Health insurance options for a freelance or self-employed work permit in Berlin

Tia Hardy Robinson
May 17, 2016 · 4 min read

LAST EDITED: 19.04.2018

If you need or have a freelance or self-employed work permit in Berlin, health insurance can be a frustrating, bureaucratic and very expensive topic.

The Berlin Ausländerbehörde, or foreign residency office, often sends mixed messages about which insurance is acceptable in Germany. People are often told that a German health insurance is required, and that international insurance won’t work — but on the other hand, German insurance companies won’t accept a non-EU freelancer with no work/residency permit!

We’ll explain the differences between international and German options, and suggest some helpful solutions and contacts — but as always, we can’t provide legal advice, so be sure to talk to an insurance broker about the best solution for your own individual situation!

German insurances figure in the extra costs in health care as you age, and charge higher rates accordingly — this is called Alterungsrückstellung, or “ageing reserves.” International insurances don’t have to build in these financial reserves, making them significantly cheaper.

Some international insurances also have a limited lifespan of 5 years, as they are generally geared towards younger, healthier workers who are only in Germany temporarily. This means that if you decide to stay longer, you’ll have to find another solution. One potential problem with this is that if you develop a serious or chronic illness while on a short-term international plan, and then need to change to a German private insurance when the 5 years is up, you’ll struggle to find a provider — or that illness will be considered a pre-existing condition and won’t be covered.

In general, the German insurance system is for employees, whereas freelancers and the self-employed usually get German insurance.

(One notable exception here is for professional working artists, who can join the Künstlersozialkasse (KSK) and through that program then get into the public insurance system — but the application process takes many months so this also won’t work if you need insurance asap to apply for a work permit.)

The problem is, German private insurance companies generally will not accept people who do not have a residency permit of at least 24 months.

In short, it is usually not possible to get German insurance before you have a work permit.

Here are two popular options:

  1. An international health insurance plan for workers in Germany such as Care Concept, aLC, Mawista, etc.
  2. A concrete offer of coverage from a German insurance company provided you are issued at least a 24-month work/residency permit

Option 1: international insurance. If you already know you’ll be here just a year or two before moving on, international insurance coverage is usually the cheapest and easiest option. Be sure to book coverage for workers (not tourists) and that your plan lasts at least 12 months from the date of your Ausländerbehörde appointment. You’ll receive a certificate of coverage and other policy details to take with you to your appointment.

Option 2: an offer for German insurance. You can pre-apply for insurance with a German company — even though they will not start your coverage without the residency permit in hand — and ask for a letter from the company to take to your Ausländerbehörde appointment. The letter should state that you have an official offer of insurance from the company (i.e. they have received your information and pre-approved you, provided you get the work permit) and confirm the conditions of your coverage. In most cases this should be sufficient for issuing the permit, and once you have your permit you can sign a contract with the insurance company to begin coverage. (We recommend using an insurance broker to try this option, as companies may refuse to write such a letter for you if you contact them directly.)

Now more than ever, it’s essential to get official, individual advice from a reliable insurance broker or agent! Meeting with an insurance broker should always be free, and look for someone with experience helping expats, as he/she should be familiar with the latest changes at the Ausländerbehörde. Expath recommends contacting Berlin-based independent insurance broker Keith Tanner, at, who can help with public or private insurance. If you are a professional artist and want to join the KSK, contact Alex Holz at AOK Nordost (a public insurance).

As always at the Ausländerbehörde — don’t panic if something goes wrong during your appointment. Your case worker has the right to ask for any extra paperwork, insurance coverage or financial proof he or she feels necessary to complete your application, and that’s not necessarily a sign that your entire application will be rejected (and even in this case you can appeal the decision).

If you don’t understand the problem, ask your case worker to write down what the problem is (missing document, insufficient financial resources), so you can then ask an expert for help. Ask him/her for extra time to get the missing documentation together, and try to already schedule a follow-up appointment directly with your case worker before you go. Also, nicely ask your case worker’s full name and email so you can send him or her any missing documents via email.

— and remember, keeping your health insurance coverage is a pre-requisite for having your work permit renewed, so be sure not to let your coverage drop!

Silicon Allee

Curated essays from Berlin’s start-up scene.

Tia Hardy Robinson

Written by

Co-founder of Expath — helping expats move to Germany, get a job, flat, work permit, insurance, do taxes, learn German & more!

Silicon Allee

Curated essays from Berlin’s start-up scene.