What is a chronic illness, and how will it impact my health insurance application?
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What is a chronic illness, and how will it impact my health insurance application?

In this article, we talk about chronic illness, what it is and how it impacts people when they apply for different insurances. 

For many who are either thinking of moving to Germany or who are already here, they have to ask themselves: how will a chronic illness affect my insurance application? Since insurance is about sharing risk among a group of people, it means that insurers are incentivized not to include people with chronic illnesses since they would be taking more money from the collective contributions of a group than putting in. 

This is often seen in cases of job lock or the inability to leave a position because someone would risk losing certain employee benefits. These benefits often either help treat a chronic illness or allow them to continue working in a position in a market that might not hire someone with a chronic illness.

How the Robert Koch Institute (RKI) defines chronic illness

The Robert Koch Institute (RKI) is a federal institute in Germany within the Federal Ministry of Health. The RKI is part of the Federal Government in the field of disease surveillance and prevention, which is why you’ve probably heard about them at some point during the pandemic if you were in Germany. The core tasks of the RKI are the detection, prevention, and control of diseases (especially infectious diseases). Because of their standing and authority, they are also the ones that give the closest definition of chronic illness used by the German government.

So, what do they think chronic illness is? Well, they openly state that there is no formal definition, but any sickness that is not curable and has a lasting negative impact on health can be considered a chronic illness. They list diabetes, heart disease, and lung disease as examples. They also say that the impact on the healthcare system is high since three-fourths of all deaths are caused by chronic illness in Germany and are the cause of around a fourth of all funds used by the healthcare system. 

See their press release for more information.

So, am I covered if I have a chronic illness?

Yes! The German healthcare system is really good at covering newcomers with public health insurance if you have a full-time position at a German company. If you were thinking about checking out private or expat health insurance, we can pretty confidently recommend to anyone with a chronic illness to not go that route. Not only will your illness not be covered by expat health insurance, but it’s pretty likely that you won’t be covered under private health insurance.

What about prescriptions? Can I get a special card that makes it so I don’t have to pay?

Such a specific question! Yes, there is a special card that you can apply for if you have a chronic illness like diabetes. You just need to go to your general practitioner (Hausarzt) who will verify that you are diabetic – this will probably just be a simple conversation if you already know them. 

After that, you’ll need to speak with your public health insurance provider to get something called a Befreiungsausweis (Exemption of payment for medications). This card needs to be renewed every year, but with a regular general practitioner, it shouldn’t be a problem submitting it each time.

That’s amazing, do I have to pay more when I have a chronic illness?

That’s not actually true because everyone is required to contribute to Zuzah­lungen (additional payments). For people without chronic illnesses, the limit of their contributions is 2% of their combined family income (that includes income for their children like Kindergeld, or government payments for children). 

For people with chronic illnesses, however, the contribution limit for additional payments is set at 1% of their combined family income. This is still the case if both parents are working full time, and they have a child that has a chronic illness.

If I have a chronic illness, do I have to contribute to additional payments?

Additional payments, or Zuzahlungen, which we literally translated into English, are additional payments that need to be made in addition to your insurance policy.

They include the following as examples:

  • Medicines and dressings
  • Travel expenses
  • Household assistance
  • Remedies (for example physiotherapy or massages)
  • Aids
  • Home nursing
  • Vaccinations
  • Sociotherapy
  • Inpatient treatment in hospital
  • Inpatient preventive or remedial treatment

Please note: Each additional payment must contain the following information to be refunded: 

  • First and last name of the person
  • Type of service, for example, copayment for physiotherapy
  • Co-payment amount
  • Date of payment
  • Name of the provider, for example, stamp of the physiotherapist or pharmacy

Because additional payments are different depending on the public health insurance provider, please see the following government websites for more specific rules and regulations:


You can submit documents to your public health insurance provider to no longer contribute any additional payments. This is a hard thing to prove though since it’s only considered for people who are schwer­wie­gend chro­nisch krank, or severely chronically ill. 

The definition that TK gives of severely chronically ill is that the illness needs to have existed for at least a year and requires quarterly treatment from a doctor for an assumed ongoing period of time. 

The second condition that must be fulfilled in order to be listed as severely chronically ill is that the person needs to be continuously in treatment to make sure their illness does not become life-threatening, life expectancy is not reduced or quality of life is not permanently impaired.

If this is not the case, the person can also be listed with Care Level 3 (Pflegegrad 3) or be 60% disabled as determined by a specialist.

How do I prove that I or a relative is severely chronically ill?

To prove that you fulfill the requirements for a diagnosis as severely chronically ill, you need to go to your regular doctor and request form 55 to submit to your public health insurance provider. This will be processed to calculate your new level of contributions for additional payments. 

The exception to this includes anyone who has been listed with Care Level 3 (Pflegegrad 3) for more than a year. If you are changing insurance providers or have changed in the past year, you’ll need to get confirmation of this from your previous insurance provider. 

Have more questions about chronic illness?

Let us know if you want to hop on a free consultation with one of our experts.

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Did you know that more than 85% of Germans have personal liability insurance? Most people who move to Germany hear about it pretty quickly because some landlords even require it when renting apartments!