Home 
Germany Brief overview of the German health system
Germany Brief overview of the German health system | Brief overview of the German health system |
|
|
|
If you are considering living in Germany, you will basically have three options; the government-regulated public health insurance system (GKV), private health insurance from a German or international insurance company (PKV) or a combination of the two. You can opt for full private plans only under certain circumstance, with the two most common being: if your income is above a certain threshold or if you are self-employed. Making sure that you find the best service provider of state health insurance or finding the most suitable coverage from a private health insurer at a competitive rate is not always easy but it is well worth the effort. As people have different requirements or expectations from health insurance, it is important to understand the system in order to find the most suitable plan for you. Given that if you have a gross salary is below €48,600 per year, which roughly equates to €4,050 per month, (2009 figures) then membership in the GKV is mandatory. The government health insurance scheme is administered by Krankenkassen, and they all must charge the same rate. As a consequence of this, there is no longer competition based on price but only on service and possible refunds. The cost of government health insurance is currently 15.5 % of your eligible gross salary to a maximum monthly limit of €3,675 income. If you earn more than this you do not pay a higher insurance premium. Assuming you pay the maximum monthly premium of €570 as an employee earning at or above the threshold and are therefore a voluntary member, your contribution is in the region of €300 Euros and your employer pays approximately €270 Euros. The benefits include in-patient (hospital) care as a ward patient with the doctor on duty at your nearest hospital, out-patient care with registered doctors (Kassenärzte) and basic dental care. Regrettably, with such health insurance, there is no coverage for private doctors or surgeons, a private room in hospital, alternative/homeopathic medical care, dental implants, and vision products for adults or benefits outside of Europe. Your non-working dependents living at your address in Germany are presently insured at no additional cost and simply need to be registered with the Krankenkasse. You and your dependents must also become members of the government long-term nursing care scheme (Pflegeversicherung). This covers some of the cost of meeting personal nursing needs, such as the feeding and bathing of those who become substantially disabled. This presently costs 1.95% or 2.2% of your gross salary (maximum of approx. 80 Euros per month) of which your employer pays half. You can switch government health fund providers by giving two months notice if the premiums are increased. The general minimum period of membership with a Krankenkasse is 18 months. Essentially, if you would like supplemental insurance coverage to top up the government system benefits, you can purchase a supplemental policy from any private insurance company, German or international; if, for instance, you would like a private doctor and a private room in hospital, homeopathy and other alternative treatment or higher dental reimbursements. Emergency evacuation from places outside Germany and travel insurance should also be considered as these are not paid for by the state health insurance plan and their cost is low. Furthermore, Public health insurance funds have recently begun to offer supplemental insurance plans from a particular provider, offering a group rebate. Please be aware that you would then be committed to them for three years and could not cancel even if premiums are increased. Such tied plans are largely unnecessary as you have a wider choice of benefits on the private health insurance market. Generally, private health plans cover a wider choice of medical and dental treatment and provide broad geographical coverage. By having private health insurance you are considered a private patient and can expect more service from the medical profession; the costs are also higher than for government patients. The hospitals and doctors depend to a certain extent on private patients to supplement their incomes and therefore welcome them. A private patient can also request and will often get, doctors who speak their native language. Understandably, the government insurance premium covers you and all your non-working dependents, whereas the private medical insurance premium is generally paid for each person covered. You can reduce the monthly cost of your private insurance by agreeing to a deductible. German private health insurance companies are not allowed to cancel your policy if you submit claims and are also required to put 10% of your premiums aside as a provision towards keeping the cost stable at retirement. Caution should always be exercised if you are considering purchasing an expatriate health insurance as a substitute for the government scheme because many of the foreign insurance companies are not registered with the "BaFin" to do business in Germany. Even those that are find their health insurance plans do not meet the standards set in the new reforms. The crux is that the German government insists that there may be no set upper limits on reimbursement levels and there may be no annual out-of-pocket deductibles higher than 5,000 Euros. Other issues involve how the insurance premiums are calculated. The present situation in 2009 is that few of the expatriate health insurance companies may legally provide a certificate recognized by all visa authorities in Germany. Whether or not this will change depends on the German's fully recognizing European directives for cross-border selling of health insurance for non-Germans seeking a residence permit. You may choose to purchase private health insurance (Private Krankenversicherung or PKV) instead of joining the government health plan if your gross salary is more than €48,600 per year. Self-employed persons, German civil servants and those persons working part-time and earning less than €400 per month are also eligible. Keeping with this, if you are an employee, you must also prove that you earned more than the threshold amount of income in each of the past 3 calendar years. If not, you will automatically be registered as a compulsory member of the government system and will not be able to change to a private insurance plan until you have met this requirement for 3 consecutive years. Incidentally, this is the result of the newest health insurance reform and is intended to force those people earning higher incomes to remain in the government system for a longer period of time. Now, if on arrival in Germany you wish to be privately insured, you will need to inform your employer promptly to avoid possible confusion; otherwise, you may find yourself automatically registered in the government system. On the other hand, if you have earned above the earnings threshold in the past 3 years and will do so in the coming year, have never been previously insured in Europe in a government scheme at all or cannot prove that you were a member of the German government health insurance for at least 36 months in the past 5 years you will be forced to purchase a private health insurance plan as you do not qualify as a voluntary member of the German state system. Given that if you purchase a private medical insurance plan from a German health insurance company that provides a certificate recognized by the German government (Par. 257 SGB V Arbeitgeber-bescheinigung) you may take advantage of the same employer subsidies as a government plan member. This translates to roughly €290 per month of employer subsidy towards the cost of your private health insurance policy. If such certification is not provided, however, your employer has the option, but is under no obligation, to compensate you for part of the cost of your medical insurance. Most German employers now demand this certificate as proof that your insurance benefits meet the regulations. Furthermore, another measure of the health reform bill of 2007 is that all self-employed persons had to be insured after July 1, 2007 and can purchase private health insurance if they were previously privately or even uninsured. It is now illegal to be uninsured. Regulations, as they now stand, state that German private health insurance companies are now forced to accept all applicants, irrespective of their health situation, in their "Basistarif" which has become available from January 1, 2009. In other words, if you have a serious pre-existing medical condition and cannot be accepted into normal private health insurance tariffs, you can purchase this tariff as a last resort. It offers similar benefits to the government system and the cost is capped at the rate of the Krankenkasse. The rate is around €570 per month for each adult and €250 per dependent child. Alternatively, if you are basically in good health, you could try to purchase suitable benefits plans from a private health insurance company, but we would suggest that you consult a fully regulated and qualified insurance broker specialized in expatriates, like ourselves. Unless regulations change, if you would like to keep the non-German insurance please note that you must in any event still pay into the government long-term nursing care scheme (Pflegeversicherung) and may also wish to purchase supplemental sick pay insurance. This may be difficult to find as German insurers are not particularly keen on insuring self-employed foreigners. Depending upon whether you are self-employed and were already covered by an international insurer before the cut-off date of April 1, 2007, you should always check to make sure your coverage is suitable for living in Germany as you will probably need to prove that your insurance is still in force and provide some certification in the German language to the visa authorities. Summarising, some the current basic facts regarding the German Health service are as follows:
This is our current understanding of the German State health scheme (GKV) and no liability whatsoever can be accepted for any errors or omissions contained therein.
|
Bookmark This Site?
RSS Syndication:
