Healthcare for asylum seekers in Germany: what the law covers

Last checked against the official sources: 29 August 2026

Healthcare for asylum seekers in Germany is not one system but two quite different phases. The first applies a restricted catalogue built around acute illness and states of pain. After thirty-six months the legal basis changes entirely and you move to the SGB XII catalogue with an electronic health card. And crucially, two groups escape the restriction from day one — the statute names them expressly.

The limit of phase one: the word “acute”

§ 4(1) ties the entitlement to the “treatment of acute illnesses and states of pain”. That wording is the source of most disputes: a stable chronic condition, long-term rehabilitation and anything that can be postponed all fall outside the text unless they turn acute or painful.

But note what is inside the text and widely assumed not to be: the second sentence expressly provides that vaccinations are given in line with §§ 47 and 52(1) sentence 1 SGB XII, and that medically indicated preventive examinations are performed. Refusing them because they do not treat an acute illness has no basis in the statute.

Dentures are the only item carrying an express restriction: they are provided only where, in the individual case, they cannot be postponed for medical reasons.

Pregnancy sits outside the argument altogether: paragraph 2 gives expectant and new mothers full care without any acuteness test, and names midwife assistance explicitly.

Delivery is the authority’s job: paragraph 3 requires it to ensure that the benefits are provided, and also to ensure that beneficiaries are offered at an early stage the completion of their vaccination protection — a positive duty on the administration, not mere availability.

The two exceptions that lift the restriction from day one

First: minors. § 4(4) opens with a decisive phrase — “by way of derogation from paragraphs 1 to 3” — and then refers to §§ 47 to 52 SGB XII. A child beneficiary is therefore not subject to the “acute” restriction at all. Two further points matter just as much: co-payments and own contributions are borne by the benefits authority, and treatment begun on that basis continues without interruption or delay once the person reaches majority — no course of treatment is cut off by a birthday.

Second: people with special needs holding a § 24 permit. § 6(2) provides that persons holding a residence permit under § 24(1) of the Residence Act who have special needs — and the text gives two examples: unaccompanied minors, and persons who have suffered torture, rape or other severe forms of psychological, physical or sexual violence — shall be granted the necessary medical or other assistance. The wording is mandatory, not discretionary.

Alongside them, § 6(1) remains a general gateway: “other benefits” may be granted in particular where, in the individual case, they are indispensable to secure subsistence or health, are required to meet the special needs of children, or are necessary to fulfil an administrative duty to cooperate. They are given in kind, and in money where special circumstances exist.

Month thirty-six: the real switch

§ 2 is the turning point. Anyone who has been in Germany for 36 months without substantial interruption and has not themselves influenced the duration of that stay abusively comes — by way of derogation from §§ 3, 4 and 6 to 7 — under SGB XII and Part 2 of SGB IX by analogy.

Both conditions operate together, and the second is where disputes arise in practice: the authority may argue that delay in the procedure was caused by the beneficiary’s own conduct, so the switch does not happen. That is why it is worth keeping proof of cooperation — documents handed in, appointments attended, requests answered — from the first day.

The health consequence is the important one: once SGB XII applies, the “acute” restriction ends and treatment becomes, in substance, what statutorily insured people receive.

The health card: when it is a right and when it is an agreement

This is where the greatest confusion sits, and § 264 SGB V separates it cleanly into two routes.

The mandatory route. Paragraph 2 provides that treatment of recipients of ongoing benefits under § 2 or § 4(4) AsylbLG who are not insured is taken over by the health fund. Paragraph 3 then requires them to choose a fund without delay in the area of the responsible authority — and where several beneficiaries live in one household, the head of household exercises the choice for themselves and for the family members who would be family-insured. Paragraph 4 gives them an electronic health card and applies the same co-payment rules and out-of-pocket ceiling that apply to insured persons.

The agreement route. For recipients of § 4 and § 6 benefits — phase one — paragraph 1 says a fund is obliged to take over treatment if required to do so by the Land government or the supreme authority it has instructed, and if an agreement is concluded at least at the level of districts or district-free cities. The text adds that the issue of an electronic health card “may be agreed” — it is not an individual right.

That explains what looks like a contradiction: two people in the same legal position, one holding a card, the other queuing at the office for a paper voucher per visit. The difference is not in their files but in their Land and district.

Practical steps

1. Establish your phase first. § 4 or § 2? The answer changes the entire catalogue, not a detail within it.
2. Do not accept a refusal of vaccination or preventive screening. Both are named inside § 4, and the authority must offer to complete vaccination protection early.
3. If the patient is a minor, cite paragraph 4 verbatim. “By way of derogation from paragraphs 1 to 3” means the acute restriction does not apply, and co-payments are borne by the authority.
4. In cases of severe violence, or an unaccompanied minor on a § 24 permit, rely on § 6(2). The statute names these situations expressly.
5. Keep proof of your cooperation from day one. The “no abusive influence on the duration of stay” condition is what gets invoked to delay the 36-month switch.
6. On reaching § 2, choose a fund immediately. The text says “without delay”, and on this route the electronic card is a right, not a favour.

Frequently asked questions

Is a chronic condition treated?

§ 4 limits the entitlement to acute illnesses and states of pain, so a stable chronic condition falls outside it unless it turns acute. § 6(1) nevertheless opens a route to other benefits where they are indispensable for health in the individual case.

Are vaccinations included?

Yes, expressly in § 4(1), together with medically indicated preventive examinations. Paragraph 3 even obliges the authority to offer completion of vaccination protection at an early stage.

My child is a minor — do the same limits apply?

No. Paragraph 4 expressly derogates from paragraphs 1 to 3 and refers to §§ 47 to 52 SGB XII, requires the authority to bear co-payments, and keeps treatment already begun running without interruption after the child turns 18.

Why do some beneficiaries have a health card and others not?

Because for § 2 recipients and minors a fund must take over treatment and issue an electronic card, whereas in the § 4 and § 6 phase it depends on the Land government requiring it and an agreement at district level — and issuing the card “may be agreed” only.

When do the 36 months start?

They count from residence in Germany without substantial interruption, and require that the beneficiary has not abusively influenced the length of that stay. Both limbs apply together, and the second is the usual point of dispute.