Health insurance for the self-employed abroad

Checkpoints

Where do you live and work?
Temporary or permanent?
Inside or outside the EU?
What happens to your German contract?

Inside the EU

Which rules apply in the EU

Within the EU, the EEA and Switzerland, only one country’s social security law applies to you at a time. As a rule, that is the country where you pursue your activity [source].

Two exceptions matter for the self-employed [source]:

Temporarily abroad: If you normally work self-employed in one country and pursue a similar activity temporarily in another, you stay in your previous system as long as the expected duration does not exceed 24 months. You apply in advance for the certificate that proves this, the A1.
Working in several countries: If you normally work self-employed in two or more countries, the law of your country of residence applies if you pursue a substantial part of your activity there. Otherwise the law of the country where the centre of interest of your activities lies applies.

The German liaison body for health insurance abroad (DVKA) explains which body confirms this [source].

Outside the EU

What applies outside the EU and agreement countries

Outside the EU, the EEA, Switzerland and the countries with a social security agreement, there is no rule that keeps you in the German system [source]. If you have German statutory insurance, your entitlement to benefits is generally suspended while you are abroad [source]. To live there you usually need your own cover: international health insurance or a solution in your destination.

What your destination requires, for example as proof for a visa, is set out in the country guides.

Always on the move

Digital nomads: travel or life abroad?

Moving from country to country without a fixed home puts you between two worlds. Long-stay travel plans are designed for long trips and can often be taken out without health questions [source]. They are not made for a life centred abroad. According to Germany’s consumer advice centre, whether a stay is still temporary depends on whether you establish a new main residence abroad [source].

So check what the plan is meant for under its terms, its maximum duration, whether it can be extended and what applies during visits to Germany. More: International health insurance for expats

Your German contract

What happens to your insurance in Germany

If you have private insurance, a dormant policy (Anwartschaft) can keep the way back into your contract open. There are two forms, which differ in how they treat your ageing reserve. Whether it makes sense depends on your plan and your intentions.

If you are voluntarily insured in the statutory system, ask your health fund in writing before you leave whether and how your membership continues and what applies on your return.

Clarify first

Your checklist before the move

Place: Which country do you live in, which do you work in, and for how long?
Law: Do you stay in the German system (A1), or move into the destination’s system?
Destination: Which insurance do your visa or registration require?
Plan: Is the cover meant for life abroad or only for travel?
Way back: What happens to your German contract, and how do you return?

Frequently asked questions

Which health insurance rules apply if I work self-employed in another EU country?

As a rule, those of the country where you work. If the activity there is expected to last no more than 24 months and you normally work self-employed in Germany, you can stay in the German system. The A1 certificate proves this.

If you normally work in several countries, the law of your country of residence applies if you pursue a substantial part of your activity there.

Sources: [1], [2]

Does my German statutory health fund pay if I live outside the EU?

Generally not. While you are abroad, the entitlement to benefits is suspended unless the law provides otherwise. Exceptions exist mainly within the EU, the EEA and Switzerland and in agreement countries.

Ask your health fund in writing before you leave what applies in your case.

Sources: [3], [2]

Is long-stay travel insurance enough for a digital nomad?

It depends on whether you are still travelling or already living abroad. Long-stay travel plans are designed for long trips. If you establish a new main residence abroad, you usually need cover designed for living there.

Check the maximum duration, extension, area of cover and visits to Germany in the terms.

Sources: [4], [5]