One Parent Has Private Insurance, One Has Statutory: Which One Covers the Kids?
When married parents split between private insurance (PKV) and statutory insurance (GKV), a specific rule called the Höherverdienenden-Regel under Section 10 SGB V decides whether a child can still get free coverage through the statutory parent. Free GKV family coverage is excluded only if both conditions hit at once: the privately insured parent earns more than the statutory parent, and that PKV parent's income regularly exceeds one-twelfth of the annual earnings threshold, 6,450 euros a month for 2026. Meet either condition and the child stays freely covered under GKV regardless of the other parent's insurance type. Fail both and the child needs their own PKV contract or a paid voluntary GKV membership instead, though an employer subsidy of up to 508.59 euros a month toward the family's combined private health premiums can offset a PKV route if the higher-earning parent is a regular employee rather than self-employed or a civil servant.
The Official Rule
For married couples in Munich splitting between private insurance (PKV) and statutory insurance (GKV), a specific legal test decides whether their child can still ride along on the statutory parent’s free family coverage, and it’s more forgiving than the shorthand version of this rule that tends to circulate.
Section 10 of Germany’s Social Code Book V (SGB V) sets what’s commonly called the Höherverdienenden-Regel, the higher-earner rule. A child is excluded from free GKV family coverage only when two specific conditions are both true at the same time, not just one.
| Situation | Free GKV coverage for the child? |
|---|---|
| PKV parent earns less than the GKV parent | Yes, still qualifies |
| PKV parent earns more, but under 6,450 euros a month (2026) | Yes, still qualifies |
| PKV parent earns more AND over 6,450 euros a month (2026) | No, excluded from free coverage |
Both conditions have to land together for the exclusion to actually apply. The privately insured parent needs to regularly earn more than the statutory-insured parent, and that same parent’s income needs to regularly exceed one-twelfth of the annual earnings threshold (Jahresarbeitsentgeltgrenze), which works out to 6,450 euros a month for 2026 based on the 77,400 euro annual figure. A privately insured parent who out-earns their spouse but stays under that monthly number doesn’t trigger the exclusion. Neither does a privately insured parent who’s above that income level but actually earns less than their statutory-insured spouse. Only the combination closes the door on free coverage.
This specific mechanism is written around spouses and registered life partners. For unmarried couples, the income-comparison test as described here doesn’t apply the same way, and which parent’s insurance covers a shared child tends to depend more on custody and residence arrangements instead. If you’re not married, this is worth confirming directly with your Krankenkasse rather than assuming the married-couple rule applies or doesn’t.
If both conditions are met and the child is excluded, there are two real paths, not a dead end. The child can get their own PKV contract, a separate policy with its own premium, generally lower than an adult’s premium but still a genuine ongoing cost. Or the child can become a voluntary member of the statutory system, which is different from free family co-insurance, this comes with its own contribution, cited around 210 to 230 euros a month.
A standard employer subsidy can meaningfully offset the PKV route specifically. Under Section 257 SGB V, if the higher-earning parent is a regular employee (not self-employed, not a civil servant, who get a separate Beihilfe reimbursement system instead) earning above the annual earnings threshold and fully privately insured themselves, their employer covers up to 50 percent of the family’s combined private insurance premiums. For 2026, that subsidy caps at 508.59 euros a month for health coverage and 104.63 euros for long-term care coverage, for the whole family together, not per child, which matters when estimating what the subsidy will actually offset.
What Real People Say
Guides written specifically for expat and international families describe this as one of the most consistently confusing corners of German health insurance, and specifically call out that the confusion isn’t really about the rule itself once it’s explained clearly, it’s that most people only ever hear the compressed version: “higher earner covers the kids.” That shorthand skips the actual income threshold entirely, which is exactly the detail that determines whether a family in Munich with a comfortably but not dramatically higher-earning PKV parent needs to worry about this at all.
The other point that comes up repeatedly is timing: this is worth working out before a child is born or before a family’s insurance situation changes, rather than during the scramble of a birth registration deadline. Since Munich’s international, often dual-career families are exactly the population most likely to have one spouse on a company’s private insurance plan and the other on statutory coverage, this specific question tends to come up more often here than the national averages might suggest.
Step by Step
- Confirm whether you’re legally married or in a registered life partnership. The Höherverdienenden-Regel’s income-comparison test is built around that status specifically, unmarried couples should confirm the applicable rule directly with the Krankenkasse instead.
- Compare both parents’ regular income, not just a single month’s snapshot. The rule looks at what the privately insured parent regularly earns, not a one-time bonus or unusual month.
- Check the PKV parent’s income against 6,450 euros a month for 2026 specifically, both conditions, higher earner and over the threshold, need to be true together for the exclusion to apply.
- If both conditions are met, compare the child’s own PKV contract against voluntary GKV membership rather than assuming one is automatically cheaper, actual quotes vary by insurer and the child’s specific circumstances.
- If considering PKV for the child, check whether the higher-earning parent’s employment status qualifies for the Section 257 SGB V subsidy before assuming the full premium is out of pocket.
- Work this out well before a birth or an insurance change, not during an unrelated deadline like newborn registration, since the two processes run on separate clocks.
FAQ & Common Pitfalls
We're not married, just living together. Does the Höherverdienenden-Regel still apply to us?
The rule as written in Section 10 SGB V is framed around spouses and registered life partners specifically, so the income-comparison mechanism that applies to married couples doesn't map onto unmarried couples the same way. For unmarried parents, which parent's insurance covers a child tends to depend more on custody and residence arrangements than on comparing incomes. This is genuinely worth confirming directly with your Krankenkasse for your specific situation rather than assuming either the married-couple rule or its absence applies automatically.
If our child ends up needing their own private insurance, is that expensive?
It's a real ongoing cost, but not the same scale as an adult's PKV premium, children's premiums are generally lower. What can meaningfully offset it is the Section 257 SGB V employer subsidy: if the higher-earning parent is a regular employee (not self-employed, not a civil servant) earning above the annual earnings threshold and fully privately insured themselves, their employer covers up to 50 percent of the family's combined private premiums, capped at 508.59 euros a month for health coverage and 104.63 euros for long-term care coverage in 2026. That cap applies to the whole family together, not per child, worth knowing before assuming the subsidy stretches further than it does.
What if the privately insured parent earns more than their statutory-insured spouse, but not by much?
Only the specific 6,450 euro a month threshold for 2026 matters here, not a general sense of who earns more. If the privately insured parent's income is above their spouse's but still stays under that monthly figure, the second condition of the Höherverdienenden-Regel isn't met, and the child still qualifies for free coverage under the statutory parent. Both conditions have to be true at the same time for the exclusion to apply, higher earner alone isn't enough on its own.