
Fee-based interpreters, direct booking on the website possible. Telephone interpreting is also available. Cost coverage can be requested from LAF.
Face-to-Face Interpreting:
Community Interpreting Service
Freelance fee-based interpreters, direct booking on the website.
Integration Guides
Support for daycare/school, language course, and financial and insurance matters.
Language Mediation Pool Berlin UG
Fee-based interpreters, direct booking on the website possible. Telephone interpreting is also available. Cost coverage can be requested from LAF.
Each One Teach One
Languages of the African continent, support in discrimination cases, detailed information on the website.
Pros and Cons of Face-to-Face Interpreting:
Search Engine for Language Mediators:
Federal Association of Interpreters and Translators
Database and search engine for qualified language mediation services.
Video Interpreting:
SAVD
Video or telephone interpreting service with secure video conferencing software, after determining the need and registration.
LingaTel
Video or telephone interpreting service with secure video conferencing software, after online registration.
Global Voices
Video interpreting service with special computers. Online price inquiry possible.
Pros and Cons of Video Interpreting:
Video interpreting is becoming increasingly popular as it combines elements of telephone and face-to-face interpreting. Video interpreting is flexible, allowing for requests from any location. It saves travel costs and is independent of appointment commitments.