Health Insurance System in Germany

After your arrival in Germany, your first bureaucratic task is to register yourself with your local authority, stating your address (see our Anmeldung article here). Once you have done that, you need to make sure you get health insurance, if you don’t already have one. Everyone who lives in Germany is legally required to have health insurance, irrespective of their nationality. 

How does the German health insurance system work?

There are two kinds of health insurance in Germany: statutory – or public – health insurance (SHI) and private health insurance (PHI). SHI can be availed by most residents here in Germany while certain conditions determine who may have PHI.  It is very important to understand the system and to know what the health insurance covers before you apply for it.

Statutory health insurance – How much does it cost?

The rate of statutory health insurance contribution varies according to a person’s income. 14.6 percent of the total gross income (as of 2020) of an individual is levied towards statutory health insurance. This percentage is shared equally between the employer and the employee (7.3 per cent each). Students, people who are self-employed, and the unemployed have to contribute the total amount themselves, since they do not have an employer to bear the other 50 percent. If the calculated contribution exceeds the assessment ceiling of EUR 4,687.50 per month, no higher sum than that will be levied. SHI also covers the insurance of (unemployed) spouses and children without extra cost if one member of the family has a family insurance policy. 

The contribution paid by students, unemployed and self-employed people ranges between EUR 105 and 110.

There are more than 100 statutory health insurance companies in Germany. Some of the biggest ones are TK, AOK, Barmer, HKK, IKK, DAK. You can choose any one of them that best suits your needs. 

If you are new to Germany and do not speak the language yet, TK might be a good choice, as their English-speaking customer service team is very competent. They will guide you through the process in English.

If you have statutory health insurance, you should be aware that some medical professionals only treat privately insured patients. When making an appointment with a new doctor, always make sure that they accept patients who are covered by public health insurance.

What does your statutory health insurance cover?

• Medical care

The German National Association of Statutory Health Insurance Funds makes sure that all public health insurance companies in Germany provide coverage for essential medical services. Basic care deemed medically necessary includes, for example, visits to doctors, hospital care, prescribed medications, diagnostic procedures, and certain therapies. All necessary medical care should be covered by your insurance for no extra cost. However, what is considered “necessary” is a matter of definition. Certain treatments and therapies, including, for example, much dental work, may not be covered by your insurance. You may be required to pay a contribution towards a treatment or pay the entire amount yourself. In such cases, your doctor is obliged to inform you and gain your consent before commencing any treatment that will incur additional expenses.

• Coverage for children and spouses

The greatest benefit of having public health insurance in Germany is that all your dependents, such as an unemployed spouse or children, are covered under your plan at no extra cost. You do not need to pay any extra amount to get them insured in Germany. Many people with a family opt for statutory health insurance as it works out cheaper than private health insurance. 

Public health insurance comes with even more benefits that are really worth considering when you are choosing a health insurance plan.

• Sickness benefit

If you cannot work due to sickness or injury, your employer is entitled to support you by continuing to pay your wages for up to six weeks. If you are still unable to work after that time, your public health insurance provider will take over to pay you approximately 65% of the last salary you received before becoming unable to work.

• Maternity benefit

If you are covered by public health insurance and you are employed, the parent who stays at home with the newborn baby will receive maternity benefit from the Federal Insurance Office for the period of maternity leave. 

Long-term care insurance

All public health insurance companies in Germany have been obliged to provide long-term care insurance since 1995. This is a part of the social security system in Germany that works independently to provide financial provision for the risk of necessary care.

Private health insurance in Germany – How much does it cost?

The private health insurance system in Germany is used by around ten percent of the German population, including people with higher income and the self-employed. It is possible to opt for private health insurance instead of statutory health insurance if you meet certain conditions. If you start a new job and wish to be privately insured, you have to let your employer know immediately, otherwise they will automatically register you for statutory health insurance You are eligible to apply for private health insurance if you fall under any of the following categories:

• Annual income of more than EUR 64,350 per year
• A civil servant in Germany 
• A freelancer or self-employed person
• A foreign student who is exempt from the obligation of statutory health insurance in Germany

There are many factors that determine the cost of private health insurance. These include age, income, potentially pre-existing medical conditions and, of course, the specific healthcare services to be covered.

The average premium can range between EUR 400-700 per month, but is significantly less for students who wish to be privately insured. For example, the basic plan of Mawista Classic for students is EUR 33 per month (as of 2021). 

• What does your private health insurance cover?

Like statutory health insurance, private health insurance also covers basic medical care such as visits to doctors, hospital care, prescribed medications, diagnostic procedures, and certain therapies. However, the main difference is that privately insured patients usually have to pay up front and then submit the invoice, which should be reimbursed within a few working days. With statutory health insurance, you do not usually need to pay any amount when you visit a doctor. Even when you buy prescribed medication, the maximum contribution to be paid by those with statutory health insurance will be between EUR 5 - 10, depending on the price of the medications.

There are, however, a few services and conveniences that you may benefit from if you are privately insured, such as private hospital rooms, shorter waiting times for appointments, alternative medicine, or child sickness benefit. But private insurance does not cover your dependent family members as statutory health insurance does. If you want your kids or unemployed spouse to be insured, you will have to pay more for each individual. 

Don’t wait any longer, choose the right health insurance!

If you are staying in Germany for longer than just a brief visit, it is mandatory for you to get insured. Some policies have been created to provide for the specific needs of certain groups, such as guest workers, guest scientists,  asylum seekers, apprentices or au pairs. This means that even if you are not planning to stay in Germany forever, you will find appropriate insurance. 

So now is the time to start looking for the health insurance that best suits your needs! You can search for options online, but there are also agents who will help to guide you through the German health care system and advise you on the best choice for you and your family.

Written by: Sanchari Banerjee

Photo: Unsplash

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