Germany\'s Trickiest Family Insurance Rule
Couples where one partner is privately and one statutorily insured meet a rule few countries could invent: whether the children may use free GKV family insurance depends on a statutory income comparison between the parents. Get the constellation right and children cost nothing; get it wrong by a euro of salary and each child needs a paid policy.
The rule (§ 10 SGB V): children are excluded from free family insurance via the GKV parent if the PKV parent (married to or in a registered partnership with the GKV parent) earns more than the GKV parent and above the annual threshold (€77,400 in 2026, one twelfth monthly).
The Constellations
| Situation | Children\'s position |
|---|---|
| PKV parent earns more, above threshold | No free family insurance — children join PKV (own premium) or GKV as paying voluntary members |
| PKV parent earns more, but below threshold (e.g. self-employed) | Free family insurance via GKV parent possible |
| GKV parent earns more | Free family insurance possible |
| Parents unmarried | The exclusion rule does not apply — free family insurance via the GKV parent generally works regardless of the PKV parent\'s income |
The unmarried row surprises everyone: the exclusion only binds married and registered-partner couples. Unmarried parents with a high-earning PKV partner can still family-insure children via the GKV parent — one of German insurance law\'s odder incentives.
If the Children Must Be Insured Separately
- PKV for the child: roughly €150–€250/month for good cover, no underwriting via Kindernachversicherung when arranged within two months of birth on a parent\'s established policy
- Voluntary GKV for the child: possible, at a contribution — compare against PKV child tariffs, which often win on benefits at similar cost
- Employer subsidy: the employed PKV parent\'s employer contribution also applies to children\'s premiums within the overall cap
- Beihilfe families: civil-servant children receive 80% Beihilfe, making the PKV share small
Life Events That Flip the Switch
The comparison is not carved in stone: parental leave, part-time phases, salary changes and self-employment can move either income across the lines, changing the children\'s entitlement — in both directions. Marriages themselves trigger the rule where cohabitation did not. Re-run the comparison at every family or career event, and inform the sickness fund of changes honestly: wrongly enjoyed family insurance is unwound retroactively.
The Bottom Line
For mixed couples, the children\'s insurance is arithmetic: who earns more, and does the PKV parent clear the threshold? Married couples with a high-earning private partner should budget for children\'s own policies (softened by employer subsidy or Beihilfe); everyone else should verify their free-family-insurance entitlement and re-check it whenever incomes shift.
Frequently Asked Questions
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