This article was translated from the original human-written German version. While we strive for accuracy, we cannot guarantee it is error-free. We recommend consulting the German original for the most precise information. This content is for informational purposes only and does not constitute financial or legal advice. Always consult with a qualified professional before making insurance or financial decisions.

Private and Public Health Insurance for Children: How Premiums Are Calculated and What Options Exist?

Choosing the right health insurance for your offspring is one of the most important financial decisions for parents. Many parents face the decision of how to secure their children's healthcare: in Statutory Health Insurance (GKV) or Private Health Insurance (PKV)? This question is multifaceted, as it affects not only the immediate costs but also the scope of benefits and long-term flexibility. In particular, the calculation of premiums for children in the PKV and the conditions for free family insurance in the GKV often raise questions.

This article examines in detail the basics of premium calculation for children in both systems. We will investigate which factors influence costs, what benefits are offered, and what options arise for different family constellations, to provide you with a well-founded basis for decision-making.

Basics of Health Insurance: GKV and PKV in Comparison

The German healthcare system is based on two pillars: the GKV and the PKV. Both systems fulfill the requirements of mandatory insurance.

Statutory Health Insurance (GKV):

The GKV operates on the principle of solidarity. Premiums are income-dependent.
Financing is based on a pay-as-you-go system, where current income covers current healthcare expenses.
No individual provisions for old age are made.
The scope of benefits is legally defined in the Social Code Book (SGB V).

Private Health Insurance (PKV):

The PKV is based on the principle of equivalence. Premiums are based on the chosen tariff, age at entry, and health status.
In a funded system, provisions for old age are made to stabilize premiums in old age.

Statistical comparisons by industry associations show that the percentage increase in per capita premium income in the GKV has been slightly higher in recent decades than the increase in premium income in the PKV. However, such average values do not reflect the individual situation.

Premium Calculation for Children in Private Health Insurance (PKV)

In the PKV, each family member is insured individually and pays their own premium. The calculation of the premium for children is based on several factors:

Chosen Tariff: The scope of benefits directly influences the premium amount.
Age at Entry: The younger the child is at entry, the lower the premium generally is.
Health Status: For subsequent insurance of children (admission immediately after birth), a health check is not required. If admitted later, it is necessary.

A significant difference from adults is that children typically only start building up provisions for old age from the age of 21. This means that premiums for children are considerably cheaper than for adults.

There are usually reduced tariffs for children, pupils, and students.

Employer Contribution and Tax Deductibility

For employed parents, the employer contribution is an important factor. This can also be used for the children's premiums in the PKV, provided the maximum employer contribution has not yet been exhausted. The premiums for basic coverage are also tax-deductible.

Conditions for Free Family Insurance in the GKV

The free family insurance in the GKV is a significant advantage, as spouses and children can be co-insured without their own premium under certain conditions.

Regulations for Free Family Insurance:

Age: Children can generally be co-insured free of charge until the age of 18, until 23 if not gainfully employed, and until 25 if in school or vocational training.
Income Limit: Family insurance for partners or children is subject to a low personal income limit (for 2025: €505 per month or €556 for mini-jobs).

Restrictions for Mixed-Insured Parents:

Free family insurance for children is excluded if the following three conditions are met simultaneously:

The parents are married or in a registered partnership.
One parent is privately insured, and the other is publicly insured.
The privately insured parent earns more than the publicly insured parent, and their income exceeds the annual income limit (JAEG).

JAEG 2025: €73,800
JAEG 2026 (Forecast): approx. €76,800

In this case, the child must be insured either voluntarily in the GKV or in the PKV for their own premium.

Scope of Benefits, Long-Term Perspective, and Flexibility for Children

Benefits in the PKV for Children: The scope of benefits is individually guaranteed by contract in the chosen tariff. Depending on the tariff, benefits can be insured that go beyond the GKV standard, e.g., for orthodontics, visual aids, or choice benefits in the hospital.

Benefits in the GKV for Children: The scope of benefits is comprehensive and legally defined in the SGB V. It is subject to the efficiency requirement.

Long-Term Perspective and Flexibility for Families

Maternity Protection and Parental Leave (Employees): GKV-insured individuals are exempt from premiums during maternity leave. During parental leave without salary, premium exemption often also applies. PKV-insured individuals must continue to pay their premiums, which represents a significant financial difference, especially during parental leave.
Flexibility in the PKV: Insured individuals have a legal right (§ 204 VVG) to change tariffs. After completing studies or starting a career, children can often convert their contract into adult insurance.
Return to GKV: A return from the PKV is only possible under certain conditions and generally only up to the age of 55.

Summary: Finding the Right PKV or GKV for Your Child

The decision for the appropriate health insurance for children is complex and depends heavily on the individual life situation and family preferences.

GKV: In many cases, offers cost-effective free family insurance and a solid, legally defined scope of benefits.
PKV: Requires a separate premium for children, which is often cheaper than voluntary GKV membership. It allows for an individualizable and contractually guaranteed scope of benefits.

Choosing health insurance for children is a long-term decision that should be carefully considered. It affects not only the financial burden but also access to medical care. It is advisable to consider all individual factors and seek comprehensive advice.

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Private vs. Public Health Insurance for Children: Costs and Options