Important Aspects of VVG §192+§193 and SGB V §257

Health Insurance Law in Germany

The following information is based on the official translation from the Bundesministerium der Justiz (

Section 192
Typical obligations incumbent on the insurer

(1) In the case of cost-of -illness insurance, the insurer shall be obligated to reimburse any expenses for medically necessary treatment due to sickness or in consequence of an accident and for other agreed services to agreed extent, including those expenses associated with pregnancy and childbirth, as well as outpatient medical-check-ups for the early diagnosis of diseases in accordance with statutory programmes.

Section 193
Insured person; obligatory insurance

(1) The health insurance may be taken out for the policyholder or for another person. The insured person shall be that person for whom the insurance is taken out.

(2) Where the knowledge and the conduct of the policyholder are of legal significance under this Act, in the case of insurance for another person, account shall also be taken of the knowledge and conduct of that person.

(3) Each person with a place of residence in Germany shall be obligated to conclude and maintain with an insurance company licensed to operate in Germany for himself and for the persons legally represented by him, insofar as they are not themselves able to conclude contracts, a cost-of-illness insurance which comprises at least a cost refund for outpatient and inpatient treatment and in which the absolute and percentage excesses for outpatient and inpatient treatment which have been agreed for services covered by the respective tariff for each person to be insured are limited to an amount of Euro 5,000 per calender year.....

SGB V §257
Beitragszuschüsse für Beschäftigte/ Premium Contributions for Employees

Please note: This section does NOT apply to freelancers and self-employed. It deals only with employers' contributions to private health insurance of employees.