Can family members be covered under the supplementary health insurance plan?

The Family Option is one of the most appealing features of modern supplemental health insurance plans. It allows spouses, domestic partners, and children to be covered under the same policy—often without a medical exam and at group rates.

Three financing models

  • Employer-sponsored: The employer pays the premiums for family members. The most appealing benefit in terms of marketing, but also the most expensive.
  • Hybrid model (most common): The employer pays the employee’s share, and the employee covers the family portion at their own expense. Simple from a tax perspective and effective in terms of communication.
  • Pure out-of-pocket share: Employees pay their family premiums themselves but benefit from a group plan that offers better terms than an individual policy.

Don't miss the opportunity

For the enrollment of family members, there is typically a window of 3, 6, or 12 months following the employee’s start date. No medical examination is required during this window. After this period expires, the standard individual insurance rules apply—including a medical examination, potential risk surcharges, or exclusions.

Special rule for newborns

Newborns can be enrolled in almost all plans within two months of birth without a medical exam—regardless of how long the family has been insured. Coverage often begins retroactively from the date of birth.

Which family members are eligible

  • Spouses and registered partners — almost always
  • Unmarried partners — covered under many plans, provided proof of cohabitation
  • Children up to age 18 (up to age 25 if still in school) — almost always
  • Stepchildren and foster children — depending on the plan, they are usually treated the same if they live in the household

Tax implications

If the employer covers premiums for family members, these are included in the employee’s €50 non-cash benefit exemption limit. A €40 employee contribution plus a €20 partner contribution results in a total non-cash benefit of €60—either as a self-pay model for the family or subject to flat-rate taxation.

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Related terms

Are employees required to undergo a medical examination?
No, most modern group health insurance policies do not require a medical examination at all. Even employees with pre-existing conditions are accepted without an examination. The requirements are that the insurer’s minimum enrollment threshold is met and that the employer covers the costs. In a few cases—such as very small groups, late enrollments, or family members enrolling outside the enrollment window—a simplified medical examination may apply.
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What happens to your supplemental health insurance when you change jobs?
When employees leave the company, they can generally transfer their supplementary health insurance to an individual policy with the same insurer without undergoing a new medical examination. Their coverage remains in effect, and the employee is then responsible for paying the premium. The deadline for this transfer is typically 2 to 6 months after the contract ends.
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What does the bKV cover for dental prosthetics?
Supplementary health insurance typically covers the full cost of dental prosthetics—crowns, bridges, implants, and dentures—either as part of the annual health budget or through a separate dental coverage option. Standard annual budgets range from 300 to 1,200 euros. Some plans have tiered coverage limits during the first few years of the policy or short waiting periods for major dental treatments.
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