If you are considering purchasing an expatriate health insurance as a substitute for the government scheme, this could be quite stressful because most of the foreign insurance companies are not registered with the “BaFin” to do business in Germany. Even those that are, find their health insurance plans do not meet the standards set in the new reforms. The crux is that the German government insists that there may be no set upper limits on reimbursement levels and there may be no annual out-of-pocket deductibles higher than 5,000 Euros. Other issues involve how the insurance premiums are calculated. The present situation is that none of the major international expatriate health insurers will provide a German language certificate recognized by all visa authorities in Germany. Whether or not this will change depends on the Germans fully recognizing European directives for cross-border selling of health insurance for non-Germans seeking a residence permit.
Be careful to avoid limited-term policies with no requirement for medical underwriting. These policies very rarely offer a permanent extension and do not cover pre-existing conditions. If you decide to stay longer than the limited contractual term (anywhere from one to five years) and the health insurance contract expires, it could be both difficult and much more expensive to get new health coverage at that point. In addition, even though you may have purchased such a plan from a German health insurance company upon arrival in Germany, it may not be recognized by the visa authorities and you will be forced to purchase a permanent health insurance plan in order to be permitted to stay. Penalty fees may apply.
Additional information for employees
You may choose private health insurance (Private Krankenversicherung or PKV) instead of the government health plan if your gross salary is higher than 59,400 Euros per year (2018 figures). Self-employed persons, German civil servants and those persons working part-time and earning less than 450 Euros per month are also eligible.
If you are presently in the German public scheme and earn more than 59,400 Euros per year, you can change to private health insurance with two months’ notice because you are no longer a mandatory member of the German public scheme (GKV); you are allowed to either stay in the public system as a voluntary member or cancel your membership and arrange private health insurance with a German private health insurance company.
If upon arrival in Germany you wish to be privately insured, you will need to inform your company's human resources department promptly to avoid possible confusion; otherwise, you may find yourself automatically registered in the government system. It is your decision and your employer is not allowed to restrict your freedom of choice among the various Krankenkassen or private health insurance providers.