Pflichtversicherte

Pflichtversicherte are individuals who are legally required to be insured under Germany’s social security system. The term refers to people who fall under compulsory insurance, meaning their health, long-term care, pension, unemployment, or accident coverage is governed by law and contributed to through payroll or mandatory contributions. Members of the statutory schemes typically cannot freely opt out to private insurance, except under specific conditions.

In the context of health and long-term care insurance, Pflichtversicherte are usually employees, apprentices, and students who are not privately insured. They are automatically enrolled in the Gesetzliche Krankenversicherung (GKV) and, for those insured in the GKV, receive statutory long-term care coverage as well. There are circumstances in which higher earners may switch to private health insurance, in which case they are no longer Pflichtversicherte in the GKV.

Beyond health insurance, Pflichtversicherung also applies to other social security branches. For example, employees generally become Pflichtversicherte in the Gesetzliche Rentenversicherung (pension insurance) and in unemployment and accident insurance through their employer. Self-employed individuals and some other groups may be voluntarily insured (Freiwillig versichert) in the statutory schemes or opt for private alternatives, depending on eligibility and income.

The distinction between Pflichtversicherte and freiwillig Versicherte hinges on whether insurance is mandatory by law or chosen voluntarily within the available statutory or private options. The term emphasizes the mandatory nature of coverage in standard employment or student situations, ensuring access to core social security benefits.