Last checked against the official sources: 29 August 2026
Family insurance is the most generous feature of the German system: full health cover for a spouse and children at no additional contribution. It is not an open gift. § 10 SGB V sets five tests that must all hold at once, two completely different income ceilings, and a clause that removes children from cover because of the other parent’s income, not their own. Because it lapses by operation of law rather than by decision, people often find out far too late.
The conditions as the statute states them
- Who is covered
- The spouse, the registered life partner and the member’s children — and also the children of family-insured children (grandchildren whose own parent is a minor covered by family insurance).
- Five tests, all at once
- Residence or habitual abode in Germany · not insured under § 5(1) nos. 1–8, 11–12 and not voluntarily insured · not free of insurance and not exempt from it · not self-employed as a main occupation · total income not regularly exceeding one seventh of the reference figure per month.
- The mini-job carve-out
- Family members in marginal employment are allowed a regular monthly total income up to the marginal earnings threshold — which is higher than the one-seventh line. A mini-job therefore does not end the cover.
- Pensions
- Counted at the amount paid minus the part attributable to earnings points for child-raising periods — a rarely quoted clause that keeps many mothers below the line.
- Age limits for children
- 18 · 23 if not in paid work · 25 in school or vocational training or a voluntary social or ecological year · no limit for disabled children unable to support themselves.
The fifth test is the one that usually breaks
The first four tests are descriptive: where you live, whether other cover exists, whether you are exempt, whether you are fully self-employed. The fifth is numerical, and it is where most cases collapse.
The provision requires that the family member has no total income regularly exceeding one seventh of the monthly reference figure under § 18 SGB IV in any month. The reference figure is not fixed: it is set annually in line with wage developments, so the income ceiling moves every year. Never rely on a number published in an earlier year.
Note the words “total income”: not salary alone, but every source — rent, profits, pensions. That is why the trap usually springs from a direction people do not watch.
Then comes the exception that changes the arithmetic: a family member in marginal employment under § 8(1) no. 1 SGB IV is allowed a regular monthly total income up to the marginal earnings threshold itself, which is higher than one seventh. A mini-job is therefore a lawful way to stay inside the cover, while the very same amount from another source could end it.
Severance payments have their own rule: a one-off termination payment is spread arithmetically across the months following payment at the level of the last monthly wage, up to the month in which continued wages would have reached the severance amount. It is not all counted in a single month.
The clause that removes children because of the other parent
This is the harshest part of § 10, and it shocks families with mixed insurance: children lose cover because of their other parent’s income, not their own.
Paragraph 3 requires three things to hold together before a child’s cover falls away:
- the member’s spouse or life partner who is related to the children is not a member of a statutory health fund — privately insured, for instance, and
- their total income regularly exceeds one twelfth of the annual income threshold per month, and
- their income is regularly higher than the member’s.
The conditions are cumulative: if any one fails, the child stays covered. So where the privately insured parent earns above the threshold but less than the statutorily insured parent, the child remains covered free of charge.
If the cover does fall away, the statute provides an exit: § 9(1) no. 2 gives a right to join voluntarily to anyone whose family insurance has lapsed — or never existed for precisely this reason — provided they, or the parent from whom the family cover was derived, meet the qualifying period. The deadline is three months.
Children: four brackets and two special cases
Paragraph 2 sets an age ladder with no exceptions beyond those written into it:
- To 18, unconditionally.
- To 23, if the child is not in paid work.
- To 25, if in school or vocational training, or completing a voluntary social or ecological year.
- No age limit for disabled children unable to support themselves — provided the disability existed at a time when the child was within the earlier brackets, or family insurance was excluded only by a priority insurance.
Two details inside the third bracket are widely missed.
First: if the training is interrupted or delayed by the discharge of a statutory service obligation, the insurance extends by the length of that service beyond the 25th birthday. The same applies to voluntary military service, the federal voluntary service, comparable recognised voluntary services and work as a development aid worker — for a maximum of twelve months.
Second: where the training ends with a degree at a state or state-recognised university, cover continues until the end of the semester — but at the longest until the 25th birthday. The end of the semester does not push past the age limit.
When a spouse’s cover stops abruptly
Two sentences at the end of paragraph 1 create exceptions almost nobody anticipates.
First — maternity and parental leave. Spouses and life partners are not covered for the duration of the protection periods under § 3 of the Maternity Protection Act and for the duration of parental leave, if they were not statutorily insured immediately before those periods. Moving into family cover on the occasion of maternity or parental leave is therefore closed to anyone arriving from private insurance.
Second — the partial pension. A spouse is not covered where three things coincide: they draw an old-age pension as a partial pension, they would exceed the income test if they drew it in full, and they were not statutorily insured before claiming the partial pension. The purpose is plain: to stop a pension being trimmed on paper to slip into free cover.
Who counts as a “child” — and who picks the fund
Paragraph 4 widens the definition: stepchildren and grandchildren count as children where the member predominantly maintains them or has taken them into their household. Foster children are included. Children taken into the care of an adopter with the intention of adoption, and for whom the parents’ necessary consent has been given, count as children of the adopter and no longer as children of the biological parents. Stepchildren also include the children of a member’s registered life partner.
Where the conditions are met more than once at the same time, the member chooses the health fund (paragraph 5) — a genuine right of choice, normally used to keep the whole family in one fund.
Finally, paragraph 6 places an express duty on the member: to report to the fund the data needed to operate the family insurance and every change to it. Breaching that duty is the most common cause of retrospective reclaims.
Practical steps
- Read the five tests as a single unit. Failing one ends the entire cover, and meeting the rest does not compensate.
- Separate the one-seventh line from the mini-job line. If your income comes from marginal employment your ceiling is the marginal earnings threshold — a difference that sometimes decides the case.
- Deduct the child-raising component from a pension before comparing. The statute expressly excludes it from total income.
- In mixed-insurance families, test all three conditions together. A child’s cover falls away only when all three coincide, never on one alone.
- If cover lapses, start counting three months at once. The right to join voluntarily is written into § 9, and nobody will remind you of it.
- Report every change in writing and keep the proof. The duty lies with the member, and a reclaim runs from the date of the change, not the date it was discovered.
Official sources
§ 10 SGB V — family insurance · § 9 SGB V — voluntary membership when family cover lapses · § 18 SGB IV — the reference figure (Bezugsgröße)
Please note: this page is general guidance, not legal or medical advice. Income thresholds and amounts are set by regulations that change every 1 January, and each case is assessed individually — check with your health fund or an insured-persons advice centre before deciding anything.
Frequently asked questions
Does a mini-job end family insurance?
No. The statute allows family members in marginal employment a regular monthly total income up to the marginal earnings threshold, which is higher than the one-seventh line that applies to everyone else.
My husband is privately insured — are our children still covered free with me?
Yes, unless three conditions coincide: he is not a member of a statutory fund, his income regularly exceeds one twelfth of the annual income threshold, and his income is regularly higher than yours. If any one fails, the children stay covered.
My son is at university and turning 25 — when does his cover end?
It runs to the end of the semester in which he completes his degree, but at the longest until his 25th birthday. Voluntary services and statutory service obligations extend the limit by their duration, capped at twelve months.
Can I move into family cover during parental leave?
Not if you were not statutorily insured immediately before the leave or the maternity protection periods began. The statute excludes spouses in exactly that situation.
What if I exceed the ceiling in a single month?
The statute requires the ceiling to be exceeded regularly in a month, not occasionally. The assessment lies with the fund, so report the change in writing rather than waiting for the annual review.