The German state health insurance system, GKV, operates under the aegis of German social security, who govern around 110 insurers, some of which are more specialized than others. BKK, for example, covers corporate health insurance.

The system is funded by statutory health insurance funds, which operate on two core principles: the solidarity principle (anyone needing medical treatment will receive it) and the principle of benefits in kind (you will not have to make upfront payments for medical care).

Currently, approximately 90% of the German population is covered under state medical insurance.

You are automatically eligible for state insurance if you fall into the following categories:

• you are an employee and have a gross annual income of below €60,750
• you are a pensioner
• you are a trainee
• you are receiving unemployment benefits

If you are in some self-employed categories, you can apply for state health insurance independent of your income.

If you are working in Germany, your employer will register you with the state system, although you are free to choose your own insurer and register yourself. If you do so, you will need to take your passport and residence permit to the local office. Your insurer will then issue you with a health insurance card (Krankenversichertenkarte).

The state system includes coverage for the following:

• doctors\' visits
• hospital care (inpatient and outpatient)
• x-rays
• medical treatment
• mental healthcare
• sick leave
• rehabilitation
• pregnancy care
• prescriptions (you may have to pay a small supplementary charge, known as a Zuzahlung, for prescriptions)

If you access medical care, you will have to contribute an excess charge of €10 per quarter. If you do not access medical treatment, you will not have to pay this.

If you are an expat who has been living in Germany for some time and you have been paying into the state pension fund for the minimum required period, you will already have been making automatic contributions to the Pensioner\'s Health Insurance (Krankenversicherung der Rentner) at a contribution rate of 14.6%, and will be covered under the national scheme.

If you are from an EU member state, you will be covered by your S1 insurance.

If you are a new resident from a non-EU country, you will need to register with the GKV or take out private cover. You will need to show proof of cover in order to apply for a visa, if you need one, and a residence permit.

You will be covered by the state system if you are an international student, but you will need to pay a premium of around €80 if you are over the age of 25. This will increase at the age of 30.

You can sign up to private health insurance within three months of enrolment at your educational institution, but you will not then be allowed to return to state coverage.

Your family (spouses, civil partners and children up to the age of 23, plus stepchildren, grandchildren and foster children up to the age 23) will be covered, depending on their income. If they earn less than €415-435 per month, they will be co-insured.

Basic dental treatment such as fillings, hygiene and emergency visits will be covered under the state system, which operates on a co-payment system. Dentures and crowns will also be covered.

The contribution rate in Germany for state health insurance decreased in 2015, from 15.5% to 14.6% of net income. If you are employed, up to a maximum monthly income of €5.062,50, your contributions will be split between yourself and your employer: you will each pay 7.3%.

You may also be asked to pay a supplementary rate (0.3 - 1%) by your insurer, which fluctuates relative to healthcare expenditure. They must notify you of any changes to the rate.

Some expats choose to top up their national insurance with a premium known as a private Zusatzversicherung, which can include cover for:

• hospital choice and treatment
• more advanced dental coverage
• no co-payment for prescription charges or quarterly fee
• repatriation costs
• treatment abroad

You may also have to take out private cover if you are an employee earning above a set threshold called the annual earnings limit (JAEG), currently a gross annual income of €60,750. This could render you ineligible for state health insurance.

The JAEG does not apply to most categories of self-employed people. However, self-employed gardeners, farmers, artists and publicists will be subject to the limit.

Private insurance in Germany covers:

• shorter waiting times
• wider access to specialists
• more advanced dental treatment
• elective cosmetic surgery
• fixed-rate premiums
• some alternative therapies

Private health insurance operates on a reimbursement system: patients must pay upfront and then claim their money back.

An average premium for private health insurance will cost €400-700 per month.

You can choose a higher excess fee (Selbstbehalt) which will lower your monthly contributions.

Dental plans start around €10-20 per month.

For those seeking international private medical insurance (iPMI) cover for multiple countries including Germany, numerous variables can have an impact on the cost.

The most important variables are:

• age (the higher the more expensive)
• area of cover (i.e. in addition to Germany, which other areas is coverage required in? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
• product choice (higher end insurance products are more expensive)

Other variables include:

• deductibles
• co-insurance
• payment frequency
• gender
• nationality
• country of residence

As so many variables have an effect on the cost of international private medical insurance in Germany it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

The big international providers operate in the region along with some local providers such as:

• AETNA
• Barmer
• BKK
• Cigna Global
• DAK Gesundheit
• Erikon
• KKH
• Ottonova
• Techniker Krankenkasse
• Versicherungskammer Bayern

gesetzliche Krankenversicherung/GKV) - state health insurance

krankenversicherung der Rentner - Pensioner\'s Health Insurance

krankenversichertenkarte - health insurance card

private Krankenversicherung/PVK - private health insurance

private Zusatzversicherung - top-up premium

selbstbehalt - higher excess fee

zuzahlungen - small supplementary charges for prescriptions