Health Insurance for Children in Germany: GKV or Private?

Having a baby in Germany or moving here with children brings a long list of practical questions. One of them is harder to answer than expats expect: how exactly is a child insured?

In Germany, children can often be covered free of charge through statutory health insurance (GKV) via Familienversicherung — free family coverage through the statutory system. But this does not apply automatically to every family. The parents' insurance status, income and marital status can all change the answer. So the honest short version is: usually yes, sometimes no, and the reason why is worth understanding before you sign anything.

What are GKV and PKV?

Two German terms come up constantly, so it helps to fix them early:

• GKV (gesetzliche Krankenversicherung) — statutory or public health insurance. Contributions are a percentage of income, and dependants can often be included at no extra cost.
• PKV (private Krankenversicherung) — private health insurance. Each insured person has their own contract, their own benefits and their own premium.
• Familienversicherung — free family coverage through statutory health insurance, available where the legal requirements are met.

A useful mental model: the statutory system insures a household through one member's contribution; private insurance insures individuals, one policy at a time. That single difference explains most of what follows. If you want the wider picture first, see our overview of private health insurance for expats in Germany.

When can a child be covered free of charge through the GKV?

Children of a GKV member can generally be included in family insurance without paying an additional premium, provided the statutory requirements are fulfilled. Those requirements look at the child rather than only the parent, and typically concern:

• residence in Germany;
• the child's own income, which must stay within the statutory limits;
• whether the child is already subject to compulsory insurance in their own right (for example through their own employment);
• age limits, with longer cover possible during education or training, and no age limit where a disability prevents self-support.

Where those conditions are met, adding a child costs nothing extra — which is why family insurance is one of the strongest features of the German statutory system. What complicates the picture is not the child, but the constellation of the two parents.

One parent has private insurance and the other has statutory insurance — what happens to the child?

This is the situation that causes the most confusion, and the most misinformation. You will often read "if one parent is private, the child must be private." That is not what the law says.

Where parents are married or registered partners and one is privately insured while the other is in the GKV, free family insurance for the child can be excluded — but only where both of the following apply to the privately insured parent:

1. their regular total income is above the applicable compulsory insurance threshold (Jahresarbeitsentgeltgrenze, JAEG / Versicherungspflichtgrenze), and
2. their regular total income is higher than the income of the parent covered by statutory health insurance.

If only one condition is met — the private parent earns above the threshold but earns less than the GKV parent, for instance — the exclusion does not apply on that basis. This is why two families with almost identical job titles can end up with completely different answers.

Does it matter whether the parents are married?

Yes. The exclusion rule described above is tied to married couples and registered civil partnerships. For unmarried parents the legal framework is different, and the married-couple logic should not simply be transferred to their situation.

For international couples this matters more than it might seem: a marriage concluded abroad, a registered partnership, or a partnership that carries no legal status in Germany can each lead to a different assessment. If your family falls into one of these cases, have the circumstances checked rather than relying on a general article — including this one.

What does the income threshold have to do with my child's insurance?

The Jahresarbeitsentgeltgrenze (JAEG) is the annual income threshold above which employees are no longer subject to compulsory statutory insurance and may insure themselves privately. It also serves as the reference point in the family-insurance exclusion rule.

For 2026, the general annual compulsory insurance threshold is €77,400 per year, which is €6,450 per month.

We track this figure in detail in our guide to the 2027 income threshold and grandfather protection, and explain how it affects employees on the page for private health insurance for employees.

Five family situations, and what usually happens

These are educational illustrations, not individual insurance advice. They assume both parents live and work in Germany.

1. GKV parent earns €70,000, PKV parent earns €60,000 (married)

The privately insured parent earns less than the parent in the statutory system, so the second condition of the exclusion rule is not met. Free family insurance for the child through the GKV parent is generally possible, provided the child meets the usual requirements.

2. GKV parent earns €60,000, PKV parent earns €100,000 (married)

Here the privately insured parent is above the 2026 threshold of €77,400 andearns more than the GKV parent. Both conditions point towards the exclusion, so free family insurance may not be available and the child would typically need their own private policy. Because the comparison is based on regular total income, bonuses, parental leave or a change of job can shift the picture from one year to the next.

3. Both parents in the GKV

The straightforward case. The child can normally be included in one parent's family insurance at no additional premium, as long as the child's own requirements are met.

4. Both parents privately insured

Private insurance does not provide free family coverage in the way the statutory system does. A child in a fully privately insured family generally needs their own private policy with its own premium. Children's premiums are usually far lower than adult premiums, and insurers commonly offer newborn insurance without a fresh health assessment when a parent's policy has been in place long enough.

5. Unmarried parents, one GKV and one PKV

The exclusion rule for married couples and registered partners should not simply be applied here. Free family insurance through the GKV parent may well be possible, but the exact circumstances — including custody and household situation — decide the outcome.

My baby was just born in Germany — what happens with health insurance?

Cover for a newborn should be arranged promptly, not once the paperwork settles down. Hospitals, paediatric check-ups and the first vaccinations all start immediately.

• Whether the baby can be included in GKV family insurance depends on the same requirements described above, applied to your family's constellation.
• Private cover can be the relevant route depending on the parents' insurance situation — and private insurers typically offer newborn cover without health underwriting only within a short window after birth, so the timing matters.
• Do not assume the child automatically takes on either parent's insurance status. That assumption is the single most common mistake we see.

If you are still expecting, it is worth clarifying the child's route before the birth. It takes one short conversation and removes a deadline you do not want to discover late.

GKV or PKV for my child?

Neither system is automatically better for a child. They are structured differently, and the right answer follows from your family's circumstances.

A deeper side-by-side comparison for adults is on our public vs. private health insurance guide.

What should expat families consider?

International families rarely fit the textbook German case, and that is exactly where the standard advice breaks down. Situations we see regularly:

• Moving to Germany with children. Cover is often needed for the visa application, before anyone has a German employment contract or a registered address.
• Having a baby after the move. The parents' insurance status at the time of birth — not at the time of arrival — determines the child's options.
• One spouse working in Germany, the other not yet. The non-working spouse and the children may be covered differently from what you expect.
• One spouse insured abroad. Cover from another country rarely maps onto German family insurance; see our guide to using foreign health insurance in Germany.
• Family reunification. Joining spouses and children have their own proof-of-cover requirements — see health insurance for family reunification.
• Returning to Germany, or switching systems later. A move between GKV and PKV changes the children's position too, which is why the decision should be made as a family, not per person.