Guide to German health insurance
It is mandatory to have health insurance in Germany, and laws dictate whether you require German health insurance or private health insurance. Compare which German health insurance you need.
Germany has one of the best healthcare systems in Europe and foreigners living and working in Germany are eligible to access subsidised German healthcare services. However, to access German healthcare it is mandatory for all residents in Germany to have some form health insurance.
By law, everyone living in Germany needs to be insured for hospital and outpatient medical treatment through state or private health insurance. It is also mandatory to show proof of health insurance to apply for a German residence or work permit.
Once you are a resident in Germany, it is compulsory to be a member of either a statutory health insurance scheme (gesetzliche Krankenkasse, GVK) or a private insurance scheme (private Krankenversicherung, PVK); which insurance you are eligible to claim is largely dependent on your employment situation, explained below. Some exemptions can apply, for example, if you are an international student.
This guide explains which health insurance you must apply for to access the German healthcare system and how to compare health insurance policies:
- Health insurance for visitors to Germany
- Who must take out German state health insurance?
- Who must take out private health insurance in Germany?
- Costs of state health insurance
- How to register with German health insurance
- Why choose German private insurance?
- Health insurance for students
- Other costs and insurances
Citizens from the EU (Europe Union), EEA (European Economic Area – EU plus Iceland, Liechtenstein, and Norway) or Switzerland are allowed healthcare on the same basis as German nationals if they are travelling to Germany or are temporary visitors. To be eligible for state healthcare, you’ll need to get an EHIC (European Health Insurance Card), typically before you arrive. However, residents planning to stay longer than a year or those working in Germany should arrange either German state health insurance or join a private insurer.
Temporary visitors from outside the EU member area may be able to claim healthcare under reciprocal agreements with their home country, otherwise will have to pay for healthcare services. Your local government or the German consulate in your home country can advise you.
Around 90 percent of residents are covered by the German state healthcare scheme. Both EU and non-EU nationals working in Germany will also typically be subject to compulsory state healthcare (known as statutory sickness insurance, or gesetzliche Krankenversicherung, GKV) if they are:
- in paid employment or in vocational training, including trainees and apprentices, and earn less than EUR 56,250 per year (2016 figures);
- pensioners who have been insured for a sufficient period of time;
- receiving unemployment benefits or assistance;
- in some form of youth assistance (Jugendhilfe);
- students in an approved higher education institution;
- farmers or assisting family members;
- artists, writers and those in publishing professions (under the Artists Social Welfare Act);
- have no other access to healthcare services (under certain conditions.
Spouses, civil partners and children (up to age 23, or 25 if studying) of someone covered by state healthcare insurance are eligible for family co-insurance in certain conditions, without having to pay contributions, provided their income does not exceed EUR 415–450 each month, depending on the situation (casual or regular, respectively).
The vast majority of German workers remain on the state health insurance system, but it is possible to take out more extensive private health insurance in some circumstances. Swiss health insurance contributions are split between employers and employees, regardless of whether you use a private or public scheme.
Whether you are eligible to switch from a state to private health insurance fund is largely dependant on your employment status. If you earn less than EUR 56,250 per year (or around EUR 4,688 per month), it is compulsory for you to stay on the statutory system.
However, you can opt for either state or private insurance if you:
- are self-employed
- are a civil servant
- earn above the salary threshold
- have no basis to join a state insurance scheme
- a student who renounces their state insurance.
Private health insurance typically offers more extensive services and quicker waiting times plus you can have a better chance of finding English-speaking providers. In some cases, it can work out about the same cost as state healthcare. However, unlike the state health insurance, private insurance does not typically cover children and partners for free.
It is not always advised to switch to a private fund, as premiums are based on personal factors and prices increase with age, health risks and added family members. If you are young with few health issues and have sufficient income to pay the premiums, then switching to private insurance can be a viable option.
If you have serious health issues and have trouble being accepted into a private scheme, you can opt for a ‘Basistarif’, which obliges insurers to accept all cases under the same conditions as the government system.
If you move to Germany to live and work, you’ll need to register with a health insurance fund before you can use the German healthcare state system. If you have a salaried job, your employer will usually register you with a provider.
Payment for the German healthcare system is covered by German social security, while around 120 insurers are responsible for administering state healthcare access. In January 2015, the state healthcare contribution was reduced from 15.5 percent to 14.6 percent of net income. Generally, you’ll pay around half of this amount (around 7.3 percent up to a maximum monthly income of EUR 4,238) which is automatically deducted from your salary. You employer covers the remaining fee, at a cap of 7.3 percent.
In addition, state health insurers charge a ‘contribution rate’, which can fluctuate year-to-year depending on healthcare expenditure. The contribution rate varies between insurers and is only payable by the employee based on a percentage of their income. Your insurance fund is required to send notification of any changes to their contribution charges, in case you want to find a cheaper alternative.
You need to stay with the insurer you sign up with for at least 18 months, after which you can switch health providers at any time with two months’ notice. While some insurers have millions of members and others only have a few thousand, their service is unlikely to differ greatly, as each insurer must meet the government’s minimum regulations for healthcare. The additional contribution rate, however, is one factor to consider when choosing your health insurer.
The state insurance system, however, has come under pressure in recent years to cut healthcare costs, and co-payments have been increasing for certain medical treatments and medicines and are likely to increase in future. Now in some areas such as dental, orthodontic treatment and glasses, state health insurance only covers a small portion of the cost.
Away from the more specialist areas, state healthcare policies cover most types of medical treatment, including GP visits, hospital care (inpatient and outpatient), medical treatment, x-rays, sick leave, mental health care, rehabilitation, prescription drugs and giving birth in Germany. In some cases you may be subject to a co-payment (Zusatzzahlungen) towards the costs of treatment and prescription drugs.
For each quarter of the year that you seek medical help, you’ll need to pay a one-off charge of EUR 10. If you don’t require medical assistance, you won’t have to pay this charge, while if you require assistance several times in a three-month period, you only have to pay it once.
In some instances, it’s possible to purchase add-ons from private insurers – supplementary insurance (Zusatzversicherung) – to top up your state coverage for better hospital choice and treatment, more extensive dental coverage, no co-payment for prescription charges, no quarterly fee, treatment abroad and repatriation costs.
Usually, your employer will take care of registering you with a regional healthcare provider. However, you are free to choose the insurer of your choice, and can do so by informing your employer within two weeks of starting work. If you’re self-employed you’ll need to arrange your own registration with an insurer. It’s usually a fairly straightforward process taking your passport and residence permit to a regional office and filling out the forms.
Once you’ve become a member, your insurer will issue you with a card (Krankenversichertenkarte), which you’ll need to show each time you visit a doctor or specialist. Factors that might influence your decision are the insurer’s contribution rate, additional services they provide, ease of contact or, in some cases, you might find a provider with English-language information.
Around one-in-ten German residents opt for private health insurance.
While contributions to the state health insurance are based on your income, private health insurance contributions are based on your risk profile, which includes your age and medical history.
If you choose to take the private route, you’ll typically pay doctor’s fees upfront and then ask for reimbursement from your insurance company. Unlike state healthcare services, it’s important to remember there is the prospect of being out-of-pocket for a while after any treatment, although you’ll typically get a full reimbursement unlike in state healthcare where you normally pay part of the medical costs.
Around 40 companies oversee the private medical insurance market and there are lots of packages and combinations available to suit different budgets.
In general, private healthcare offers more extensive cover. In addition to the prospect of more specialist treatments and better accommodation, you’ll also have access to some doctors who restrict their practices to private patients, resulting in shorter waiting times, and you won’t need to pay any additional co-payments for medicine. It’s also much easier to find a doctor who speaks your native language if you’re a member of a private scheme.
Typically, you can choose the level of your excess or deduction fee, where you opt to pay up to a certain amount each year for your treatments. This is called a Selbstbehalt, and choosing a higher excess is one way to reduce your lower monthly contributions.
If you’re studying in Germany at a state-approved university or education institution, you’ll need to pay a premium for health and nursing care, which currently stands at around EUR 83 per month if you’re over 25 and don’t have any children; until age 25, children in education can be covered for free under their family’s health insurance.
After you turn 30 or complete your 14th semester, the premiums increase by around EUR 50 per month. International students who are not covered by their country’s healthcare system and can’t join the state system (such as overseas graduate students) can access health insurance from around EUR 26 per month.
Students will first be assigned to the compulsory state health insurance but can opt for private insurance if they request an exemption within three months of enrolment. Whichever system the student chooses, it is binding for the entire period of study.
State health insurance includes sickness benefit, with your employer paying your wages and salary for up to six weeks if you’re unable to work, and your health insurer paying 70 percent of your regular salary for a maximum of 78 weeks.
Statutory sick pay (Krankengeld) is paid up to the value of EUR 2,966 per month, so if you earn more than that you might consider purchasing additional sick pay insurance.
In addition to the 14.6 percent premiums paid for state healthcare, you must also become a member of the government’s nursing care scheme (Pflegeplichtversicherung), which covers the costs of meeting any nursing needs. This costs up to 2.6 percent of your gross salary.
Useful links (in Germany only)
- Minister of health: call 030 340 60 66 01 for information on health insurance.
- GKV Spitzenverband: the head organisation for state health insurance.
- PKV Association: the head organisation for private health insurance.
- Germany social insurances and benefits
Information on health insurance for foreign students: Hiffs and Deutsche Insurance (English available)
- A guide to the German healthcare system (English)
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