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German Healthcare System made easy for Expats

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Now that you have finally settled down in Germany, there are a few things regarding the German healthcare system that you need to know. This is also interesing for people thinking about coming to Germany. Learn more

Just like most their neighbors, Germany has a great healthcare system! Find out more below some of the core tenets of the German healthcare system

German Health Insurance

healthcare

In Germany everyone must have health insurance. Depending on the requirements you meet, you are compulsorily insured with a statutory health insurance company, you have to take out voluntary statutory health insurance or choose private health insurance. Members of a statutory health insurance company can in many cases also insure their children and spouses or partners in a registered civil partnership free of charge. 

The German statutory health insurance (GKV)

What is the task of the statutory health insurance?The main task of the statutory health insurance (GKV) is to “maintain, restore or improve the health of the insured”.

The insured are jointly responsible for their health.
Who is covered by the statutory health insurance?

All employees with an income below the so-called “income limit ” are compulsorily insured by statutory health insurance.

Contributions must be paid in the amount of the uniform contribution rate for all health insurance companies, but only up to the so-called 
contribution assessment limit . This changes from year to year
Who are the members of the statutory health insurance?By law, all workers and employees are compulsory members in the statutory coffers. 
Anyone who earns above the mandatory insurance limit can leave the system if they wish.
How do the contributions come about?For employees, the contributions are based on the amount of gross income (more precisely: the gross earnings subject to contributions). 
A percentage of 14.6% of this income is set as a general contribution rate (by the legislator)
Are there different amounts of contributions?The sum of the general contribution rate and the additional contribution rate results in the total contribution rate of a fund.
Can the doctor be chosen freely?Every citizen can freely choose his doctor. 
The only prerequisite for the benefit from the statutory health insurance (GKV) is that the doctor in question has a “health insurance certificate”.
Free choice of medical doctors

You are free to choose your general practitioner. 
However, in order to be able to use the services of a specialist without having to pay a new practice fee, you need a referral from your family doctor. 
This means that you can then freely choose the specialist.
Can the hospital be chosen freely?When choosing a hospital, it should be noted that treatment must take place in the nearest suitable hospital. 
If another hospital is chosen that charges the health insurance company higher costs than the hospital actually designated, the difference can be charged to the insured person.
How are the costs reimbursed?Statutory insurance does not have to advance the cost of treatment. 
The providers settle accounts directly with the health insurance companies.

In private health insurance (PKV), however, the costs usually have to be paid by the insured person first; 
these are then reimbursed by the insurance company.
Alternatives to statutory health insuranceAnyone who earns more than the mandatory insurance limit as an employee, is a civil servant or self-employed, can take out private health insurance (PKV) .

Here, the premiums are based on the individual risk and the entry age. This leads to much more differentiated contributions, some of which are far below those of the statutory health insurance (GKV).

For many privately insured persons, however, the much more extensive benefits such as
• Very high performance for dentures, also for gold crowns etc.
• Single room with head physician treatment in the hospital
• Treatment by alternative practitioners
• Alternative healing methods / natural medicine
• Payment of massages etc.
• No co-payments for medication
• Worldwide insurance coverage

However, private health insurance can also refuse members and each family member must have their own insurance. During parental leave or longer illness, the contributions usually have to be paid in full.
Private health insurance

Those who can choose are appealed to at a young age by the favorable contributions and high benefits offered by private health insurances. 
However, some companies have rightly taken advantage of the ignorance of the insured and caused premiums to rise exorbitantly with improper calculations. 
If you are interested in private health insurance, you should definitely not be attracted by low premiums, but rather check the actual quality of the insurance.
What is long-term care insurance?

Long-term care insurance is the youngest branch of social insurance alongside statutory pension insurance, statutory health insurance, statutory accident insurance and statutory unemployment insurance.

The long-term care insurance funds are usually linked to health insurance. 
If you need care, you pay relatives or care services so that the person concerned can be adequately cared for.
Care insurance

Regardless of whether you have statutory or private health insurance: long-term care insurance is a must! 
The contributions are practically identical everywhere, so that they should not play a role in the decision of a health insurance company.
When is someone in need of care?

Someone is only in need of care if they need substantial help on a permanent basis, but for at least six months, because of a physical, mental and / or emotional illness or a disability in the usual and regularly recurring activities of daily life.

The assessment of the medical service on the classification into one of the five care levels is decisive.
What services are there?

Recipients can choose between a low cash benefit or a higher benefit in kind for the use of professional care services.
healthcare

Why everyone has to have health insurance in Germany

What every Expat in Germany should remember about health insurance in Germany:

  • Employees who earn less than 62,550 Euros gross per year (as of 2020) must be covered by statutory health insurance. This salary limit increases every year.
  • If you earn more or are not compulsorily insured for another reason, you must take out voluntary statutory health insurance or take out private health insurance. The latter applies to the self-employed and civil servants.
  • In some cases, you can get exempt from compulsory health insurance and get private health insurance even though you earn little. This decision cannot always be reversed and should be carefully considered. 

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Who has to take out statutory health insurance?

In principle, all employees whose gross wages do not exceed the currently applicable annual income limit (compulsory insurance limit) are compulsorily insured in statutory health insurance . For 2020 this is 62,550 euros or 5,212.50 euros per month. In addition to the current monthly salary, this also includes regular annual payments such as vacation or Christmas bonuses.

The legislator regularly increases this salary limit at the turn of the year. If the regular income of an employee falls below the limit as a result, he or she becomes subject to health insurance. It has no effect on the compulsory insurance if the income is only temporarily below this limit due to short-time working or reintegration. 

If, as a privately insured person, you fall below the annual income limit, you have a special right of termination. In this way you can return to statutory health insurance. However, you can also be exempt from compulsory insurance.

The compulsory insurance is regulated in the Social Security Code (§ 5 SGB V ). In addition to employees, the following persons are obliged to take out statutory insurance:

  • Apprentices, students and interns who carry out an internship as stipulated in study or examination regulations without pay;
  • Interior and retired pensioners if they were long enough insured by law; 
  • Recipients of unemployment benefit or maintenance allowance in accordance with SGB III and, under certain conditions, recipients of unemployment benefit II;
  • Agricultural and forestry entrepreneurs and their working family members in agriculture as well as retirees who have handed over their business to the next generation and receive from them, for example, maintenance payments; 
  • Artists and publicists ;
  • People without any other entitlement to coverage in the event of illness, who were last covered by statutory health insurance or who can be assigned to statutory health insurance.

Exemptions from compulsory insurance

People who are self-employed or freelance as well as civil servants, judges and temporary soldiers are not subject to statutory health insurance. In addition, the compulsory insurance from the statutory health insurance for employees ends if their annual gross income exceeds the applicable annual income limit.

As soon as you become compulsorily insured

If you are required to have insurance as an employee, you must decide on a health insurance company within two weeks. After the deadline, the employer can register you with a health insurance company of his choice. 

Everyone can freely choose which statutory health insurance company they want to become a member of. Since the health insurance companies differ in terms of contribution and small parts of their benefits, it is worth making a comparison. 

Who can voluntarily take out statutory insurance?

If you are not or no longer required to take out insurance, you must either take out voluntary statutory health insurance or take out private health insurance (PKV) . The following applies: Nobody who was previously in a statutory health insurance company has to leave it. Entrepreneurs in particular do not have to take out private health insurance, but can and should usually take out voluntary statutory insurance.

As soon as employees who were voluntarily insured retire, they are either compulsorily insured in the health insurance of the pensioners or must continue to insure themselves voluntarily. Membership in the health insurance of pensioners has the advantage that fewer contributions are due.

Who can be exempt from compulsory health insurance?

  • Even if you are actually required to have insurance, you do not always have to stay in the statutory health insurance. In some cases ( § 8 SGB V ) you can be exempt from compulsory health insurance and take out private insurance. This applies, for example, to the following events:
  • After the legislature increased the annual income limit, your income is now below the limit;
  • You become unemployed and have not been legally insured for five years;
  • You are not fully employed during parental leave. This is the case, for example, if you work a maximum of 30 hours a week;
  • You have cut your hours to look after a family member;
  • You reduce your working hours to a maximum of 50 percent, which means that for the first time in at least five years your regular income no longer exceeds the annual wage limit;
  • You retire and become compulsorily insured in the health insurance of the pensioners ;
  • You are doing a retraining or further education funded by the pension insurance ;
  • You are starting your studies or doing an internship such as an internship;
  • You are a doctor and are doing an internship; 
  • You have a disability and you work in an institution for disabled people.

How do I get exempt from compulsory health insurance?

You must submit an application to a statutory health insurance company in order to be exempt from compulsory insurance. You can usually request the application from the cash registers online or by telephone. 

If you submit the application before the start of compulsory insurance, you can do so with any health insurance company. Please note, however, that you will also be insured with this if the health insurance company rejects the application. If you are already legally insured, your previous health insurance company is the right contact.

The application must be received within three months of the start of compulsory insurance. For example, the following applies to an employee previously privately insured whose income in 2020 is below this limit due to an increase in the annual income limit: He or she must submit the application by March 31, 2020 at the latest, because compulsory insurance came into effect on January 1, 2020. 

The application will only be approved if you can prove that you are covered by other means. This is the case if you have private insurance or are entitled to benefits or free medical care.

If you have not yet used any benefits from the statutory health insurance fund, the exemption applies from the day on which you are required to take out insurance. Otherwise only from the month after you submitted the application.

healthcare

German Child Healthcare

The statutory health insurance in Germany covers your children until the age of 18. Generally, all pediatricians will provide healthcare for children up until the age of 12 when they transfer to a GP. Around 90% of German children aged under 6 are seen primarily by a pediatrician. In addition, you are free to choose a pediatrician for your child.

Health examinations for children and adolescents

If you are an Expat in Germany with children, your children will also get health examinations as benefits of the statutory health insurance in § 26 SGB V set. The Federal Joint Committee (G-BA) specifies the content, times and structure of the examination program in the directive on the early detection of diseases in children (children directive).

The so-called “individual U-examinations” for children consist – in addition to special screening examinations for certain diseases – of physical examinations of the child as well as advice to the parents.

In addition to the early detection of illness, the doctor checks whether and, if so, which individual stresses and health risks are present in the child and advises the parents on how they can reduce them. If necessary, the doctor can issue a prevention recommendation and refer to regional parent-child offers.

In addition to the statutory examinations of the U examination program, a number of health insurance companies offer additional examinations, especially for children of primary school age (U10 and U11) and for young people (J2). Their examination spectrum is not specified by the G-BA. The costs are taken over by individual health insurance companies as a voluntary service.

healthcare
U1 Initial examination of the newborn immediately after birthRecognition of life-threatening complications and diseases and malformations that require immediate treatment, pregnancy, birth and family anamnesis, control of breathing, heartbeat, skin color, signs of maturity
Extended newborn screening 2nd – 3rd day of lifeEarly detection of congenital metabolic defects and endocrine disorders (e.g. also for cystic fibrosis)
Newborn hearing screening up to the 3rd day of lifeHearing screening to identify bilateral hearing impairments from a hearing loss of 35 decibels
U2 3rd – 10th day of lifeRecognizing congenital diseases and essential health risks, avoiding complications: taking anamnesis and detailed examination of organs, sensory organs and reflexes
U3 4th – 5th week of lifeExamination of the age-appropriate development of reflexes, motor skills, weight and reactions, examination of the organs, query of drinking, digestive and sleeping behavior, examination of the hip joints for hip dysplasia and dislocation
U4 3rd – 4th month of lifeExamination of the age-appropriate development and mobility of the infant, the organs, sensory organs, genital organs and the skin, examination of growth, motor skills and nervous system
U5 6th – 7th month of lifeExamination of age-appropriate development and mobility, the organs, sensory organs, genital organs and the skin, examination of growth, motor skills and nervous system
U6 10th – 12th month of lifeExamination of age-appropriate development, organs, sensory organs (especially the eyes), control of the musculoskeletal system, motor skills, language and interaction
U7 21st – 24th month of lifeExamination of age-appropriate development, recognition of visual disturbances, test of language development, fine motor skills and body control
U7a 34th – 36th month of lifeFocus on age-appropriate language development, early detection of visual disturbances
U8 46th – 48th month of lifeIntensive examination of the development of language, pronunciation and behavior, examination of mobility and coordination skills, reflexes, muscle strength and tooth status
U9 60th – 64th month of lifeExamination of motor skills, hearing, eyesight and language development in order to identify and counteract any illnesses and undesirable developments before starting school
J1 13-14 years of ageExamination of the general state of health and growth development, the organs and the skeletal system, survey of the vaccination status, examination of the state of puberty development, mental development and the occurrence of mental abnormalities, school performance problems and harmful behavior (smoking, alcohol and drug consumption), advice Basis of the individual risk profile of the adolescent on possibilities and aids to avoid behavior which is harmful to health and tips for a healthy lifestyle
6th – 72nd month of lifeA total of six dental early diagnosis examinations for dental, oral and jaw diseases, including a detailed examination and inspection of the oral cavity, assessment of the risk of caries, advice also to legal guardians on oral hygiene and nutrition, motivation for prophylaxis and recommendation of suitable fluoridants
6-18 years of ageIndividual prophylactic services including a survey of the oral hygiene status, education of the insured person and, if necessary, their legal guardians about the causes of the disease as well as their avoidance, motivation and remotivation, local fluoridation and sealing of caries-free fissures and pits in molars. From the age of twelve, the six-monthly examinations are entered in a bonus booklet; These entries are intended to demonstrate regular dental care and increase the fixed allowances if dentures should later become necessary
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