In Germany's public health insurance, a member's husband, wife or civil partner and their children can be covered at no extra cost through the member: family insurance (Familienversicherung). They have to live in Germany, not be insured in their own right, not work mainly as self-employed, and have no more than €565 a month of income of their own in 2026, or €603 for someone with a minijob. Children are covered up to 18, up to 23 if they aren't working and up to 25 while in education. Children stay free. From 1 January 2028 the member pays a surcharge of 2.5 percentage points for a family-insured spouse, unless one of the exceptions applies.
1. Who can be covered
Family insurance runs through a member of a public health insurance fund (Krankenkasse): an employee, a pensioner, a voluntary member such as a self-employed person, or someone on unemployment benefit. Through that member, these people can be covered (§ 10 SGB V):
- A spouse or registered civil partner (Ehegatte, Lebenspartner). An unmarried partner can't be, however long you have lived together.
- Children, and also stepchildren and grandchildren the member mainly supports or has taken into the household, and foster children (§ 10(4) SGB V).
Each of them has to meet all of these conditions:
- They live in Germany. Their residence or habitual abode is here. A spouse or child living in another EU country isn't covered this way, but EU rules can give them cover where they live, paid for by the member's fund (Article 17, Regulation (EC) No 883/2004). The fund issues the form for it (S1).
- They aren't insured in their own right. Someone who is compulsorily insured, for example as an employee earning more than a minijob, or who is a voluntary member, has their own membership instead. Family insurance comes before students' insurance, though: a student spouse within the income limit is covered free.
- They aren't exempt from public insurance. Civil servants, and anyone who had themselves exempted, can't be family-insured.
- Self-employment isn't their main occupation, however little it earns. A small freelance sideline next to studies or childcare can be fine; a business that takes most of their working time isn't.
- Their own income stays within the limit, below.
There is no age limit for a spouse, and the rule that closes public insurance to many people from 55 doesn't apply to family insurance (§ 6(3a) SGB V covers compulsory insurance only). A privately insured spouse who comes to meet the conditions, for example after stopping work, can therefore move into family insurance at any age.
2. The income limit
The family member's total income (Gesamteinkommen) must not regularly exceed a seventh of the monthly reference figure (Bezugsgröße) of social insurance. In 2026 that is €565 a month (§ 10(1) No. 5 SGB V; reference figure €3,955 in the § 1 of the 2026 ordinance). The figure moves every January with the reference figure; the 2027 one is set by an ordinance the government adopted on 7 October 2026, which still needs the Bundesrat.
- What counts. Income in the sense of income tax law (§ 16 SGB IV): pay from a job, the profit of a sideline, rent, investment income and pensions. A pension counts at the amount paid out, without the part earned for raising children.
- With a minijob, a little more. For someone whose job is a minijob, total income may go up to the minijob limit (Geringfügigkeitsgrenze): €603 a month in 2026 and €633 from 1 January 2027, when the minimum wage rises to €14.60 an hour (§ 8(1a) SGB IV, § 1 MiLoV5).
- Regularly, not in one month. The limit is about income that comes in regularly. The fund asks what the family member expects to receive and for proof, such as payslips, a pension notice or a tax assessment.
- Maternity leave and parental leave. A spouse who wasn't publicly insured just before maternity protection or parental leave (Elternzeit) isn't family-insured during it, even with no income (§ 10(1) SGB V).
The arithmetic, with round numbers: a spouse with a minijob paying €500 a month and no other income is within the €603 limit. Add a freelance sideline with a profit of €200 a month, and their income, €700, is over it, so they need cover of their own. Treat this only as the method: how a fund weighs uneven or one-off income turns on the details.
3. Children: the age limits
A child is family-insured if the conditions above are met and (§ 10(2) SGB V):
- Up to 18, in every case.
- Up to 23 if they aren't working.
- Up to 25 while at school, in vocational training or at university, or in a voluntary social or ecological year. A university degree keeps the cover to the end of the semester, but not past 25.
- Past 25, for the time of a service. Where compulsory service delayed the education, the cover runs on for as long as the service; voluntary military service, federal volunteer service or development work add up to twelve months.
- Without an age limit for a child with a disability who can't support themselves, if the disability began while they were family-insured within the age limits.
A child whose own income goes over the limit, or who starts a job or an apprenticeship with pay above a minijob, gets a membership of their own, as does a student who has passed the age limit. Grandchildren can be covered through a family-insured child.
4. When one parent is privately insured
If the parents are married or civil partners and one of them isn't in public insurance, usually because they are privately insured or a civil servant, the children may not be family-insured through the other parent. That is the case when the parent outside public insurance has a total income regularly above a twelfth of the annual threshold for compulsory insurance, €6,450 a month in 2026, and more than the publicly insured parent (§ 10(3) SGB V; § 2 of the 2026 ordinance).
The children then need a policy of their own: a private one, usually with the privately insured parent's insurer, or a voluntary public membership with contributions. Unmarried parents aren't caught by this rule: their children can be covered through the publicly insured parent, whatever the other one earns. For a baby, the deadlines that apply at birth are in the new baby money checklist.
5. What family insurance covers
- The same care as the member. Doctors, specialists, hospital, dental treatment, prescriptions and preventive check-ups, with the same co-payments. Each family member gets their own health card from the member's fund.
- Long-term care too. The same people are covered in long-term care insurance (Pflegeversicherung) through the member, on the same conditions (§ 25 SGB XI).
- No sick pay. Family members have no right to sick pay (Krankengeld), since they have no pay of their own to replace (§ 44(2) SGB V).
- One fund for the family. Family members are insured with the member's fund. If both parents are members and a child could be covered through either, the parents choose which (§ 10(5) SGB V).
6. The spouse surcharge from 2028
A law of 24 July 2026 adds a new rule to the public system. From 1 January 2028, a member with a family-insured spouse or civil partner pays a surcharge of 2.5 percentage points on their own contribution rate, worked out on the same income as their contributions (GKV-Beitragssatzstabilisierungsgesetz, BGBl. 2026 I Nr. 228, new § 242b SGB V, in force 1 January 2028). Children stay free.
- The member pays it alone. The employer doesn't share it, but deducts it from pay with the contributions.
- Not on pensions at first. Until 30 June 2028 no surcharge is charged on the statutory pension or on company pensions.
- No surcharge while there is a young child. When the member or the spouse has a child under 12 living in the spouse's household, or a child with a disability who can't support themselves. Stepchildren and grandchildren taken into the household, and foster children, count.
- No surcharge while the spouse cares for a relative with at least care grade 2, for at least ten hours a week over at least two days, or is on care leave (Pflegezeit).
- No surcharge once the spouse reaches the standard retirement age, or if the spouse has care grade 3 or more, a full disability pension, a degree of disability of at least 60, or receives basic income support as someone unable to work.
Each exception applies from the start of the month it begins to the end of the month it ends, and the fund applies it without proof when it already knows the facts. With round numbers: a member whose contributions are worked out on €4,000 a month would pay €100 a month for a family-insured spouse with none of the exceptions. Treat this only as the method.
7. Signing up, and when it ends
The member reports the family members to their fund, with the details it needs and any changes later (§ 10(6) SGB V). The funds' national association sets one standard form for it, and funds ask for proof such as a marriage or birth certificate, a student's certificate of enrolment, and proof of income. Cover starts when the conditions are met, for example on the day of the wedding or the birth, so report it soon after.
- Coming from private insurance. When family insurance begins, a private policy can be cancelled back to that date within three months (§ 205(2) VVG). The insurer can ask for proof of the family insurance.
- Changes to report. A new job, income above the limit, a child finishing school or university, a move abroad, a divorce. Funds also ask every so often whether the conditions still hold.
- When it ends, cover continues. The day after family insurance ends, it carries on as a voluntary membership, with contributions, unless within two weeks of the fund's notice the person leaves and shows other cover, such as a job with its own insurance (§ 188(4) SGB V). Nobody drops out of cover in between.
8. Family insurance or private cover
For a family, the two systems work differently, and each has its strengths.
- Public insurance covers a spouse with little income and the children through one member's contributions, which follow the member's income, not the number of people. Nobody is asked about their health. From 2028, the spouse surcharge applies when none of the exceptions does.
- Private insurance has no family insurance: each person has a premium, set by their age and health when they join and the cover chosen. Cover is set by contract and can go beyond the public catalogue, and an employee's employer pays half towards the family's premiums too, up to the same cap as for public cover (§ 257 SGB V).
How the two compare over the years, with a spouse and children, is in what private health insurance costs over a lifetime; the basics of both systems are in German health insurance explained.
9. When an insurance expert can help
Family insurance itself needs no adviser: the member's fund decides and the form is short. Where an insurance expert helps is the choice around it: whether a family is better off public or private, what cover the children need when one parent is privately insured, or what the move means when a spouse starts or stops working. They can compare what insurers would offer each of you. Have each person's age, your incomes and how they are made up, your current insurance, and the ages of the children ready. You can ask for an insurance expert who works in English.
Primary sources checked on 31 October 2026: the statutes, the Bundesgesetzblatt and the EU regulation linked above.