INSURANCE IN GERMANY

SIRTRARASAN BHARATHIDHASAN

ABSTRACT

• Germany has a reputation for having one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage•  Approximately 85% of the population are mandatory or

voluntary members of the public health scheme while the rest have private health insurance• Since 2009 it has been mandatory for all residents of

Germany to have either state or private health insurance• It is now illegal to be uninsured

• Germans are offered three mandatory health benefits, which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.• Accident insurance for working accidents

(Arbeitsunfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace• Long-term care (Pflegeversicherung) is covered half and half by

employer and employee and covers cases in which a person is not able to manage his or her daily routine• There are two separate types of health insurance: public health

insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung)

Government Health Insurance System (GKV)

• Most German residents (approx. 70 million people) are members of the government health system• If a person’s gross salary is less than 56,250 Euros per year, or

4,688 Euros per month in 2016 then membership in the GKV is mandatory.• The government health insurance scheme is administered by

approximately 120 Krankenkassen and they charge the same basic rate of 14.6% plus a possible median supplemental rate of 1.1% of a person’s eligible gross salary• The maximum monthly premium is 775 EUR [425-Employee and

350-Employer]

• The medical benefits provided include in-patient (hospital) care as a ward patient with the doctor on duty at the nearest hospital, out-patient care with registered doctors (Kassenärzte) and basic dental care• 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 any medical benefits outside of Europe

Benefits of Statutory Health Insurance

 The benefits of statutory health insurance change often. Some of the treatments covered are (as of 2015):• Medical and dental treatment, with free choice of doctors

and dentists• Hospital treatment• Drugs, dressings, complementary treatment, and aids such

as hearing aids and wheelchairs• Sickness benefit (Krankengeld)

• Measures for the prevention and early detection of certain diseases• Preventive dentistry and in particular individual and group

prophylactic measures• Orthodontic treatment, normally only up to the age of 18.• Immunizations• X-rays

• Patients covered by the state insurance system still need to pay 10 EUR per quarter year in case they need medical help in a period of 3 months• 10 EUR are paid for the first doctor’s visit during a quarter

of a year. If a person doesn’t make any visits in a quarter year, no payment is required• For multiple visits during a quarter of a year the price is still

10 EUR paid at the first visit• The dentist costs another 10 EUR for the first visit per

quarter.

Additional contribution

In the following cases, a person will have to an additional contribution to treatments and medicines (as of 2015):• The cost of dentures 20 - 70% of these costs may be paid

by the state.• A share in the cost of in-patient preventive treatment and

rehabilitation, out-patient rehabilitation, and in-patient hospital care (€10/day for a maximum of 28 days)• 10% of the cost of prescription drugs and dressings,

minimum 5 EUR and maximum 10 EUR

Private Insurance

• It is based on an individual agreement between the insurance company and the insured person defining the set of covered services and the percentage of coverage• It depends on the amount of services chosen and the

person's risk and age of entry into the private system• It is used to build up savings for the rising health costs at

higher age (required by law)

• Private health plans cover a wider choice of medical and dental treatment and provide broad geographical coverage• The private medical insurance market is served by about 40

German insurance companies•  Per person cost of full medical insurance is based on the

level of benefits chosen, as well as on entry age and any pre-existing medical conditions.• The government insurance premium also covers a person’s

non-working dependents, whereas the private medical insurance premium is generally paid for each person covered• 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 when you retire.

References

• http://www.howtogermany.com/pages/healthinsurance.html• https://www.justlanded.com/english/Germany/Germany-Gui

de/Health/Health-insurance• http://www.germanyhis.com/compulsory-health-insurance-g

ermany/• http://www.internationale-studierende.de/en/prepare_your_

studies/entry_into_germany/health_insurance/• https://www.gkv-spitzenverband.de/english/statutory_healt

h_insurance/statutory_health_insurance.jsp