Family Co-Insurance in GKV (Familienversicherung)
One of the most valuable features of the German public health insurance system is Familienversicherung — free co-insurance for your spouse and children. In no other major country is family health coverage this straightforward.
Spouse / Registered Partner
- Must live in Germany
- Monthly income below 505 EUR (or 538 EUR for mini-job)
- Must not be self-employed as a primary occupation
- Must not be a civil servant
- Must not be voluntarily insured in GKV
Children (biological, adopted, stepchildren)
- Covered until age 18 automatically
- Until age 23 if not employed
- Until age 25 if in education (school, university, vocational training)
- No age limit for disabled children (if disability began before age 25)
- Higher-earning parent must not be in PKV above the JAEG
When Family Co-Insurance Does Not Apply
There are important situations where free family co-insurance is not available. These catch many expat families by surprise:
Spouse earns above the threshold
If your spouse earns more than 505 EUR/month (538 EUR in a mini-job), they need their own insurance. This is gross income before taxes. Even a part-time job can push a spouse over this threshold.
Spouse is self-employed
If your spouse works as a freelancer or is self-employed as their primary occupation, they cannot be co-insured regardless of income level. They must get their own GKV (voluntary) or PKV policy.
Higher-earning parent is in PKV
If the higher-earning parent is privately insured and earns above the JAEG (77,400 EUR in 2026), the children cannot be co-insured in the other parent's GKV for free. Each child must have their own PKV policy.
Children in PKV
Unlike GKV, private health insurance does not offer free family co-insurance. Each child needs their own policy, which adds up quickly for larger families.
Monthly premium per child
Free co-insurance in PKV
Health checks for newborns
On the positive side, children in PKV benefit from no pre-existing condition exclusions if enrolled within 2 months of birth (Nachversicherungspflicht). The PKV insurer must accept the child without health checks or waiting periods. This is a legal obligation for the insurer.
Mixed Systems: One Parent in GKV, One in PKV
This is one of the most confusing — and most common — situations for expat families. When one parent is in public insurance and the other in private, the rules for insuring children get complicated.
The Key Rule: Follow the Higher Earner
Children can be co-insured for free in the GKV parent's policy. This is the simplest and most cost-effective scenario.
Children cannot be co-insured in GKV for free. Each child needs their own PKV policy (100-200 EUR/month each) or their own voluntary GKV policy (around 200 EUR/month for student-age children).
Children can be co-insured in the GKV parent's policy for free. This situation is less common but possible (e.g., self-employed parent in PKV with lower income).
Maternity and Newborn Coverage
Germany provides comprehensive maternity care regardless of whether you are in GKV or PKV. Here is what expecting expat parents need to know:
Prenatal Care
- Regular check-ups with your gynecologist
- 3 standard ultrasounds in GKV (more in PKV)
- Blood tests and screenings
- Prenatal classes with a midwife (Hebamme)
Birth and Postpartum
- Hospital birth fully covered
- Midwife home visits for 12 weeks postpartum
- Mutterschaftsgeld (maternity pay) during protection period
- Kindergeld: 250 EUR/month per child (universal benefit)
When Family Size Changes Your Insurance Math
For single high-earners, PKV is often the better value. But as your family grows, the math can shift dramatically in favor of GKV.
| Scenario | GKV Cost | PKV Cost |
|---|---|---|
| Single, no children | ~500-950 EUR/mo | ~350-700 EUR/mo |
| Couple, spouse not working | ~500-950 EUR/mo (same!) | ~650-1,200 EUR/mo |
| Couple + 1 child | ~500-950 EUR/mo (same!) | ~800-1,400 EUR/mo |
| Couple + 2 children | ~500-950 EUR/mo (same!) | ~950-1,600 EUR/mo |
| Couple + 3 children | ~500-950 EUR/mo (same!) | ~1,100-1,800 EUR/mo |
Note: GKV costs are based on the member's income only (employee share). PKV estimates assume comprehensive tariffs. Actual costs vary by provider and individual circumstances.
Practical Tips for Expat Families
Register with a Pediatrician (Kinderarzt) Early
Good pediatricians in major cities fill up quickly. Start looking during pregnancy or as soon as you arrive. Ask for recommendations in expat parent groups. Many pediatricians in international areas speak English.
U-Untersuchungen (Child Health Checks)
Germany has a mandatory series of 12 health examinations for children from birth to age 6 (U1 through U9, plus U10, U11, J1). These are fully covered by all health insurers. Keep the yellow Kinderuntersuchungsheft (examination booklet) — schools and kindergartens will ask for it.
Vaccination Schedule (Impfkalender)
Germany follows the STIKO (Standing Committee on Vaccination) recommendations. All recommended vaccinations for children are free and covered by health insurance. Since the Masernschutzgesetz (2020), measles vaccination is mandatory for children entering daycare or school.
Frequently Asked Questions
Yes. In GKV, your spouse and children can be covered at no additional cost as long as the conditions are met: the spouse earns less than 505 euros per month (or 538 euros in a mini-job), and children are under 18 (or under 25 if in education). There are no additional premiums or deductibles for co-insured family members.
If one parent is in GKV and the other in PKV, the children are generally insured in the system of the higher-earning parent. If the PKV-insured parent earns more than the JAEG (77,400 euros in 2026), the children cannot be co-insured in GKV for free and must be insured in PKV individually. This is one of the most important family planning considerations.
Children in PKV typically cost 100 to 200 euros per month each, depending on the tariff and provider. Unlike GKV, there is no free family co-insurance in PKV. For families with multiple children, this cost difference can make GKV significantly more attractive from a pure cost perspective.
Both GKV and PKV cover comprehensive prenatal care including regular check-ups, ultrasounds (3 standard in GKV, often more in PKV), blood tests, and screenings. GKV covers a midwife (Hebamme) for prenatal classes, birth assistance, and postpartum home visits. Mutterschaftsgeld (maternity pay) is provided during the 6 weeks before and 8 weeks after birth.
This depends on income and the specific PKV tariff, but as a general rule: for families with 2 or more children and a non-working or low-earning spouse, GKV is almost always more cost-effective. In GKV, you pay the same contribution regardless of family size. In PKV, each additional child adds 100-200 euros per month. A family with 3 children in PKV could pay 300-600 euros per month just for the children.
Estimate Your Family's Costs
Use our insurance calculator to compare GKV and PKV costs for your specific family situation. See exactly how much you could save — or spend.