Health insurance for a German employment visa

The employment visa most American and British professionals use is the national D visa for skilled workers holding a university degree, issued under Section 18b of the Residence Act. It is not the EU Blue Card and it is not the Opportunity Card. It is the ordinary route for someone who has been offered a German job.

Health insurance sits on the document checklist as a line item in its own right. The German Missions in the USA information sheet for skilled workers holding a university degree, dated May 2026, lists "Proof of adequate health insurance coverage" among the documents you submit, alongside the completed application, passport, employer's declaration of employment, and proof that your degree is recognised through the anabin database or a ZAB Statement of Comparability.

The German Embassy in London puts the same requirement in a single sentence on its general employment page: "Under German law, all residents must have sufficient health insurance cover." Its checklist calls for "Confirmation of health insurance cover".

Underneath both of those is one piece of statute. Section 2(3) of the Residence Act defines secure subsistence, and the official English translation reads: "Foreigners have a secure subsistence if they are able to earn a living, including sufficient health insurance coverage, without recourse to public funds." The same provision adds that a foreigner enrolled in a statutory health insurance fund is deemed to have sufficient cover. Section 5(1) makes secure subsistence a general prerequisite for issuing a residence title. That is the legal hook behind every German route page you will read, not just this one.

Two other things the London page states are worth knowing before you book an appointment. The decision on labour-market access is "taken on a discretionary basis by the Federal Employment Agency (Bundesagentur für Arbeit)", and most applications are typically processed within four weeks. After you arrive you register your address with the Meldebehörde within two weeks and apply for the electronic residence permit at your local Ausländerbehörde.

This is the part that catches people out, and the official checklist says it plainly rather than leaving it to be discovered.

The German Missions in the USA sheet states: "Health insurance coverage is required at the time of entry into the Schengen area. Usually statutory health insurance coverage provided by the university or future employer only goes into effect when you take up residency and enter into employment / begin with your studies."

Read that twice. The requirement attaches at the moment you cross the Schengen border. The German statutory cover your employer will enrol you in does not exist yet on that date. Those two facts do not line up on their own, so the same sheet tells you what fills the space between them: "If you enter before, an additional private (travel) health insurance in line with EU standards (covering the entire Schengen area, minimum coverage of 30,000 EUR) must be purchased for the duration of time until you begin your employment / your studies and are covered through the statutory health insurance."

There is a warning attached to it, and it is the single most useful sentence on the whole sheet: "Please ensure that your travel health insurance does not exclude protection if a long term or permanent stay is planned." A great many holiday policies do exactly that. They are written for a two-week trip and quietly stop applying once the trip is a relocation. If a policy carries that exclusion it does not do the job the checklist is asking of it, however cheap it looks.

So the practical shape of an employment visa file is two answers, not one. What covers you from the day you land until your German payroll starts, and what covers you afterwards. The consulate wants to see the first. Your employer arranges the second.

Once the job actually starts, German law does the enrolling. Section 5(1) no. 1 of SGB V makes "Arbeiter, Angestellte und zu ihrer Berufsausbildung Beschäftigte, die gegen Arbeitsentgelt beschäftigt sind" compulsorily insured. Employed people working for pay are in the statutory scheme by operation of law, not by choice, and the statute is the authority for that.

Two numbers set the edges of the rule, and both are published by the Federal Ministry of Health on its page for people insured in the statutory scheme, marked as at 17 February 2026.

• The floor. The obligation applies to employees whose pay from the job is more than 603 euros a month, stated as the 2026 figure. Below that you are in marginal employment and the rule works differently.
• The ceiling. The annual earnings threshold, the Jahresarbeitsentgeltgrenze, is 77,400 euros for 2026. Earn above it and you are no longer compulsorily insured, which is the doorway to private cover or to voluntary statutory membership.

Both figures are reset annually, so check the same BMG page for the year your move falls in rather than trusting a number you read somewhere in the spring.

What this means in practice is that your German employer will ask you to name a Krankenkasse, will register you, and will deduct contributions from your first payslip. You do not apply in the way an American is used to applying. You choose a fund and hand over the details. The delay is administrative rather than legal, but a card in your wallet can still take several weeks to arrive.

This is not a health insurance rule, but it lands on the same checklist and it bites exactly the age band that relocates with a family, so it belongs here.

If you are 45 or older when you first apply on this route, the mission may require evidence that you have already made adequate provision for old age, unless your salary clears a stated threshold. The two official sources publish that threshold differently, and rather than pick one we will show you both.

• The German Missions in the USA sheet, dated May 2026, asks for "Proof of adequate provision for old age, only if salary does not amount to at least 55 % of the annual contribution assessment ceiling for the general pension insurance scheme", and states the figure as 55,770.00 EUR gross per annum, labelled for 2025.
• The German Embassy London page states: "Should you be 45 years of age or older and on an annual salary of less than €50.700 (2026 threshold, subject to change) we may need to sight evidence that you already made adequate retirement provisions."

Take the rule from this, not the number: over 45, a salary below the published threshold means an extra piece of evidence, and the threshold moves. Read the figure off the page of the mission that serves you, dated, in the month you apply. If you are close to the line, that one number decides whether your file needs a pension statement or not.

Neither page defines what counts as adequate provision in a way you can measure yourself. If you are in that band, ask the mission directly what evidence it accepts before you assemble the file (verify with the German mission serving your home state or region).

The German statutory system has a feature that surprises most families arriving from the United States: dependants are covered for free rather than at a per-head price.

Section 10 of SGB V sets out Familienversicherung. Spouses, registered partners and children of a member are co-insured without a separate contribution, provided they have their residence or habitual residence in Germany, are not insured elsewhere in their own right, are not self-employed, and their income stays under the limit in the statute. The Federal Ministry of Health states the income limit as 565 euros a month for 2026 and reports 15.6 million people covered this way.

Children are covered to 18, to 23 if not in employment, and to 25 while in school or vocational training, with no age limit where a disability that began inside those periods prevents self-support. Those are the statutory brackets in Section 10.

Two conditions matter for a new arrival. Co-insurance runs off your membership, so it cannot start before your membership does. And it requires the family to be resident in Germany. A spouse and children who land three weeks ahead of your start date are neither members nor co-insured yet, which is the same gap described further up this page, applied to four people instead of one.

If your family arrives on different dates from you, work out each person's cover separately. Households often get the main applicant right and leave a child uncovered for a fortnight by accident.

Everything above points at the same window. German law wants you insured from entry. German statutory insurance starts when the job does. The consulate expects you to have solved that yourself, and it says so on the checklist.

Private medical cover bought for a visa application, or for a first period in Germany, is what is designed to carry that window: the flight, the first weeks in temporary accommodation, the Anmeldung appointment, the wait for your Krankenkasse registration to go through and your card to arrive. It is a bridge to the German system rather than a replacement for it, and once your statutory membership is running the bridge has done its job.

Three things are worth reading in the policy wording before you submit the file, because they are what a visa officer or a hospital will actually test.

• The long-stay exclusion. The mission's sheet explicitly tells you to check that protection is not excluded when a long term or permanent stay is planned. Find that clause and read it.
• The geographic scope. The sheet asks for cover across the entire Schengen area, not Germany alone.
• The confirmation document. You are submitting a piece of paper, so it needs to state the insured person, the dates, the territory and the level of cover in a form an official can read at a counter.

Then set a diary reminder for the day your employment starts. That is the handover point, and letting the two run on together by inertia is the most common way people pay twice.