In the Federal Republic of Germany around a 90 % of the population is covered under statutory health insurance.
In principle, all employees are compulsorily insured under statutory health insurance if their gross pay exceeds € 400 per month and does not exceed a defined upper limit (2011: € 44,550 per year respectively € 3,712.50 per month). Insured persons are free to choose the health insurance fund they wish to be insured with.
Compulsorily insured are in particular:
- employees, including those undertaking vocational training for value,
- recipients of unemployment benefit or unemployment assistance,
- farmers and certain people connected with the agricultural enterprise,
- artists and those in the publishing professions, in accordance with the Artists Social Welfare Act,
- disabled persons employed at sheltered workshops and at institutions, homes or similar establishments,
- university students,
- trainees, apprentices without remuneration and apprentices in second-chance education,
- old-age pensioners/pension applicants who have been insured for a specified length of time.
Beyond this coverage since April 2007 all persons who are not protected in case of disease and who have been insured under statutory health insurance before the loss of protection are compulsorily insured. In case of disease also persons without protection who have not been insured in Germany at all (under statutory or private health insurance) will be compulsorily insured if they are - systematically - assigned to the statutory health insurance.
In addition, many people carry voluntary health insurance (for example, the self-employed) or are insured as family members. The option to obtain voluntary insurance is in principle open only to those who were previously compulsorily insured or insured as a family member. Provided certain conditions are met, spouses or partners of the insured, as well as children, are covered as family members, with no need to pay contributions.
In general, employers and employees each pay half of the contribution rate. The employees have to pay a 0.9 % additional income linked contribution. Health insurance funds can demand additional contributions from the insured employees/pensioners.