To apply for private health insurance in Germany, you need proof of identity, proof of your address and employment status, an income record if you are an employee, and a completed health questionnaire. Once you are insured, a second set of paperwork matters: the invoices you pay and then submit for reimbursement. This guide covers both, plus when a hospital bills your insurer directly.
TL;DR
- To apply: passport and residence permit or visa, German address, employment contract or proof of status, income proof for employees, details of any previous insurance, and the health questionnaire.
- The health questionnaire is the part that slows things down. Answer it completely and accurately, because insurers assess your risk before the contract starts.
- For claims: most outpatient bills are paid by you first, then submitted with the original invoice and the insurer's form for reimbursement.
- Direct billing mainly applies to hospital stays and some very expensive medication, not to routine doctor visits.
Table of Contents
- The documents you need to apply
- Why insurers sometimes ask for more
- Step by step: from documents to a signed policy
- Documents for students and families
- Claims: the paperwork you keep after you are insured
- Direct billing: when it applies
- A checklist to keep in one folder
- Our perspective
- Get the paperwork right with Myhealthcarebroker
- FAQ
- Sources
The documents you need to apply
Insurers do not publish one universal list, and requirements differ by insurer and by your situation. The core set is similar almost everywhere, though. Gather these before you start an application and you avoid most follow-up requests.
Identity and residence
- A valid passport or ID card.
- Your residence permit or visa, or the visa documents if you are still arriving.
- Your German address. Many insurers and employers ask for the registration certificate (Meldebescheinigung) once you have registered. If you have not registered yet, tell your adviser early, since some insurers can start the process on the basis of your confirmed address and move-in date.
Proof of your status in Germany
What you submit here depends on who you are:
| Your situation | What you usually show |
|---|---|
| Employee | Employment contract or job offer with salary and start date |
| Freelancer or self-employed | Business registration or tax registration, plus a description of your activity |
| Student | Enrollment confirmation or admission letter |
| Family member | Marriage or birth certificate, and the main policyholder's details |
| Newcomer without a job yet | Visa documents, and where relevant a letter from your host institution |
The exact wording varies. If a document is in another language, ask whether the insurer accepts it as is or wants a translation.
Income proof for employees
Employees can generally choose private cover only when their salary is above the compulsory insurance threshold, so insurers or advisers check your income against it. A signed employment contract showing your gross annual salary is the document most often used. Your adviser can tell you which figure applies to you in the current year. Our guide on who actually qualifies for private cover walks through the threshold logic, including for EU citizens.
Freelancers and civil servants are not tested against that threshold in the same way, so an income document is usually not the deciding piece for them.
Previous insurance
You may be asked for:
- Your insurance history in Germany or abroad, including the name of the previous insurer and the end date of that cover.
- A confirmation of previous public health insurance, if you were insured in Germany before.
- A statement that you were not insured, if that applies, for example when you arrive from abroad.
These details matter because a gap in cover or a change of system affects which tariff and which start date are possible.
The health questionnaire
This is the most important document, and the one people underestimate. Private insurance in Germany is priced on the equivalence principle: your premium reflects the scope of benefits and your individual illness risk, which the insurer assesses before the contract starts. The questionnaire is how that assessment happens.
Expect questions about:
- Current and past illnesses and treatments.
- Hospital stays and operations over the past several years.
- Regular medication.
- Psychotherapy and chronic conditions.
- Dental status, if you are applying for dental cover.
The period the questions cover differs between insurers, so read each question for its time frame. Do not guess. If you cannot remember a diagnosis or date, request your records first. If your records come from a doctor abroad, you have a legal route to obtain them, which we explain in our article on using GDPR Article 15 to get foreign medical reports.
Why insurers sometimes ask for more
After you submit, the insurer may request medical reports, discharge letters, or a doctor's statement on a specific diagnosis. This is normal and depends on what you disclosed and on the insurer's own underwriting rules.
The outcome of that review can take several forms. A private insurer may decline an application because of pre-existing conditions or age, or offer a contract only with conditions, such as a risk surcharge on the premium or an exclusion of certain benefits. That is the reason accurate answers matter more than fast ones: an incomplete questionnaire can cause delays, and incorrect answers can cause problems later when you claim.
If you have a pre-existing condition and are unsure how an insurer will react, you do not have to submit a named application to find out. An anonymous pre-check for pre-existing conditions lets an adviser sound out insurers without your name attached. Our overview of the health assessment itself explains what applicants face step by step.
Step by step: from documents to a signed policy
- Check eligibility. Confirm that your status allows private cover. Employees need to be above the threshold. Freelancers, civil servants and some others have other rules. Students have their own route.
- Collect the basics. Passport, residence permit, address, contract or proof of status, previous insurance details.
- Prepare your health history. Write down diagnoses, treatments, medication and hospital stays with approximate dates. Request records where needed.
- Compare tariffs. Different insurers weigh the same facts differently, which is why an independent comparison pays off. You can start with our private health insurance calculator.
- Submit the application and questionnaire. Digital applications are common and do not need printing.
- Answer follow-up requests. Reply promptly to requests for reports.
- Receive the offer and policy documents. Read the policy conditions before signing, and keep the confirmation of insurance, which you may need for your employer, your visa office or your residence permit.
If you do not speak German, the process is still manageable. We describe how in securing private cover without German skills, and the full application sequence is in applying for private health insurance in Germany.
Documents for students and families
Students are a special case. Some students in Germany are insured through public health insurance and others use private cover, depending on age, status and exemption rules. A common requirement is proof of your insurance that you hand to the university. If you are exempt from the public system, the university usually needs the exemption notice and your insurance certificate. Ask your university's admissions office what it accepts, because forms and wording differ.
Families need the civil-status documents listed above. A key point to know: children and partners are not automatically covered in private insurance the way they can be in public insurance. In private cover, each person is insured individually, so each needs their own application and, in most cases, their own health questionnaire. Plan extra time if you apply for a whole family.
Claims: the paperwork you keep after you are insured
Getting the policy is the first half. The second half is the paperwork you handle every time you see a doctor.
You usually pay first
For most outpatient treatment, you pay the doctor's invoice yourself and then submit it to your insurer for reimbursement under your contract. This is the cost-reimbursement principle. It exists because, as Verbraucherzentrale explains, you hold the treatment contract with your doctor, so you owe the payment regardless of what your separate claim against the insurer turns out to be.
That has a practical consequence: keep enough liquidity to pay bills before reimbursement arrives, particularly after a larger treatment.
What to submit
Insurers have claim forms, and many accept uploads through an app or portal as well as post. What you attach depends on the treatment. Common items are:
- The original invoice from the doctor, dentist, laboratory or pharmacy.
- The insurer's claim form, where the insurer requires one.
- Prescriptions for medication and aids.
- Referrals or reports where the tariff requires them.
Some cases need specific detail. One insurer's claim page, for instance, asks that optician invoices show lenses and frames separately and include the diopter number, and that accident or nursing cases come with additional forms. If you also receive benefits from another cost carrier, insurers often want proof of what that carrier already paid, for example from public health insurance.
Keep copies of everything. A phone photo of each invoice with its date is enough as a backup. Keep the insurer's decision letters too, since you will need them if a payment is cut.
If the insurer pays less than expected
If a claim is rejected or reduced, tell your doctor or the billing office promptly and share the insurer's letter. According to Verbraucherzentrale, you can then ask for a written, professional justification of the disputed charges. Do not ignore the doctor's bill in the meantime, because the payment duty sits with you.
Direct billing: when it applies
Many newcomers expect to show a card and walk out without paying. That is how public insurance feels, and private insurance works differently. Direct billing, where the insurer settles with the provider, mainly applies to hospital inpatient treatment and occasionally to very expensive medication.
In practice:
| Situation | Who usually pays first |
|---|---|
| Visit to a general practitioner or specialist | You, then you claim reimbursement |
| Dentist | You, then you claim reimbursement |
| Pharmacy (typical prescriptions) | You, then you claim reimbursement |
| Inpatient hospital stay | Often settled between hospital and insurer |
| Very expensive medication | Sometimes settled directly with the insurer |
For planned hospital stays, ask your insurer about a cost-coverage confirmation before admission, and bring your insurance certificate to the hospital. Private insurers have also agreed a standardized form for follow-up rehabilitation requests to speed up cost approval, so ask your hospital's social service whether this applies to you.
A checklist to keep in one folder
- Passport and residence permit
- Registration certificate with your German address
- Employment contract, business registration or enrollment confirmation
- Insurance history and previous insurer details
- Notes on your health history and any medical reports
- Policy documents and insurance certificate
- Claim forms and the insurer's app login
- Copies of all paid invoices and decision letters
Our perspective
Most application delays we see are not about eligibility. They come from a health questionnaire filled in from memory, or from a document in the wrong form that has to be sent again.
Our advice is to do the preparation once and do it well. Write your health history down before you open any application. Decide what you want from the tariff before you compare prices. And treat the first claim as a rehearsal: submit it fast, keep copies, and learn how your insurer's portal works.
Because we are independent and compare across all major providers, we can ask the same questions of several insurers and see who handles your profile best, in plain English or Spanish, and with a paperless process. That is the real value of an adviser here, more than a lower number on a screen.
Marco
Get the paperwork right with Myhealthcarebroker
Myhealthcarebroker is an independent consultancy for people living and working in Germany. We check your eligibility, compare private and public options across providers, and guide you through the application and the documents it needs, with ongoing support afterwards. Our service is free to you.
Start with a free quote for private health insurance, or read our guide to health insurance for newcomers in Germany. If you want help with appointments and the day-to-day admin, see our healthcare concierge service.
FAQ
Do I need German documents to apply?
Not necessarily. Passports, residence permits and foreign contracts are routinely used, and insurers differ on whether they want translations. An adviser can tell you in advance what a given insurer accepts and complete the German forms with you in English.
Does my doctor bill my insurer directly?
Usually not for outpatient care. You pay the invoice and submit it for reimbursement. Direct settlement mainly applies to hospital stays and some very expensive medication.
What happens if I leave out something on the health questionnaire?
Incomplete or inaccurate answers can lead to delays now and to disputes when you claim later. If you are unsure about a diagnosis or date, request your medical records first and answer from them.
Can I use the same documents for a public health insurance application?
Many are the same, such as passport, residence permit, address and proof of employment. Public insurance does not use a risk-based health questionnaire. Our page on public health insurance in Germany explains what it requires.
How long should I keep invoices?
Keep them at least until the insurer has paid and you have checked the statement, and longer for anything you may need to dispute or document. Your insurer's conditions and your tax adviser can tell you the exact periods that apply to you.
Sources
- Bundesgesundheitsministerium: Private Krankenversicherung
- PKV Verband: Versorgung
- PKV Verband: Leistungen in der stationären Versorgung
- Verbraucherzentrale: Was, wenn der private Krankenversicherer Arztrechnungen nicht zahlt
- VKB: Leistungsantrag zur privaten Krankenversicherung
- Württembergische: Leistungsfall melden