Germany is known for having one of the best health care systems in the world with all residents having access to comprehensive health insurance coverage.
About 85% of the population have mandatory or voluntary government health plans, while the remainder are insured with private health insurance plans.
The 2007 health insurance reform requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment. This minimum insurance must also include pregnancy coverage and specific medical check-ups.
Health care costs in Germany are rising each year due to demographic shifts and the inflation of medical costs. Recent cost control legislature has clamped down on medical expenditures in an an attempt to make the industry more competitive and reduce costs for the government health insurance providers (Gesetzliche Krankenversicherung or GKV). These measures mean reduced benefits for dental care, increased co-payments for various treatments and an increased premium of 8.2% of gross income.
The Gesundheitsfonds (GKV) is the central government organization that collects all monies paid into the GKV and distributes the payments to the various state insurance plans (Krankenkassen). The current 130 Krankenkassen claim that the distributed funds are not enough to pay the per member costs of their health insurance claims and a few Krankenkassen have even registered for bankruptcy. in this case, the members of these distressed Krankenkassen will still be able to change to a different provider.
The German law provides that Krankenkassen are allowed to charge members an unlimited supplemental premium if the Krankenkasse cannot meet its annual expenses. In 2014 no Krankenkasse has charged supplemental premiums, but this is expected to change in 2015. Therefore, it will be necessary to compare different rates and benefits before deciding on a provider. Further government health care reforms are expected in the future, with yet more changes to benefits and increased premiums.
The three options for health insurance:
- the government regulated publish health insurance system (GKV)
- private health insurance from a German provider
- private health insurance from an international insurance company
(or a combination of the above)
While living in Germany, you can choose a private health insurance plan if your income exceeds the regulatory threshold or if you are self-employed.
Comparing and choosing among the many and varied government and private health insurance plans is certainly not easy, but it is worth the effort to find the most competitive rate with the best benefits for a person’s expectations and requirements.
Proper health insurance provides critical financial support in times of illness or injury. Different health insurance policies offer more or less coverage than others and the scope and quality of the terms and conditions vary and can severely impact your expenses when emergency or critical procedures are not fully covered.
Government Health Insurance System (GKV) The government health system (GKV) covers about 85% of German residents (approx. 70 million people). If your gross income is less than 53,550 Euros per year, or 4,463 Euros per month in 2014 then membership in the GKV is mandatory.
The government health insurance is administered by approximately 130 Krankenkassen. All Krankenkassen charge the same basic rate of 15.5 % of your gross income up to a maximum monthly income of 4,050 Euros (as of 2014).
If your income is higher, you do not pay a higher insurance premium. The maximum monthly premium is 710 Euros as an employee earning at or above the threshold. Your actual payment is about 373 Euros and your employer will contribute the balance of 338 Euros.
In general, a Krankenkasse requires a minimum membership period of 18 months. You can switch government health fund providers by giving two months notice after the 18 month membership or if a supplemental premium is demanded.
The coverage benefits of the mandatory government health plan include:
- in-patient (hospital) care as a ward patient with the doctor on dutyat your nearest hospital.
- out-patient care with registered doctors (Kassenärzte)
- basic dental care.
The Krankenkasse does not cover expenses for private doctors or surgeons, private hospital rooms, alternative and homeopathic treatments, dental implants, vision products for adults or any medical benefits outside of Europe. Your non-working dependents living at your address in Germany are insured at no additional cost and simply need to be registered with the Krankenkasse.
When purchasing a government health insurance plan, you can register with any of the available Krankenkassen. These are non-profit companies administrating the government health-care program. Some (for instance AOK, TK, BEK, DAK) are very large and have millions of members, while others (often called BKKs) might have just a few thousand members - but benefits across the board tend to be similar. Policies and communications are in German only and few English speakers are available. The government long-term-nursing care insurance is also mandatory. This is additional disability insurance in the event of long-term nursing requirements and the cost is currently set at 2.05% to 2.3% of gross income - of which the employer pays half up to a maximum of 93 Euros per month (with no children).
If you feel the government insurance coverage is not sufficient for you and your family, you may purchase supplemental health insurance from any private insurance company - national or international. For example, if you would prefer to see private doctors or clinics or have coverage for private hospital rooms or higher dental coverage, then a private supplemental plan might is recommended. Also, if you travel outside the country frequently, a private supplemental plan can cover emergency recovery and evacuation to a German emergency ward or hospital - which the state plan does not cover.
Private Health Insurance (PKV)
Private health plans generally give you a broader range of medical and dental treatments than government plans and provide coverage internationally. With private health insurance coverage you are considered a private patient with a higher level of service from medical practitioners.
As private patients are a higher revenue source, most practitioners will gladly provide a higher level of service. You are also more likely to request and find a practitioner who speaks your native language.
Overall, there are about 40 private health insurance providers in the German market with different levels of coverage to suit your budget. The total cost of the policy is based on several factors:
- range of benefits chosen
- entry age
- pre-existing medical conditions
Other factors such as smoking or non-smoking also influence premiums. A major portion of your health-insurance premiums are tax deductible.
While the government insurance plan covers you and all your non-working dependents, the private plan coverage is calculated by individual covered.
The monthly cost can be reduced by electing a deductible before coverage applies. German health insurance may not cancel you for submitting a claim.
Many international health insurance companies offer plans for expatriates living and working in Germany. If you are considering purchasing a plan from one of these companies, be aware that most of these insurance companies are not registered with the BaFin to do business in Germany. Of those that are, most offer plans that do not meet the requirements of the new health care reforms. The main requirement is that there be no upper limit to reimbursements and the cap on annual out of pocket co-payments is 5000 Euros.
Currently no international expatriate insurance company provides an insurance certificate in German in order to be recognized by the visa authorities in Germany.
Additional Information for Employees
If your gross annual income is higher than 53,550 Euros (as of 2014), you may choose private health insurance (Private Krankenversicherung or PKV) instead of the government health plan. Self-employed persons, German civil servants and part-time workers earning less than 450 Euros per month are also eligible.
If you are currently covered in a government health plan, you can switch to a private insurance plan after giving two month’s notice. Your membership in the government plan is no longer mandatory and you may stay in the government plan or choose private insurance.
When on-boarding with your new company, you will need to inform your Human Resources Dept. that you wish private health insurance, otherwise they will automatically register you with the government health plan.
If you purchase a private plan from a German insurance company that provides a certificate recognized by the German government (Paragraph 257 SGB V Arbeitgeberbescheinigung , your employer will contribute the same amount to your premium as if you were a government plan member - equal to 296 Euros a month and 50% of the premium for long-term nursing care. Your employer will require your insurance certificate in order to comply with government regulations.
Additional Information for Self-employed or Unemployed Persons It is now illegal to be uninsured.
Private German health insurance companies are now required to accept all applicants regardless of their health situation in their basic plan called “Basistarif”. If you are denied standard coverage by a private health insurance company because of a serious pre-existing condition, you can still purchase the basic plan. Although this plan is expensive at about 710 Euros per month per adult and 300 Euros per dependent child. Welfare support is available for qualified applicants.
If you have no health issues, you should purchase a private health insurance from a company willing to accept non-German citizens. A qualified insurance broker specializing in health insurance for expatriates can assist you.
If you are self-employed and covered by an international company as of April 1, 2007, you should verify that your coverage is applicable in Germany. The German visa authorities will require health insurance certification in German.
If your non-German insurance policy is valid and in force in Germany, you will still be required to pay into the government long-term nursing care plan.
Sick Pay Insurance
In the event of an illness or injury, your employer will normally pay your full salary up to six weeks. Thereafter, the government health insurance (Krankenkasse) pays a percentage of your income, (up to approximately 2,835 Euros per month) as statutory sick pay (Krankengeld) - up to a maximum of 78 weeks. After tax deductions your net payout would be about 2,500 Euros (at maximum payout). If your monthly income is higher, you should consider purchasing supplemental sick-pay insurance - especially if your monthly expenses are higher than 2,500 Euros. Both private insurance and government insurance DO NOT cover permanent disability. Separate supplemental policies are available for critical illness and permanent disability.
Travel Insurance and Emergency Evacuation Benefits The government health plan provides for limited medical and dental coverage while traveling within the EU. You may also choose your medical provider in any country in the EU, EEA state or Switzerland and receive partial reimbursement from your government insurance plan. Please contact your Krankenkasse before engaging any cross-border medical or dental care.
Call the International Liaison Office at: +49 (0)228-9530-800
The majority of foreign doctors will accept you for treatment only as a private patient. The government health insurance will reimburse you for the amount that the plan pays for treatments in Germany - usually only a fraction of the actual cost. For more complete coverage you should purchase additional travel health insurance - available on an annual basis if you travel frequently or for single trips. The government health plan does not cover emergency evacuations from foreign countries and some supplemental travel policies limit coverage, so check the details of your coverage.
The cost of dental care in Germany can get expensive. When major dental work is required - bridges, crowns or orthodontics, you must submit a cost estimate to the Krankenkasse before commencing the procedure, otherwise you will be responsible for the majority of the cost. You can expect to pay 30% to 80% of the treatment costs if you do not have supplemental dental insurance.
Pharmacies in Germany are widely distributed and located in even the smallest towns. The pharmacies (Apotheke) are indicated by a large red “A”
outside the location. The government health plan provides for coverage of generic prescription drugs and the pharmacy is obligated to provide the lowest cost medication when you present your prescription.
Private health plans cover the costs of your prescription for brand name medications. You pay the full cost of the prescription and are reimbursed by your insurance provider. Over the counter remedies are not covered by either government or private insurance plans.