German Health Insurance When Moving Abroad 2026: Anwartschaftsversicherung, EHIC and S1 Form
Quick answer: When you move abroad permanently, German statutory or private health insurance ends. Anwartschaftsversicherung (entitlement insurance) keeps re-entry rights for both GKV and PKV. Within the EU/EEA, the S1 form lets German pensioners and posted workers access local healthcare paid by Germany. EHIC only covers temporary stays. Outside the EU/EEA, private international health insurance is required.
Key takeaways
- German cover ends on emigration.
- Anwartschaft bridges GKV/PKV re-entry.
- S1 form for EU/EEA workers and pensioners.
- EHIC for transition or short trips only.
- Private cover required outside EU/EEA.
Anwartschaftsversicherung in detail: GKV vs PKV
Anwartschaftsversicherung (entitlement insurance) is the legal mechanism that preserves your re-entry rights to the German statutory (GKV) or private (PKV) health insurance system after emigration. Without it, returning to Germany years later means starting from scratch — and PKV may refuse you entirely if you developed pre-existing conditions during your time abroad.
GKV Anwartschaft: monthly premium typically €60-120, covers right to re-entry into the same Krankenkasse on return. Mandatory for those who plan to return within 5-10 years and want to keep statutory cover. Apply directly with your Krankenkasse before departure — the application form is available online from AOK, Techniker, Barmer, DAK, etc.
PKV Anwartschaft: divided into kleine (small) and große (full) Anwartschaft. Kleine Anwartschaft preserves only the right to re-enter at the same insurer with a fresh medical underwriting (Gesundheitsprüfung) — useful if you are young and healthy. Große Anwartschaft preserves the full original contract terms, premiums and tariff structure — more expensive (typically 30-50% of original premium) but protects against premium hikes due to age or new health conditions developed abroad.
| Type | Monthly cost (typical) | What it preserves |
|---|---|---|
| GKV Anwartschaft | €60-120 | Re-entry to same Krankenkasse |
| PKV kleine Anwartschaft | €20-50 | Re-entry option, fresh underwriting |
| PKV große Anwartschaft | 30-50% of original PKV premium | Full original contract with no underwriting |
The S1 form: how Germany pays for your healthcare in another EU country
The S1 form (formerly E121) is the EU regulation 883/2004 instrument that lets you receive healthcare in your destination EU/EEA country at Germany’s expense. The S1 is issued by your German Krankenkasse (GKV) or by your private insurer’s accredited international department (PKV).
Eligible groups:
- German pensioners residing in another EU/EEA country whose pension is paid by Germany (Deutsche Rentenversicherung).
- Posted workers (entsandte Arbeitnehmer) whose German employer continues paying social security contributions.
- Cross-border workers (Grenzgänger) living in one EU country but working in Germany.
- Family members of any of the above (spouses, dependent children).
The S1 process: apply at least 4-8 weeks before departure with proof of foreign residence intent and the destination country’s health authority contact. The S1 form is then sent to the destination’s national health authority (e.g. Sécurité Sociale in France, INPS in Italy, Ministério da Saúde in Portugal). Once accepted, you register with a local doctor and receive the same care as locals.
EHIC vs GHIC: temporary cover during transition
The European Health Insurance Card (EHIC), issued free with your German GKV card on the back, covers medically necessary care during temporary visits to other EU/EEA countries plus Switzerland. EHIC is NOT a substitute for emigration cover — it covers you only as long as you remain a German resident. Once you deregister and lose German tax residency, the EHIC is invalid.
UK after Brexit: the UK now issues GHIC (Global Health Insurance Card) which provides similar reciprocal cover with EU countries. German EHIC holders visiting the UK still receive necessary care under the post-Brexit reciprocal agreement.
Outside the EU: private international health insurance is essential
For destinations outside the EU/EEA — USA, Canada, Australia, UAE, Singapore, etc. — private international health insurance is the only practical option. Plans typically cost €1,500-€8,000 per year depending on age, coverage and destination.
Recommended providers serving German emigrants: Allianz Worldwide Care, Cigna Global, Bupa International, AXA Global Healthcare. Look for plans that cover:
- Pre-existing conditions (often excluded by default)
- Maternity (12-month waiting period typical)
- Mental health and psychotherapy
- Evacuation to a regional hospital or back to Germany if needed
- Direct billing with hospitals (avoids out-of-pocket and reimbursement)
Special cases that need extra attention
PKV with self-employed contracts
Self-employed Germans on PKV often have particularly favourable Tarife with low contributions. Switching to a PKV große Anwartschaft preserves these terms. PKV insurers typically allow 5-7 years on Anwartschaft before requesting renewal — confirm in writing.
Family members with pre-existing conditions
If a family member has a chronic condition (diabetes, asthma, cancer history), avoid the kleine Anwartschaft at all costs. Fresh underwriting could lead to refusal or premium loadings of 50-200%. Großée Anwartschaft is essential.
Pension recipients moving outside EU
German Rentner moving outside the EU lose access to the S1 transfer. The Rentnerversicherung (KVdR — pensioners’ GKV) still applies if your German pension covers the bulk of your income, but care must be obtained privately at the destination and reimbursed via Krankenkasse. Alternatively, consider an Auslandskrankenversicherung für Rentner, often offered by German Krankenkassen for around €100-300 per month.
Returning to Germany after years abroad
On return, GKV must accept you back if you were Pflichtversichert (mandatory) before emigration and have proof of continuous foreign cover. PKV may refuse if you skipped Anwartschaft. The legal requirement under §5 SGB V is to register with a Krankenkasse within 7 days of return — fines apply for gaps in cover.
Cost-benefit framework: should you keep Anwartschaft?
| Situation | Recommendation |
|---|---|
| Emigrating permanently, never returning | No Anwartschaft needed; relevant only on return |
| Moving to EU country with S1 eligibility | S1 + small Anwartschaft as fallback |
| Moving outside EU for 1-3 years (academic, work) | Yes — Anwartschaft + private international cover |
| Pre-existing conditions, age >50 | Große Anwartschaft is essential |
| Pension recipient outside EU | Auslandskrankenversicherung für Rentner, plus KVdR retained |
The 30-day pre-departure healthcare checklist
4 weeks ahead: Contact Krankenkasse / PKV about Anwartschaft. Apply for S1 if EU/EEA destination. Request Versicherungsverlauf (full insurance history).
2 weeks ahead: Arrange final routine medical check-ups, dental cleaning, eye exam — costs may differ in the destination. Order 3-6 months supply of prescription medications (within legal limits).
1 week ahead: Cancel old insurance from the move date. Obtain S1 confirmation letter from Krankenkasse if applicable. Confirm international cover effective from move date.
Move day: GKV/PKV cover ends. Transition cover (EHIC for short visits, S1 for long-term, private international) takes over.
30 days post-move: Register S1 with destination country’s national health authority. Find local doctor. Confirm no gap in cover.
FAQ
How do I apply for Anwartschaft?
Directly with your statutory or private insurer before departure.
Who gets the S1?
German pensioners and certain employees — issued by your German Krankenkasse.
Is EHIC enough?
No — EHIC only covers urgent treatment during transition or short trips.
Moving to the USA?
Private international health insurance is required.
Will my PKV take me back?
Anwartschaft preserves re-entry rights to your existing PKV terms.
Can I keep my GKV in EU country if I work for a German employer remotely?
Possibly under Posted Worker rules (entsandter Arbeitnehmer). German employer continues paying GKV contributions and you receive an A1 certificate confirming German social security applies. EU regulation 883/2004 governs this. Check with your employer’s HR and Krankenkasse.
What happens to PKV pension reserves (Alterungsrückstellungen) if I emigrate?
They remain with your insurer regardless of emigration. On return with a große Anwartschaft, you keep the full reserve and original tariff. Without Anwartschaft, the reserve effectively becomes partially or fully forfeit — only kleine Anwartschaft preserves the legal re-entry right.
Is the S1 transferable between EU countries?
No — each S1 is country-specific. If you move from Germany to Spain to France, you need a new S1 issuance for each country change. The Krankenkasse can issue replacement S1s but processing takes 4-8 weeks each time.
Do I need to declare my foreign health insurance to the Finanzamt?
No, foreign private insurance is not declarable in German taxes. However, if you are still a partial-year German resident with foreign income, treaty provisions may allow deduction of equivalent foreign health insurance (Vorsorgepauschale). Consult a Steuerberater for cross-border filings.
Set up Anwartschaft and S1 early — gaps in coverage can be costly and trigger Beitragsschulden.
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See also: All Germany moving guides.