International health insurance in Germany: what expats need to know

For some groups, an IPMI policy is a legally valid option. The immigration office (Ausländerbehörde) looks at whether the cover is comparable to what a German insurer would provide, including in-patient and out-patient care.

Posted workers who remain enrolled in their home country's social security system can usually keep their international plan. Within the EU, an A1 certificate confirms this status: these workers are not subject to German social security law, so GKV does not apply to them.

Diplomats and staff of international organisations such as the UN or EU institutions typically have their own insurance arrangements that German authorities recognise. Non-residents and frequent travellers whose primary home remains outside Germany may also find that German mandatory insurance does not apply, because they are only in Germany part of the year.

Some self-employed people and freelancers who are not compulsorily insured in GKV can use IPMI, but whether it is accepted depends on the specific cover and the individual immigration office's assessment.

One important note: decisions vary between individual immigration offices. A policy that one Ausländerbehörde accepts may not satisfy another. We always recommend getting a written confirmation rather than assuming. IPMI is also a different product from short-term visitor cover. If you are arriving in Germany for a few weeks before taking up residence or starting a job, incoming health insurance is the right tool for that gap period, not a long-term IPMI plan.

For the majority of expats working in Germany, IPMI is not a substitute for German statutory insurance. Employees whose gross annual salary falls below the income threshold (Jahresarbeitsentgeltgrenze) of €77,400 in 2026 are compulsorily insured in GKV. This threshold rises to €84,150 from 2027, pending Bundesrat approval. If you earn below that figure, your employer enrolls you in GKV automatically, and no international plan replaces this obligation.

GKV costs 14.6% of your gross salary as the general contribution rate, plus an average additional rate of 2.9%, split between you and your employer. Contributions are calculated on income up to the contribution ceiling of €69,750 in 2026 (rising to €76,500 from 2027). One practical benefit: your spouse and children without their own income can join your GKV cover at no extra cost.

Employees who earn above the threshold can choose to leave GKV and take out private health insurance in Germany (PKV) instead. Your employer then pays up to €508.59 per month toward your PKV premium and up to €104.63 per month toward long-term care in 2026, but only if your policy meets German legal requirements. Most standard IPMI plans do not meet those requirements, so the subsidy is usually lost.

Long-term care insurance is mandatory for everyone living in Germany. Many IPMI plans simply do not cover it, which creates a compliance gap that can cause problems with your residence permit.

Worldwide cover means your policy pays for treatment in most countries, not just Germany. Many plans offer two variants: one that includes the USA and one that excludes it, because US healthcare costs push premiums up significantly. If you travel frequently for work or plan to move on after Germany, worldwide cover is worth the extra cost.

The practical downsides are worth knowing. Many IPMI plans require you to pay the bill first and claim reimbursement later. Deductibles (the amount you pay before the insurer steps in) vary widely. Premiums increase with age and can rise sharply if you develop a health condition.

Well-known international providers that offer IPMI plans include: Cigna Global, Allianz Care, Bupa Global, April International, and Henner. These are examples only, not a ranking.

Pre-existing conditions are handled differently by each insurer. Common approaches include permanent exclusions, a waiting period before the condition is covered, or a risk surcharge on the premium. If you have a health history that concerns you, it is worth reading the exact terms carefully. The same issue arises with German PKV, and we cover it in detail on our page about private health insurance with pre-existing conditions.