Anyone who, as a pensioner, permanently relocates their retirement residence abroad faces a different question from that facing an employed person who must decide whether or not to terminate their statutory health insurance before emigrating. For members of the statutory health insurance scheme for pensioners (Krankenversicherung der Rentner, KVdR), the real question is not “Do I have to cancel?”, but “Will my cover actually still be usable at my new place of residence – and if so, to what extent?” The answer differs markedly between a move within the EU, the EEA, or Switzerland, and a move to a genuine third country with no social security agreement. The general rules on terminating statutory health insurance on emigration – for example for voluntarily insured persons or employed people not yet drawing a pension – are dealt with in detail elsewhere and are deliberately not repeated here. This article focuses specifically on the pensioner’s situation: the requirements for KVdR, the continuation of cover in the EU/EEA via benefits-in-kind assistance and the S1 form, and the consequences of moving to a state with no corresponding agreement.
The Requirement for Compulsory KVdR Insurance: The Nine-Tenths Prior Insurance Period
Compulsory insurance under the statutory health insurance scheme for pensioners is governed by Section 5(1) No. 11 of the German Social Code, Book V (Sozialgesetzbuch V, SGB V) – § 5 Abs. 1 Nr. 11 SGB V. Under this provision, a person is compulsorily insured if they meet the requirements for entitlement to a statutory pension, have also applied for the pension, and have been a member of a statutory health insurance fund, or family-insured under § 10 SGB V, for at least nine-tenths of the second half of the period running from their first taking up gainful employment to the date of the pension application. What matters here is a so-called reference period that is split exactly in half: only the second half – from working life to the pension application – is considered for the nine-tenths quota, not the entire working career.
For each child, stepchild, or foster child, a flat-rate period of three years is credited towards this required period of membership under § 5(2), third sentence, SGB V – § 5 Abs. 2 Satz 3 SGB V – a relief that particularly benefits mothers and fathers with longer periods of childcare and is regularly overlooked when calculating one’s own prior insurance period. Anyone who does not meet the nine-tenths quota does not automatically become a compulsorily insured KVdR member, but can become or remain a voluntary member of the statutory health insurance scheme under the general requirements of § 9 SGB V. Compulsory long-term care insurance follows KVdR membership as an ancillary matter under Section 20(1), second sentence, No. 11 of the German Social Code, Book XI (Sozialgesetzbuch XI, SGB XI) – § 20 Abs. 1 Satz 2 Nr. 11 SGB XI: anyone compulsorily insured under KVdR is generally also compulsorily insured under statutory long-term care insurance.
Important for the later question of moving abroad: the law ties compulsory KVdR insurance to the prior insurance period, not to a continuing domestic residence. The real fork in the road for the cross-border case therefore does not arise at the question of whether membership exists, but at the question of whether, and to what extent, benefits in kind can actually be drawn on the basis of that membership in the state of residence.
Moving to the EU, the EEA, or Switzerland: KVdR Generally Continues
If a German pensioner permanently relocates their residence to another EU or EEA state, or to Switzerland, their KVdR membership – whether compulsory or voluntary – generally continues, as long as they draw exclusively German pensions. This is made possible by the European coordination of social security under Regulation (EC) No. 883/2004. For pensioners who would have no independent entitlement to benefits in kind in the state of residence itself, but who would be entitled to benefits in kind under the law of the state paying the pension if they resided there, Article 24 of the Regulation provides that such benefits in kind are nevertheless granted – provided by the institution of the place of residence, but for the account of the competent German institution. This so-called benefits-in-kind assistance ensures that the institution of the place of residence treats the pensioner as if they were insured there, and subsequently settles the costs with the German health insurance fund.
In practice, this entitlement is evidenced by the Portable Document S1 (formerly form E121). Before moving, the German health insurance fund should be notified in good time so that it can issue the S1; the form is then presented to the competent health insurance fund at the new place of residence, which registers the pensioner there and issues them a regular insurance card of the state of residence. The scope of benefits is governed by the law of the state of residence and may differ from the German benefits catalogue – a point that is regularly underestimated when choosing a destination country. For short-term stays, for example visits to Germany or trips to other EU states, the European Health Insurance Card additionally applies.
One point is regularly overlooked: continuing cover via benefits-in-kind assistance does not mean that no more contributions are due. KVdR contributions continue to be withheld from the statutory pension and, as discussed further below, from any occupational pension benefits, regardless of whether the residence is in Germany or in the EU/EEA.
A Genuine Third Country with No Social Security Agreement: End of the Obligation to Provide Benefits Abroad
The position is different where the retirement residence is relocated to a state outside the EU, the EEA, and Switzerland, with which Germany has not concluded a social security agreement containing corresponding health insurance coordination. In terms of entitlement to benefits, the principle in Section 16(1) No. 1 SGB V – § 16 Abs. 1 Nr. 1 SGB V – applies here: the entitlement to benefits is suspended for as long as insured persons are staying abroad. That EU regulations such as Regulation (EC) 883/2004, or a relevant bilateral social security agreement, can override this suspension follows from Section 30(2) of the German Social Code, Book I (Sozialgesetzbuch I, SGB I) – § 30 Abs. 2 SGB I – under which provisions of supranational and international law remain unaffected by the provisions of the Social Code. Where no such agreement exists, the suspension of the entitlement to benefits remains in place: the German health insurance fund can no longer arrange or reimburse benefits in kind in the state of residence.
In practice, this means that for pensioners who permanently move to a genuine third country with no agreement, KVdR health cover effectively becomes ineffective at the new place of residence, even if membership formally continues. Membership without a usable entitlement to benefits locally is, as a rule, not economically sensible – those affected need an independent, usually private, international health insurance policy for the place of residence that offers affordable cover even at an advanced age and with pre-existing conditions. Whether, and under what conditions, KVdR membership can or should additionally be terminated or suspended in such cases depends on the individual case and should be clarified with the health insurance fund before moving, as should the question of whether a later return to Germany, with a corresponding re-entry into KVdR, is even intended.
Special Case: Agreement States with Their Own Health Insurance Coordination
Not every German social security agreement is limited to pension insurance. With some states outside the EU/EEA, agreements exist that also contain their own health insurance coordination for pensioners with benefits-in-kind assistance – including the agreements with Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia, Turkey, and Tunisia. As under EU/EEA law, this also avoids the need to settle every individual treatment case separately; the costs of the benefits in kind granted in the state of residence are instead settled via monthly flat rates per month of benefit and, for example in relation to Turkey and Bosnia and Herzegovina, on a family basis.
Under other German social security agreements, a health insurance component that was in principle envisaged has in some cases never actually taken effect: in relation to Morocco, for example, the provisions on benefits-in-kind assistance have to this day not been brought into force (German Bundestag, printed paper Drucksache 21/4905 of 19 March 2026); in relation to Kosovo, benefits-in-kind assistance is suspended. In both cases, pensioners at the new place of residence therefore cannot, in practice, rely on benefits-in-kind assistance, even though the social security agreement with the state concerned formally exists. Anyone planning a retirement residence outside the EU/EEA should therefore not assume, as a blanket rule, that “agreement state equals health insurance cover”, but should have it specifically checked for the particular destination country whether the relevant agreement contains a health insurance component at all, and whether it has actually been brought into force – the relevant information is provided by the competent health insurance fund or the German Pension Insurance (Deutsche Rentenversicherung).
The Obligation to Pay Contributions on Occupational Pensions and Lump-Sum Benefits Continues Despite Residence Abroad
A frequently overlooked point concerns not the benefits side but the contributions side: as long as KVdR membership continues – for example on moving to the EU/EEA via benefits-in-kind assistance – occupational pension benefits (Versorgungsbezüge) also remain subject to contributions under § 229 SGB V. These include, in particular, occupational pensions, benefits from direct insurance policies, pension funds (Pensionskassen), and provident funds (Pensionsfonds), as well as comparable benefits from a former employment or service relationship, expressly including where they are paid from abroad or by an international institution. Where such a benefit is paid not as an ongoing pension but as a one-off lump sum, one one-hundred-and-twentieth of the benefit counts, under § 229(1), third sentence, SGB V – § 229 Abs. 1 Satz 3 SGB V – as a notional monthly payment amount, with the result that the obligation to pay contributions on this lump-sum benefit is spread over a period of ten years.
Relocating one’s residence abroad does not, in principle, change this obligation to pay contributions, as long as KVdR membership continues: anyone who believes that moving to another EU country automatically exempts them from the obligation to pay contributions on occupational pensions or a paid-out direct insurance policy is subject to a widespread misconception. Only once KVdR membership itself ends – for example because it is terminated on moving to a genuine third country with no agreement – does the associated obligation to pay contributions on occupational pension benefits also cease. Anyone with a significant occupational pension, or an imminent lump-sum payment from a direct insurance policy, should therefore expressly factor this point into their planning for a retirement residence abroad, rather than discovering it only after the move when looking at their pension statement.
The following example is entirely fictional and serves solely for illustration; it does not describe an actual case or a real person. A compulsorily insured KVdR pensioner relocates his retirement residence to Spain. He notifies his German health insurance fund of the move in good time, receives form S1, and registers with the competent Spanish health insurance fund. In the event of illness, he is treated there as a Spanish insured person, and the costs are settled between the Spanish fund and the German KVdR fund. KVdR contributions continue to be withheld from his statutory pension and from an additional occupational pension from a former employment relationship – the move to Spain changes nothing in this respect. Had he instead opted for a permanent retirement residence in a third country with no relevant social security agreement, he would not have been able to draw benefits in kind there through his German health insurance fund and would have needed a private international health insurance policy.
At a Glance: Obligation to Pay Contributions and Benefits-in-Kind Assistance
The following two overviews summarise what applies to KVdR members with a foreign connection, on the contributions side and on the benefits side:
← Tabelle nach links wischen, um weitere Spalten zu sehen
| Type of income | Subject to KVdR contributions? | Legal basis / note |
|---|---|---|
| Statutory pension | Yes | § 228 SGB V (income subject to contributions), § 249a SGB V (contribution shared equally with the pension insurance institution) |
| Occupational pension, direct insurance, pension fund (Pensionskasse), provident fund (Pensionsfonds) | Yes | § 229 SGB V, full contribution borne by the pensioner alone, no participation by the pension insurance institution |
| Lump-sum benefit from direct insurance and similar | Yes | § 229(1), third sentence, SGB V, notionally spread over 120 months |
| Interest, dividends, and other investment income | No | Not occupational pension benefits within the meaning of § 229 SGB V |
| Rental income from real estate | No | Not occupational pension benefits within the meaning of § 229 SGB V |
← Tabelle nach links wischen, um weitere Spalten zu sehen
| Destination region | Benefits-in-kind assistance for the KVdR pensioner? | Legal basis |
|---|---|---|
| EU member state, EEA state, Switzerland | Yes | Regulation (EC) No. 883/2004, form S1 |
| Bosnia and Herzegovina, Montenegro, North Macedonia, Serbia, Turkey, Tunisia | Yes | respective bilateral social security agreement |
| Morocco | No – health insurance component agreed but never brought into force | Germany–Morocco social security agreement |
| Kosovo | No – benefits-in-kind assistance currently suspended | Germany–Kosovo social security agreement |
| Other third country with no agreement | No | – |
Worked Example: Contribution Burden on Moving to Spain versus Montenegro
The following example is entirely fictional and serves solely for illustration; it does not describe an actual case or a real person. A KVdR pensioner receives EUR 1,800 in statutory pension and EUR 400 in occupational pension per month, has no children (which affects the long-term care insurance surcharge), and is a member of a health insurance fund with an average supplementary contribution. At a general contribution rate of 14.6 percent plus an average supplementary contribution of 2.9 percent (17.5 percent together), and a long-term care insurance contribution of 4.2 percent for those without children, the result is: on the statutory pension, a health insurance own-contribution of around EUR 157.50 arises (half the rate, since the pension insurance institution bears the other half), plus a long-term care insurance contribution of around EUR 75.60 (in full, since, unlike health insurance, long-term care insurance provides for no contribution from the pension insurance institution) – around EUR 233 together. On the occupational pension, the full 17.5 percent health insurance and 4.2 percent long-term care insurance contributions apply, with no participation by the pension insurance institution at all, amounting to around EUR 87. In total, this produces a monthly KVdR contribution burden of around EUR 320.
The decisive point: this amount does not change whether the move is to Spain or to Montenegro – KVdR contributions are assessed solely by reference to the level of German income, not by the actual place of residence or the treatment costs arising locally. The real difference between the two destination countries therefore lies not on the contributions side, but on the benefits side: in Spain, the pensioner is integrated into the Spanish health system via form S1 and receives benefits in kind under Spanish law. In Montenegro, benefits-in-kind assistance instead applies under the German-Montenegrin social security agreement, the scope of which is governed by Montenegrin law and can, in practice, differ noticeably from the Spanish or German level. Anyone expecting a cost advantage from moving will be disappointed – anyone who instead checks whether the respective scope of benefits is sufficient for their own needs locally is asking the right question.
Scope for Structuring the Obligation to Pay Contributions: What Is and Is Not Possible
A misunderstanding that regularly arises in advisory practice: the obligation to pay KVdR contributions under § 229 SGB V covers exclusively occupational pension benefits from a former employment or service relationship – statutory pension, occupational pensions, direct insurance policies, and benefits from pension funds and provident funds. Investment income and rental income from real estate, by contrast, are not covered: these remain free of contributions for compulsorily insured KVdR members, regardless of their amount. This is a key structural difference from private health insurance, where the contribution is based on age, health status, and the chosen tariff, not on the type of income – a compulsorily insured KVdR member with high investment or rental income and a comparatively low statutory pension pays structurally less, for the same economic capacity, than a privately insured person. A switch from compulsory KVdR insurance to private health insurance is, incidentally, in any case not freely available once the prior insurance period is met, since this is a matter of compulsory statutory insurance.
← Tabelle nach links wischen, um weitere Spalten zu sehen
| Approach | Legally capable of being structured? | Brief explanation |
|---|---|---|
| Timing of a lump-sum payment from a direct insurance policy / pension fund | Yes, within the scope of the contractual options | The tenths rule under § 229(1), third sentence, SGB V spreads the obligation to pay contributions over ten years in any event |
| Structure of future, not yet promised, retirement provision (capital investment instead of a further direct insurance policy) | Yes, with timely planning before entering into the contract | Relevant only for future building blocks, not retroactively |
| Subsequent reclassification of existing occupational pension entitlements | No | Once accrued, occupational pension benefits remain subject to contributions, regardless of the later place of residence |
| Switching from compulsory KVdR insurance to private health insurance | No | No right of choice once the prior insurance period is met, since this is compulsory insurance |
Why Health Insurance Cover Abroad Varies So Much in Cost
Anyone needing private international health insurance for a third country with no agreement quickly finds that costs differ considerably from one destination country to another – for example, noticeably higher premiums in the United States compared with often cheaper tariffs in the Balkans. What matters for the assessment is solely the outcome in terms of contribution level and scope of benefits, not speculation about the underlying causes: what counts is what the respective contribution actually covers in terms of care – range of treatment, deductibles, waiting periods, exclusions for pre-existing conditions. In some destination countries, a basic statutory or private cover that is inexpensive in principle is additionally supplemented by co-payments customarily made directly to the doctor – a cultural difference from German practice that is better known in advance than discovered in the event of illness.
Returning to Germany: Is Continuation Insurance Necessary?
Anyone who does not rule out a later return to Germany often asks whether continuation insurance (Anwartschaftsversicherung, AWR) makes sense, in order to be able to return seamlessly to statutory health insurance without a new health assessment. For former KVdR members, this question needs a more nuanced answer than it might at first appear: since the introduction, on 1 April 2007, of the fallback compulsory insurance for uninsured persons under Section 5(1) No. 13 SGB V – § 5 Abs. 1 Nr. 13 SGB V – compulsory insurance may arise on return in any event. This fallback compulsory insurance is expressly subsidiary: it applies only where no more specific compulsory insurance exists on return – if the returnee still meets the requirements for compulsory KVdR insurance under § 5(1) No. 11 SGB V (the nine-tenths prior insurance period), compulsory insurance arises directly under that provision in any event, without No. 13 coming into play at all. Whether continuation insurance is dispensable in a specific case is therefore a matter for individual legal assessment, not an automatic consequence of the fallback compulsory insurance. The position is also different where a private full health insurance policy under the law of an EU/EEA state existed during the period abroad: in that case, the right to join the health insurance fund last responsible can lapse. Whether continuation insurance is necessary in an individual case therefore depends significantly on the cover chosen during the period abroad, and on whether one of the two compulsory insurance provisions in any case secures the return to KVdR – there is no blanket answer here; this must be clarified legally on a case-by-case basis before moving.
The Route in Brief
Anyone planning a retirement residence abroad as a KVdR member should orient themselves in this order: first, clarify whether the destination country is an EU/EEA/Swiss state or an agreement state with a health insurance component that has actually been brought into force – only then does benefits-in-kind assistance remain usable. Second, specifically check the actual scope of benefits locally, rather than relying on the formal cover, since this can differ noticeably from the German level. Third, review your own income structure: anyone holding significant occupational pensions, or facing a lump-sum payment, should plan its treatment for contribution purposes before moving, not discover it only afterwards. Fourth, for destination countries with no usable agreement, obtain private international health insurance at an early stage and examine its terms closely for an advanced age and pre-existing conditions.
Conclusion
For members of the statutory health insurance scheme for pensioners, whether their accustomed health cover remains usable at a retirement residence abroad does not depend on an active termination, but on the destination country: within the EU, the EEA, and Switzerland, KVdR generally remains functional via benefits-in-kind assistance under Regulation (EC) 883/2004 and form S1, albeit with a scope of benefits governed by the law of the state of residence. In a genuine third country with no relevant social security agreement, by contrast, the entitlement to benefits is suspended under § 16 SGB V, so that independent international health insurance becomes necessary – with the exception of the few agreement states that provide for their own health insurance coordination. Regardless of the destination country, the following applies: as long as KVdR membership continues, occupational pension benefits such as occupational pensions or lump-sum benefits from direct insurance policies remain subject to contributions under § 229 SGB V – moving abroad does not automatically end this obligation to pay contributions. To put it in context, as to who this subject mainly affects in practice: noticeable scope for structuring arises above all where, alongside the statutory pension, significant investment or rental income exists that, unlike occupational pensions, is not subject to the KVdR obligation to pay contributions. This article is therefore aimed primarily at pensioners with corresponding assets or investment or rental income, rather than at average pensioners without such additional income.
When Is Legal Advice Worthwhile?
The prior insurance period for KVdR, the scope of European benefits-in-kind assistance, the very different design of individual social security agreements with third countries, and the continuing obligation to pay contributions on occupational pension benefits interact closely in an individual case. Anyone planning a permanent retirement residence abroad should clarify these points in good time before moving – particularly where a substantial occupational pension, an imminent lump-sum payment, or a destination country with no secure health insurance coordination is in play.
The Fiala law firm has published extensively on international social security law and supports clients in reliably assessing their statutory health insurance for pensioners in light of a planned retirement residence abroad, and in clarifying possible consequences for contributions and benefits at an early stage. Please contact the firm at an early stage if you have any doubts about your personal situation.
