Introduction	In brief	Description	flyer	online application	FAQs

Gesetzliche Krankenversicherung - - Statutory health insurance for employees

Statutory health insurance - - Statutory health insurance for employees

online application

Instructions for completing the form

After you have filled out and sent the online form, you will receive a printable declaration page/confirmation of coverage (Versicherungsschein) via email, assuming all provided information is complete and valid and you have been approved for coverage.

You will find help regarding the necessary details you are asked to provide by clicking on the You will find help regarding the necessary details you are asked to provide by clicking on ? the next to the respective fields. next to the respective fields.

Enabling JavaScript is required for the application form to work. Below you get specific instructions on enabling JavaScript in your browser. If your browser isn't listed, please consult its help resources.

Internet Explorer 6.0+

Click the Tools menu.
Select Internet Options.
Click the Security tab.
Click the Custom Level button.
Scroll down until you see the 'Scripting' section. Select the 'Enable' radio button for 'Active Scripting.'
Click the OK button.
If you see a confirmation window, click the Yes button.

Firefox 3.6+

Click the Tools menu.
Select Options.
Click the Content tab.
Select the 'Enable JavaScript' checkbox.
Click the OK button.

Important questions

Did the insured Person (IP) hold health insurance in Germany before commencement of coverage? Yes No

How was the VP insured?

Name of the main insured person

Please specify the insurance company with which the IP was previously insured.

Since when was the insured person insured there? (dd-mm-yyyy)

Until when was the insured person covered there? (dd-mm-yyyy)

Policyholder / Insured person

Salutation

First name

Last name

Date of birth (dd-mm-yyyy)

Age

Nationality

Has the insured person had their permanent residency for at least two years in Germany or Austria? Yes No

Additional information policyholder/ Insured person

Place of birth

Birth name

Country of birth

I have children (including stepchildren, adopted children and foster children) Yes No

I am coming from a (non-contractual) foreign country to begin my studies in Germany Yes No

Policyholder’s address/Contact information

c/o

If the policyholder’s name is not on the mailbox, please enter the recipient's name in the field, c/o.

Street building/house no.

Zip code

City

Region*

Country

Additional questions on statutory health insurance

Are you taking up employment for the first time? Yes No

Where are you employed? (employer’s company name)

Street building/house no.

Zip code

City

income

When does/did your employment begin?

Social insurance number (if available)

Do you want to include your family members into the insurance? Yes No

Information about health insurance

Insurance plan DAK - Statutory health insurance for employees

Additional contact information in the event of questions

Area code

* The fields marked with an * asterisk are not required to take out a policy, but the information provided makes it easier for us to contact you. You will not receive any unsolicited advertising material via email, and we will not forward your information on to any third parties.

Telephone

Fax no.

How did you find us?

Tipp for qq-user:
To be sure that you receive all documents, please fill in another (not qq-)e-mail in the field for the second e-mail

You can enter an additional e-mail-address here, to which we will also send the insurance documents.*

The fields marked with an * asterisk are not required to take out a policy, but the information provided makes it easier for us to contact you. You will not receive any unsolicited advertising material via email, and we will not forward your information on to any third parties.

Referrer / agent number

Terms and conditions health insurance

By clicking on the adjoining field you confirm that you have read, understood and agreed to the following conditions. Versicherungsschutz soll über die DAK - Deutsche Angestellten Krankenkasse - bestehen. At the same time, by clicking here you are confirming that you printed and / or downloaded the following terms and conditions/documents before sending your application:

In brief Information x

Type of insurance: Statutory health insurance for employees

Insurable persons: Employees in Germany insured through social security

Entry age: -

Contribution 16.1% / month

Duration: 1 month - unlimited

Benefits*

Statutory Health Insurance

*For a complete list of benefits see the general insurance conditions (GTI).

Data privacy Terminate contracts here