Insuring a team in Germany: the GKV and PKV threshold.

In short: Germany has no company medical plan for an employer to buy. Every employee holds their own policy — statutory (GKV) or private (PKV) — and the employer registers staff, runs contributions through payroll and pays roughly half. Above €77,400 gross in 2026 an employee may choose PKV instead of GKV. German employers also carry six weeks of full salary continuation for each sickness episode themselves.

Ask a mobility manager what their German health plan looks like and you often get a puzzled pause — because in Germany, the company does not have one. No group medical scheme, no benefits-broker shortlist, no plan document. Germany runs on individual compulsory insurance: every employee carries their own policy, statutory or private, and the employer’s role is to register people correctly, run contributions through payroll, and pay roughly half. Which sounds like an administrative footnote until you meet the three places it bites an international employer: a salary threshold that quietly splits your workforce in two, a personal decision with decades of consequences that lands in onboarding week, and a sick-pay liability the company carries on its own balance sheet. We review these setups independently; here is what the German file keeps producing.

No plan to buy — a system to administer

The mechanics first. Every employee in Germany must hold health insurance. Below the annual income threshold, statutory insurance (GKV) is compulsory for employees — income-based contributions, family members co-insured free, no health questions. The employer registers each hire, deducts the employee share, adds the employer share — about half the total — and remits. Above the threshold — €77,400 gross in 2026, reviewed annually — the employee may instead choose private insurance (PKV): individually underwritten, risk-priced at entry, often cheaper and richer for a young healthy professional, and structurally permanent in a way nobody explains at onboarding.

Then the uniquely German employer liability: Lohnfortzahlung — six weeks of full salary continuation for every sickness episode, paid by the company, before any insurer is involved. Most German employers insure the tail beyond six weeks through group Krankentagegeld arrangements; the six weeks themselves are yours. For a company modelling German employment costs against other countries, this self-carried risk is the line that surprises.

The threshold: where your workforce quietly splits

Every international hire above €77,400 triggers a choice in their first weeks that HR usually handles with a shrug and a payroll form: GKV or PKV. Handled that way, it is the most consequential un-advised decision in German working life. The PKV pitch to a 35-year-old arriving above the threshold is genuinely attractive — lower premium, private care, English-speaking service. What the pitch omits: the door back mostly closes. Returning to GKV generally requires becoming GKV-obligated again — an employee salary under the threshold — and past 55 the return is effectively barred. PKV premiums are per-person (a family multiplies them, where GKV co-insures free), and they climb with age on a curve the entry quote does not show. We work through the one-way nature of it in GKV or PKV: Germany gives you one chance to decide.

For international staff the calculus has a second layer the domestic advice misses entirely: an expat who expects to leave Germany in five years is choosing an exit position, not a retirement system. What do PKV years build that travels? (Little.) What does their next country’s system ask of a returning resident? (It varies enormously — we document those re-entry rules country by country.) A company cannot and should not make this choice for employees — but a company that hires internationally above the threshold and provides no independent briefing at onboarding is letting a payroll deadline make it instead. The single highest-value thing we do for German employers is exactly that briefing: neutral, in English, before the form is signed.

Posted workers, commuters, and the bKV question

Three further seams in the international file. Posted workers on A1 certificates stay in their home social system entirely — correctly administered, they never enter German insurance at all; incorrectly administered, they end up double-enrolled or uninsured, and unwinding either costs months. Cross-border commuters — Germany’s borders produce many — interact with two systems at once, and where their family is insured is a genuine design question, not an accident to discover. And bKV — betriebliche Krankenversicherung, employer-funded group supplementary cover — is the one place Germany does have a company plan: group-underwritten dental, hospital and daily-benefit top-ups that have become a real retention tool. Because bKV is group-based, it takes employees regardless of health history — which makes it disproportionately valuable for exactly the staff who could no longer buy supplementary cover individually. It is also cheap relative to its perceived value, which is the definition of a good benefit.

Cost context for the mobility budget, from our fifty-country index: Germany sits 34th of 50 at about $7,307 a year for comparable international cover — below Switzerland, France and Spain, and mid-pack globally. For most Germany-based staff the domestic system is the right home and international cover is unnecessary; the international layer earns its keep for the genuinely mobile — the employee you will move again within a few years, for whom entering and exiting national systems twice is the real cost.

How the review works

Send the shape through our companies page: headcount, how many sit above the threshold, any posted workers or commuters, what bKV or sickness-allowance arrangements exist, and renewal or hire dates. Within about a working day you get a written scope: where your onboarding currently lets a payroll form make a life decision, whether your posting paperwork does what you think, whether a bKV scheme would earn its cost at your size, and — Germany being a well-built system — quite often the finding that your setup is sound and the only gap was the briefing. We are advisers, not a carrier; anything eventually placed runs through SIP’s licences on a courtage basis we publish, and the review costs nothing either way. If you are hiring internationally into Germany this quarter, the briefing belongs in the onboarding pack before the first payroll run — that timing, not renewal, is Germany’s real deadline.