Spouse visa: Which health insurance is needed for a spouse?

For many families, moving to Germany is a long-awaited goal, but it also marks the beginning of a complex bureaucratic process. The legal hurdles often pose a particular challenge for highly qualified professionals , academics, and diplomats who wish to bring their partners to Germany through family reunification. While the protection of marriage and family, enshrined in Article 6 of the Basic Law, forms the constitutional basis, practical implementation during the visa application process frequently falters due to one detail: proof of sufficient health insurance coverage .

Legal basis for family reunification

The legal framework strictly differentiates according to the nationality of the parties involved. While EU citizens and Swiss nationals, according to Section 4 of the Freedom of Movement Act/EU, only need to have sufficient means of subsistence and health insurance coverage , third-country nationals are subject to the stricter regime of the Residence Act (Sections 27 et seq. of the Residence Act). In both cases, however, the following applies: Without insurance, there is generally no residence permit .

Even when applying for a national visa ( Type D ) at the relevant embassy or consulate, proof of insurance coverage from the moment of entry is required. As a law firm, we frequently find that clients underestimate the significance of this requirement. Health insurance, however, is taken very seriously (compared to other types of insurance). The legislator's aim is to ensure that no public funds need to be used for medical treatment.

The dilemma of statutory health insurance (SHI)

For many newcomers, the free family insurance under Section 10 of the German Social Code, Book V (SGB V) is the stated goal. This allows the spouse to be co-insured through the statutory health insurance (GKV) member who is already compulsorily insured in Germany . However, the legal hurdle lies in the details of social law: According to Section 10, Paragraph 1, Sentence 1, No. 1 of the SGB V, entitlement to family insurance requires mandatory residence or habitual abode in Germany.

According to the jurisprudence of the Federal Social Court (BSG), this habitual residence is to be assessed prospectively; however, the immigration authorities often require proof that applies even before the actual establishment of residence. Since the statutory insurance obligation only begins with the actual commencement of employment or – in the case of family insurance – with the physical establishment of residence, a dangerous gap in coverage arises between landing at the airport and formal registration.

The need for private insurance for entry

The German Federal Foreign Office's visa handbook clearly states that the period between entry into the country and the commencement of statutory health insurance must be covered by private health insurance . For employers or human resources departments recruiting international talent, this is a critical point in the onboarding process. We regularly recommend taking out so-called "incoming insurance" in such cases.

These temporary tariffs are permissible for up to five years according to Section 195 Paragraph 3 of the German Insurance Contract Act (VVG) . They serve as a bridge until the skilled worker in question or their spouse meets the requirements for statutory health insurance (GKV) or permanent private comprehensive health insurance (PKV). It is important that the scope of benefits complies with the requirements of Section 193 Paragraph 3 of the VVG . The embassy will only accept the insurance if it "covers all risks that are normally covered in Germany."

Special considerations for self-employed individuals and wealthy private individuals

For individuals not subject to mandatory statutory health insurance – such as wealthy private individuals or certain self-employed professionals – private health insurance is often the only viable option. Here, freedom of contract prevails, meaning that the insurer can require a health examination . If permanent residence in Germany is planned, the insurer must also build up reserves for old age to meet the requirements of a substitute health insurance provider.

When applying for a residence permit , the authorities carefully examine whether the insurance coverage is unlimited or at least offers a clear extension option. Temporary travel insurance policies are increasingly viewed critically for long-term stays, unless they are explicitly intended only to bridge the first few months.

Conclusion and recommendations

Choosing the right health insurance for spousal reunification is not merely an administrative matter, but a legal requirement for legal entry. While statutory health insurance often offers the most cost-effective long-term solution through family coverage, a private temporary solution is almost always necessary for the visa process . Ensure that the chosen plan is explicitly recognized by the immigration authorities and does not contain clauses that would cause coverage to lapse immediately upon establishing permanent residency without a follow-up policy in place.

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You might also be interested in:

• Guide: Securing a livelihood with a residence permit

• Guide: Health insurance coverage for foreigners

• Guide: Spouse Visa