Health Insurance Coverage in Germany
Statutory insurance is considered as the insurance for the poor, supplying only standard treatment. The legislation for statutory insurance tends to limit the payment of the doctor’s performance. Are you thinking about applying for private insurance? Be sure to think twice before taking out private. As previously mentioned, immigration law considers statutory health insurance as non plus ultra (§2 III 3 AufenthG).
What is meant by “statutory health insurance”?
“Statutory” implies that your insurance is compulsory via certain public (but not state owned) insurance companies. Most statutory health insurance companies offer mostly the same services, but the premiums have now become uniform 15.9%. However, since this amount does suffice for many insurance companies, they apply a surcharge. Though this surcharge is not capped, the highest imaginable rate is around 2%. You have to pay this surcharge alone and your employer does not have to contribute to this.
Which system is better - government or private?
That really depends on your personal situation. Private is cheaper if you´re young and healthy. You pay a contribution per person. So, if you have several children, the government scheme will probably be cheaper, since you make only one earnings related contribution for your family. If your spouse works, it gets more complicated...
Do not listen to any sales agent, who might play down your medical history to get you the lowest possible rate. If you had a severe illness reckon with a surplus on the premium, if they take you at all. If you have a minor orthopedic problem, this will cause a minor surplus to your premium. And if you hide your medical history, only to get a giant bill shortly after signing the contract to be refunded, the company will claim you cheated them. They will cancel your contract and refuse to pay for treatments and hospital stays. On top of that, you may be barred from getting insured by another private company or even by a statutory insurer. They will not even refund any premiums. All this is legal!
Will my health insurance cover my spouse?
Depends on whether you have statutory or private insurance. Being on statutory health insurance, she can be covered in so far as she has no income. Being on private insurance, she is not just because you have an insurance with a certain company. The reason for this is easy to explain because of the nature of the two different insurance systems. Statutory insurance finances itself by the solidarity of all payers. Married couples, both working, will both have to pay their premiums. The private insurance only covers the risk for the person insured.
What i the legal difference between statutory and private health insurance?
The difference in law is the private Civil Code with the fine print of the individual company in contrast to Social Code Book V for the statutory health insurance. The Social Code determines what is eligible for public coverage and what not. If a certain treatment is not covered by your statutory insurance, you will have to pay for it by yourself – unless you have a supplementary private insurance.
When can I get private health insurance?
Having a yearly income above a certain amount or being self-employed, you can choose between both types of insurances. There is virtually no way to switch between the systems, so you are locked in once you have made your choice. By the way, forget about dispensing health insurance. In Germany, it is mandatory. Even though you are entitled to choose, you can remain privately insured or sign up for a statutory health insurance as a so-called “freiwillig Versicherter” (voluntary insured person).
I heard from a health insurance company back home that I do not need to close an insurance policy here in Germany as my home coverage for students is also valid for Germany. Is this true?
Students from countries with which Germany has signed a social security treaty, which includes a health insurance clause, can continue to be covered by their home insurance company while they are in Germany. For further information, inquire at your institution's international office. But also in these cases, you still have to present proof of insurance coverage to the foreigners office (Ausländeramt) in Germany.
Which in general is better, statutory or private insurance?
Depends on your monthly liquidity, monthly income, how specialized your coverage is to be, and other factors. Choose a private insurance company: if you do not mind paying all upfront and then getting reimbursed later (except for hospital bills), or if you need flexible coverage, alternative medicine, and a private hospital room. Go with statutory insurance if you need minimum coverage, have a long-term illness or a family or if you are older. The statutory insurance company must insure you if you are not entitled to choose. This is only a very rough differentiation. Please contact an insurance agent for more competent information before signing a contract.
I’m applying for private insurance. Can you give me some hints what to pay attention to?
Be sure to list every serious illness you have had! Do not listen to any sales agent, who might play down your medical history to get you the lowest possible rate. If you had a severe illness reckon with a surplus on the premium, if they take you at all. If you have a minor orthopedic problem, this will cause a minor jump in your premium. But if you hide your medical history, and then get a giant bill shortly after signing the contract (which the company is then to refund), the company will claim you cheated them. They will cancel your contract and refuse to pay for treatments and hospital stays. On top of that, you may be barred from getting insured by any other private company or even by a statutory insurer. They will not even refund any premiums. All this is legal! So keep your common sense when any insurance broker or other people tell you that private coverage is only advantageous at a low cost!
What are the most typical advantages of private health insurance?
It is true that
- on a whole the private health insurance offers better coverage. However, this goes hand in hand that you have to “suffer” more “useless” tests and that there is a tendency you will be “overtreated”.
- the scope of medical services is much greater.
- you get preferred treatment. Hospitals and physicians will serve you on a preferred basis – simply because private insurance companies pay higher fees than the statutory companies.
- coverage is according to your personal need. You can exactly determine the tariff in relation to coverage you want and / or need. When you prefer treatment by a head physician, then book it! (Statutorily insured are not entitled to such.) You can also cover for a one- or two-bed room in the hospital.
- premiums are based on age, preexisting illnesses or disabilities and your personal co-payments (disregarding any employers co-payments). A higher co-payment significantly reduces the monthly premium.
- when you do not request the refund of a medical bill for one full year, you can receive up to three monthly premiums reimbursed.
- you are pensioned and want to save costs? You can switch to the basics tariff, which is comparable to the service range of statutory insurance or just cancel some “components” like head physician treatment or single room.
I just saw an interesting ad for insurance online? Will they be able to communicate with me in English?
Do not expect it. Most companies are reluctant to insure aliens with either no residency permit or one only recently obtained. Honestly, your health is much too important to neglect! Consider once privately insured, there is virtually no way back to statutory insurance!
How do I find the correct private insurance for me?
Good question – next question, please! In contrast to property insurance and other personal insurances, there is no ready comparison site and therefore no serious way to calculate what the differences in policies mean in coverage or cost. Your personal needs and preferences are too individual for a programmer to consider any and all possibilities.
I´ve heard that it´s now easier to move from the government health system to private health insurance. What has changed?
In the past you needed to earn more than the annual threshold for three calendar years in a row to move from the statutory scheme (GKV) to private health insurance (PKV). As of January 2018, you can change immediately if your salary is over the annual threshold - this has been fixed at € 4.537,50 for the year 2019.
How is the salary calculated?
Take your December gross salary, multiply by 12, add in any regular additional contractual payments such as your Christmas payment or holiday bonus. Most irregular payments such as performance-related bonuses don´t count for this purpose.
It looks like I can make the change. How do I it?
You could contact the health insurance companies directly, but there are a large number of different companies, they have many different and confusing combinations of coverage on offer, their English is seldom usable. Besides, some companies are reluctant to insure foreigners without a permanent residence permit. All this could be time consuming. Or try an independent insurance broker.
How does this work if I´m not working in Germany yet?
If you plan to start working in Germany and already earn more than €49,500 or equivalent - and will earn more than this in Germany - you should be able to join the private health insurance.