What Happens to Your Health Insurance When You Leave Germany
Planning to relocate abroad? Here is everything you need to know about cancelling, freezing, or transferring your German health insurance.
Cancelling GKV (Public Insurance)
Leaving Germany and cancelling your GKV membership involves several administrative steps. The process is straightforward but must be done in the right order.
Deregister at the Buergeramt (Abmeldung)
You must deregister your German address when leaving the country. This can be done up to 1 week before your departure. You will receive an Abmeldebestaetigung (deregistration certificate).
Notify your Krankenkasse in writing
Send your GKV provider a written cancellation (Kuendigung) along with a copy of your Abmeldebestaetigung. The cancellation takes effect at the end of the month in which you deregister.
Settle any outstanding contributions
Your final contribution is prorated to your departure date. Request a confirmation letter stating your membership has ended and your account is settled.
Request a refund if applicable
If you have overpaid contributions (e.g., for months after your departure), request a refund. GKV providers typically process refunds within 4-6 weeks.
Cancelling PKV (Private Insurance)
Cancelling PKV is more involved than GKV because private insurance contracts have specific notice periods and you may want to preserve your benefits for a potential return.
Notice period: Most PKV contracts require 3 months' notice to the end of the insurance year (which may differ from the calendar year). Check your contract for the exact terms.
Early cancellation: If you can prove you are leaving Germany permanently (via your Abmeldebestaetigung), many insurers will waive the notice period or allow an earlier cancellation date.
Aging provisions: When you cancel PKV, you lose your accumulated aging provisions (Alterungsrueckstellungen) unless you switch to another German PKV provider. This is a significant financial consideration, especially if you have been insured for many years.
What Is Anwartschaft (Dormancy Option)?
An Anwartschaftsversicherung allows PKV holders to freeze their policy while abroad. You pay a small monthly fee to maintain your right to return to the same coverage without a new medical examination.
Kleine Anwartschaft
(Small Dormancy)
Grosse Anwartschaft
(Large Dormancy)
Recommendation
If there is any chance you will return to Germany, the grosse Anwartschaft is strongly recommended. The monthly cost is significantly less than the premium increases you would face from a new medical exam, especially if you develop health conditions while abroad.
Moving Within the EU
Moving to another EU/EEA country offers the most seamless transition thanks to EU Regulation 883/2004, which coordinates social security systems across member states.
EHIC (European Health Insurance Card): Your GKV-issued EHIC provides emergency and medically necessary coverage during temporary stays in any EU/EEA country. It is not a substitute for permanent coverage in your new country.
S1 form (formerly E 106): If you are posted by a German employer, retired with a German pension, or receiving German unemployment benefits, the S1 form entitles you to full healthcare coverage in your new EU country, charged back to the German system.
Local enrollment: If you take a new job in another EU country, you will typically enroll in that country's national health system. Your German insurance ends, but your insurance history is recognized for any waiting period requirements.
Moving Outside the EU
Moving to a non-EU country means no automatic portability of your German health insurance. You will need to arrange coverage through your destination country's system or an international health insurance provider.
Gap coverage: Make sure you have insurance coverage from the day your German policy ends until your new coverage begins. Even a short gap can result in uninsured medical costs.
International health insurance: Global insurers offer plans that cover you in your new country and often worldwide. These are popular among digital nomads, remote workers, and expats who move between countries frequently.
International Health Insurance Options
If you are leaving Germany for a non-EU country, these global insurers are commonly used by expats.
Cigna Global
Comprehensive global coverageAllianz Care
European expats and familiesAetna International
US-connected expatsAXA Global Healthcare
Flexible plan customizationThe Return Scenario
If you return to Germany after living abroad, your insurance situation depends on how you left and what coverage you maintained:
With Anwartschaft: You can reactivate your previous PKV policy at the same conditions. No new medical exam is required (grosse Anwartschaft), and your aging provisions are preserved.
Without Anwartschaft: You must apply for new insurance. If you take a job, your employer will enroll you in GKV automatically (unless you earn above the JAEG and opt out). If you apply for PKV, you will undergo a full medical underwriting process, and any health conditions that developed abroad will be assessed.
GKV re-enrollment: If you previously had GKV and return to employment, re-enrollment is automatic and straightforward. Your previous membership history is recognized, and there is no waiting period.
Retirement Abroad
Retiring abroad while receiving a German pension has specific implications for your health insurance:
Within the EU: Retirees in the KVdR (health insurance for retirees) can use the S1 form to access healthcare in their new EU country. The costs are billed back to Germany. You continue paying German GKV contributions deducted from your pension.
Outside the EU: Your German pension is paid worldwide, but health insurance does not automatically follow. You will need local health insurance or an international plan. PKV holders may be able to continue coverage depending on their tariff terms.
Tax implications: Health insurance contributions may still be deductible from your German taxes even when living abroad, depending on your tax residency status and any double taxation agreements between Germany and your new country.
Frequently Asked Questions
Common questions about health insurance when leaving Germany.
GKV coverage generally ends when you deregister from Germany (Abmeldung) and no longer work for a German employer. PKV can sometimes continue to provide coverage abroad for limited periods, depending on your tariff. However, most expats who leave Germany permanently should cancel their German policy and arrange local or international coverage instead. If you plan to return, an Anwartschaft (dormancy option) is usually more cost-effective than maintaining full coverage.
If you leave without formally cancelling, your insurer may continue to charge premiums. For GKV, coverage technically ends when you deregister at the Buergeramt, but administrative delays can cause billing issues. For PKV, your contract remains legally binding until you formally cancel with the required notice period. You may owe back premiums for the months between your departure and the cancellation taking effect. Always cancel in writing before or immediately after leaving.
An Anwartschaft can be maintained indefinitely, as long as you continue to pay the monthly fee. There is no maximum duration. However, you should review the terms periodically, as insurers may adjust the conditions. When you return to Germany, you can reactivate your full policy without a new medical exam, which is especially valuable if you have developed health conditions while abroad.
If you maintained a grosse Anwartschaft with your PKV insurer, your health status at the time you left is frozen. Any conditions that developed while abroad are covered without exclusions or surcharges when you reactivate your policy. If you had a kleine Anwartschaft or no Anwartschaft, you may face a new medical underwriting process, and pre-existing conditions could lead to exclusions or higher premiums. GKV does not perform medical underwriting, so returning to the public system always covers pre-existing conditions.
German pension payments continue regardless of where you live. However, health insurance is more complicated. If you retire abroad within the EU, the S1 form allows you to access healthcare in your new country charged to the German system. Outside the EU, you typically need local or international health insurance. The KVdR (health insurance for retirees) in GKV may continue if you maintain a German residence, but not if you fully deregister.
Get Personalized Advice for Your Move
Every situation is different. Whether you are leaving temporarily, permanently, or retiring abroad, a licensed broker can help you navigate the insurance implications and protect your coverage.