Familienversicherung

What is the Familienversicherung?

The Familienversicherung is a feature unique to Germany's statutory health insurance (GKV). It lets spouses, registered civil partners, and children be co-insured for free under a working GKV member's contract, without paying their own contribution. The legal basis is § 10 SGB V.

For a single GKV earner with a non-working spouse and two children, the family pays one contribution and everyone is covered. This single-premium-covers-all model is one of the most tangible differences between the two German systems.

The income limits

Free co-insurance is conditional on the family member not earning above a defined threshold. For 2026:

• €565 per month, general income limit under § 10 Abs. 1 Nr. 5 SGB V (1/7 of the Bezugsgröße, €3,955/month)

• €603 per month, the Minijob limit, which has its own set of rules

A spouse earning just above the €565 line loses the co-insurance status entirely, they must then take out their own contract, either by joining the GKV voluntarily (if eligible) or by moving to the PKV. There is no pro-rata version.

Children are covered up to age 18 in general, age 23 if not working, age 25 if in education or vocational training, and indefinitely if unable to support themselves due to disability.

What it covers

Co-insured family members get the full standard GKV coverage, doctor visits, dental, hospital, prescription drugs. The only common gap: they have no independent claim on Krankengeld (sick pay) since they are not themselves employed.

Why it does not exist in the PKV

The PKV is a risk-based system. Each policyholder is individually underwritten, premium calculated from age, health, and chosen coverage. There is no concept of a household policy. Each family member needs their own contract.

For a family of four with a PKV-insured parent:

• The earning parent holds their own PKV contract (premium based on their profile)

• The non-working spouse needs their own contract: PKV or voluntary GKV, the decision depends on health and age

• Each child needs their own PKV contract, typically €120-200 per month

• There is no volume discount, no household premium, no free add-on

The arithmetic matters. A PKV family with three children can easily pay €450-600 per month for the children alone, a cost that simply does not exist in a GKV household.

When the mixed approach works

A common structure for German-PKV families who want to preserve the Familienversicherung:

• One parent stays in the GKV (voluntarily or through employment under the JAEG)

• The other parent takes the PKV

• The non-working spouse and children are co-insured free under the GKV parent

This is particularly common when one partner earns far above the JAEG and the other earns below it or is not working. The high-earning parent gets PKV benefits; the rest of the family stays in the free Familienversicherung.

Be careful about the income rule in this structure. If the PKV spouse's income becomes too high, their children are excluded from the GKV Familienversicherung even if the GKV parent earns less, but only under § 10 Abs. 3 SGB V. The rule applies only to married couples and registered civil partnerships: for unmarried cohabiting parents, § 10 Abs. 3 SGB V's income test does not apply (BVerfG 1 BvR 429/11, 14 June 2011), so the parents can choose freely, either the GKV parent's free Familienversicherung or the PKV parent's contract. For married or partnered couples, the children lose free co-insurance only if the PKV parent's regular monthly income exceeds 1/12 of the JAEG (€6,450 in 2026) AND that income is higher than the GKV parent's.

The decision for new arrivals

For expats arriving with a family, the Familienversicherung is often the factor that tips the scales back toward the GKV. A single-earner household with a stay-at-home spouse and several young children typically comes out materially cheaper in the GKV, even at higher incomes. A PKV advisor who has not asked about children and spouse income is skipping the most important variable.