Before you start

Employment contract or proof of income
Meldebescheinigung from your Anmeldung
Steuer-ID
A German bank account for contributions

Step-by-step

1
Understand the two systems before choosing
Statutory charges a percentage of income up to a ceiling, covers dependants at no extra cost, and allows free switching between funds. Private prices on age and health at entry, charges per person, and rises with age.
OnlineWho: YouFirst month
2
Choose statutory if eligible and unsure
Statutory funds differ modestly in rate and extras, and switching between them is easy. Starting statutory keeps the option open; the reverse move generally does not exist.
OnlineWho: You
3
Get your insurance confirmation for the residence permit
Proof of health cover is required for the permit application. Your insurer issues a confirmation once you enrol.
OnlineWho: You
4
Register with a Hausarzt
Your GP is the entry point to specialist care in practice. Cologne's practices are less oversubscribed than Munich's, but register while you are well rather than when you are ill.
In personWho: You
5
Learn the out-of-hours system
For urgent but non-emergency problems, 116117 is the national medical on-call number and can direct you to an out-of-hours practice. Emergency departments are for emergencies.
Mobile appWho: You
6
Know what carnival does to emergency services
Cologne's emergency departments and ambulance service run at extreme load during carnival, with alcohol-related presentations dominating. If you need non-urgent care that week, it will wait; if you need urgent care, expect delays. Plan any elective appointment around it.
In personWho: You

Documents you’ll need

Employment contract or proof of income
Meldebescheinigung
Steuer-ID
Passport and residence permit
Bank details for contributions

Things most newcomers don’t know

Carnival puts real strain on emergency services for about a week.

Cologne's emergency departments and ambulances run at sustained peak load through the carnival days, dominated by alcohol-related cases, and the city stands up temporary treatment facilities to cope. It is a known, planned-for annual event — but if you need care that week, expect delays, and do not schedule anything elective into it.

Source: community-reported

Going private is nearly a one-way door.

Private cover is often cheaper than statutory for a young, healthy, high-earning newcomer, and brokers sell on exactly that comparison. But premiums rise with age, each family member is priced separately rather than covered free, and returning to statutory later is difficult and near-impossible above a certain age.

Source: Bundesministerium für Gesundheit

Statutory cover includes dependants at no extra cost.

A non-working spouse and children are covered under a statutory member's contribution at no additional charge. Under private cover each is a separate premium. For anyone with or planning a family this usually outweighs the headline comparison.

Source: Bundesministerium für Gesundheit

116117 is the number that saves an emergency department visit.

The national medical on-call service handles urgent but non-life-threatening problems out of hours. Germans use it routinely; newcomers default to the emergency department and wait a long time as low priority.

Source: Kassenärztliche Bundesvereinigung

Common mistakes to avoid

Choosing private insurance on the first year's premium without modelling the long run.
Not realising statutory covers dependants free while private does not.
Scheduling an elective appointment into carnival week.
Going to an emergency department for something 116117 would have handled.
Forgetting the insurance confirmation the Ausländeramt requires for your permit.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.