Which health insurance fits during the clerkship rarely depends on a single factor. What matters is your status, a possible Beihilfe entitlement (the German civil servant health allowance), your family insurance, your expected costs and the deadlines. This guide takes you through five steps and ends with a worked example.
Short answer: Five questions decide it: which status applies to you, whether you are entitled to Beihilfe, and whether family insurance is possible. Then look at your expected remaining costs and the deadlines. With a Beihilfe entitlement, a PKV top-up policy is usually the way to go. Without Beihilfe, voluntary GKV or a full policy are the options. Last updated: October 2026.
The most important points at a glance
- Your status during the clerkship decides on Beihilfe and on insurance obligations. Your appointment letter shows which status applies.
- The standard Beihilfe rate for civil servants on a provisional basis without children is 50 percent in many states. Some states differ, for example Hesse.
- Family insurance is usually not available during the clerkship, because the income limit is exceeded.
- A PKV top-up only makes sense if you expect remaining costs that are worth covering. You can calculate this.
- Some deadlines, such as the choice of lump-sum Beihilfe or the PKV opening offer, are partly irrevocable. Check them early.
Step 1: Clarify your status
Read your appointment letter. It states whether you were appointed as a civil servant on a provisional basis or whether the traineeship is organised as a public law training relationship (öffentlich-rechtliches Ausbildungsverhältnis). This distinction matters because it affects Beihilfe, insurance obligations and pay. Since the rules differ between the federal states, the law of your state always applies. You can find an overview of trainee pay in our guide trainee pay by federal state (in German).
Step 2: Check your Beihilfe entitlement
With a Beihilfe entitlement, you need health insurance that covers the remaining costs. In many states, the standard rate for civil servants on a provisional basis without children is 50 percent. Hesse is different. According to the leaflet of the Regierungspräsidium Kassel on the Hessian Beihilfe regulation, the rates there are higher: 70 percent for outpatient and dental treatment and 85 percent for inpatient treatment.
| Status | Beihilfe | Typical cover |
|---|---|---|
| Civil servant on a provisional basis with Beihilfe entitlement | Yes, rate set by state law | PKV with a Beihilfe-compatible top-up |
| Civil servant on a provisional basis with lump-sum Beihilfe | Allowance towards contributions instead of invoice reimbursement | Full cover with an allowance under state rules |
| Public law training relationship | Set by each state | GKV or PKV, to be clarified with your employer |
How the lump-sum Beihilfe works in Thuringia is explained in our guide Beihilfe in Thuringia. According to the leaflet of the city of Erfurt (status June 2024), the choice is irrevocable. The leaflet describes the lump-sum Beihilfe for people entitled to Beihilfe who are voluntarily insured in statutory or private health insurance.
Step 3: Check family insurance
Family insurance is only possible if your total income stays below a limit. For 2026, this limit is 565 euros per month. Trainee pay is usually well above that, so family insurance is generally ruled out during the clerkship. For 2027, the draft ordinance sets the limit at 590 euros per month, which only becomes binding after the Bundesrat approves it.
Under section 10 SGB V, further conditions also apply, such as a residence in Germany and no main self-employment. It is worth checking your individual case if you were previously insured through a relative.
Step 4: Compare the costs
The contribution is only one side of the picture. The other side is what you are likely to pay out of pocket. A worked example makes the difference clearer.
Assumed: You are 25, have no children and are voluntarily insured in statutory health insurance. You would then pay 278.17 euros per month for health and long-term care insurance together, with the average additional contribution. Health insurance alone is at least 222.80 euros per month (calculated for 2026).
Assumed: In one year, eligible costs amount to 1,200 euros and the rate is 50 percent. Beihilfe then pays 600 euros. The remaining 600 euros must be covered by a top-up policy or paid by you. A top-up pays off when its contribution is clearly lower than the share of the remaining costs it would cover. For the actual comparison, use the contribution quoted to you.
Step 5: Clarify deadlines and options
According to the Erfurt leaflet, the choice of lump-sum Beihilfe in Thuringia is irrevocable and only applies to the future. According to the leaflet of the PKV association, the opening offer applies only within the first six months after the first appointment as a civil servant. If you are appointed later, check these deadlines early, because the benefit may otherwise be lost.
What speaks for GKV and what speaks for PKV?
Both routes have strengths. Voluntary GKV has a fixed framework and is easier to estimate. PKV offers more room for choice in tariff and benefits, but it requires a health check and a comparison of the terms. Neither is right for everyone.
- For voluntary GKV: a fixed contribution framework, benefits set by law and no health check on joining.
- For PKV: benefits, choice of chief physician and reimbursement rates depend on the tariff. With a Beihilfe entitlement, a top-up covers the remaining costs specifically.
- Against GKV: with a Beihilfe entitlement, Beihilfe does not apply there, and the scope of benefits is set by law.
- Against PKV: the contribution depends on age and health, and changing tariffs is often tied to conditions.
The question is therefore less which insurance is better in general and more which one fits your status and your costs. If you are healthy, expect few remaining costs and only stay a short time in the traineeship, voluntary GKV can work well. If you expect larger costs or have a Beihilfe entitlement, take a PKV top-up seriously.
Frequently asked questions
Can I stay in GKV if I am entitled to Beihilfe?
With individual Beihilfe, voluntary GKV is usually not the suitable solution, because Beihilfe does not apply there. With lump-sum Beihilfe, voluntary GKV may be possible in some states, because the allowance partly covers the contributions. Which rule applies in your state is decided by the competent office.
What changes when I become a civil servant on probation?
When you are appointed as a civil servant on probation, Beihilfe may change, and trainee tariffs are often designed only for the training period. Check the conversion rules of your tariff before you start the traineeship.
Do I need health insurance between the state exam and the clerkship?
Yes, insurance cover is mandatory. If you have a gap between the state exam and the clerkship, clarify it early. We have a separate guide on this: health insurance between the state exam and the clerkship (in German).
What to do next
- Read your appointment letter and note your status.
- Ask your employer about the Beihilfe rate and about the option of lump-sum Beihilfe.
- Calculate your expected remaining costs for one year, using the example in this guide.
- Compare offers with the same example and note the deadlines before you submit an application.
Related articles
- Health insurance during clerkship: GKV, PKV and Beihilfe
- Health Insurance for Referendare in Germany
- Beihilfe in Thuringia
- Beihilfe during the clerkship (in German)
- Referendar with statutory insurance: how voluntary GKV works (in German)
Sources: Section 10 SGB V, family insurance (gesetze-im-internet.de, in German); Contribution rules, GKV-Spitzenverband (status 1 January 2026, in German); Draft ordinance on social insurance reference values 2027, BMAS (draft, status October 2026, in German); Leaflet on the Hessian Beihilfe regulation, Regierungspräsidium Kassel (status 2026, in German); Leaflet on lump-sum Beihilfe, city of Erfurt (status June 2024, in German).
Last updated: October 2026. This guide is general information, not individual advice.
