Health Insurance

Health insurance in Germany is divided into two different systems:

• statutory health insurance and
• private health insurance.

The majority of the population (around 90%) has statutory health insurance. Health insurance offers financial protection in the case of illness and motherhood, as well as in the case of many accidents.

In principle, a general obligation for all people domiciled or permanently resident in Germany to have health insurance has existed since 1 January 2009. Accordingly, every adult person who lives and works in Germany must provide evidence that he has taken out health insurance for himself and his minor children.

Statutory health insurance

In the case of statutory health insurance, a distinction is made between compulsory insurance and voluntary insurance. In certain circumstances, there is the possibility of contribution-free family insurance.

Statutory health insurance is part of the standard system provided for under German social insurance law. Unlike in the case of private health insurance, all insured persons pay their health insurance contribution into the statutory health insurance fund similarly, whether they are young or old and whether they are permanently ill or healthy. The insured’s contributions are assessed on their economic ability to pay. The benefits are in theory the same for everyone. All insured persons receive the medical services which they require, regardless of their monthly contribution. The scope of the services provided is established by law. Services are guaranteed in the following areas:

• disease prevention;
• early detection of disease;
• treatment of disease;
• services relating to medical rehabilitation, where these are intended to prevent, remove or alleviate a disability or the need for care and
• pregnancy and motherhood.

Compulsory insurance in the case of statutory health insurance

The compulsorily insured circle of people and the requirements for the coming into effect of the obligation of insurance is established by § 5 of Book V of the Social Code. The persons mentioned there have insurance cover by virtue of compulsory insurance. Among others, the following people are obliged to have insurance:

• workers, employees, and trainees;
• recipients of benefits according to Book III of the Social Code;
• recipients of unemployment benefit II who are not covered by family insurance;
• artists and publicists;
• disabled people;
• students and training placement employees;
• pensioners and pension applicants;
• people who do not have any other entitlement to insurance in the event of illness and who were last covered by statutory health insurance or
• people who have so far not been covered by either statutory or private health insurance, but who are classed as being covered by statutory health insurance on account of their professional activity.

The amount of the contribution is based on the income of the insured person. The contribution is calculated as a percentage of work income:

• The general rate of contribution with regard to statutory health insurance has been statutorily established as being 15.5% since 2011.
  • Workers and pensioners pay 8.2% of their income on which they are liable to pay contributions or their pension.
  • Employers or the statutory pension insurance scheme pays 7.3%. When calculating the contribution, the latter is, however, only considered up to the contribution assessment threshold (2012: 45,900.00 euros).
• In the case of unemployed people, the recipients of unemployment benefit II and subsistence, the Bundesagentur für Arbeit (‘Federal Employment Agency‘) bears the cost of the insured’s contributions which are to be paid. The insurance starts to apply from the start of the receipt of benefits. Recipients of income support receive the same benefits as people covered by health insurance.

TIP: After the amount of 45,900.00 euros, there is the possibility of voluntary insurance in the case of statutory health insurance (see below).

• Voluntary statutory health insurance

Statutory health insurance offers the possibility of voluntary insurance. The circle of people eligible to accede to the insurance is established in § 9 of Book V of the Social Code. Able to take out voluntary health insurance are

• employees whose normal annual remuneration has exceeded the compulsory insurance threshold (2012: 49,500.00 euros) and
• people who have left family insurance or
• former employees who have become self-employed.

TIP: Those starting out in a career and who have a work income which is above the compulsory insurance threshold also have the opportunity to take out voluntary insurance. In this case, the existing right to choose can be exercised within three months of the start of employment. The same right exists in the case of those who start employment in Germany for the first time.

The contribution to voluntary statutory health insurance is assessed on the basis of the insured person’s overall economic ability to pay. In this respect, all income of the insured person is in principle taken into account, including income from

• capital investments,
• leases and pledges, and
• pensions which have been paid out.
• The partner’s income is also included.
• There are tax-exempt contributions for children.

When calculating the contributions, the income of the insured person on which the assessment of contributions is to be based in the case of a similar employee who is liable to pay contributions is at least taken into consideration.

The bases for the assessment of contributions change on an annual basis. In the year 2012, a basis for the assessment of the contributions of

• at least 875.00 euros and
• no more than 3,825.00 euros

is assumed when calculating the contributions.

• Sentence 2 of paragraph 4 of § 240 applies to people whose main occupation is on a self-employed basis and who are voluntarily insured by a statutory health insurance fund. The health insurance fund initially assumes an income which is the amount of the contribution assessment threshold (2012: 3,825.00 euros).
• If the insured person provides evidence of a lower income, the latter will be taken into consideration. However, the “minimum limit“ is regarded as being a 40th of the monthly income (2012: 1,968.75 euros).
• In cases of particular hardship and in the case of self-employed people with a low income. A lower minimum basis for the assessment of the contributions is used as a basis for the establishment of the income on which contributions are liable to be paid (2012: 1,312.50 euros)).

Family insurance in the case of statutory health insurance

If a person is covered by statutory health insurance, family members who are domiciled in Germany can have joint insurance or family insurance cover without having to pay any contributions,

• if they have no income or
• if they only have a small income.
• Children and young people up to the age of 18 are jointly insured.

The age limit depends on whether children are in education or not.

• Students and training placement employees are usually covered by family insurance up to the age of 25. However, there are certain rules which apply if the latter work in addition to participating in education.
• A child is covered by family insurance without any age limit if he is disabled and unable to maintain himself on the basis of Book 9 of the Social Code. The requirement is that the onset of the disability occurred at an age when the child was covered by family insurance.

The individual requirements for having access to family insurance are established in § 10 of Book V of the Social Code. The possibility of family insurance is one of the advantages which distinguishes statutory health insurance from private health insurance.

Private insurance

In the case of private health insurance, people who are not subject to compulsory insurance in the case of statutory health insurance and who are to this extent free to choose their insurance cover can insure themselves.

• Employees whose regular annual employee remuneration has exceeded the threshold for compulsory insurance must insure themselves privately as must
• self-employed people and
• officials who are not voluntarily insured in the case of statutory health insurance.

The benefits of private health insurance are set at an individual rate. The amount of the contribution is based on the respective health risk of the insured person at the time of his entry into the insurance scheme. The higher this is, the more expensive the insurance contribution can be. Where there is a high health risk, the taking out of private health insurance at the full rate can be refused.

Since 2009, private health insurance funds have had to offer a basic rate which corresponds to the catalogue of benefits of statutory health insurance and which must be granted without examination of the insured person’s state of health.

Attention: In the case of private health insurance, the principle of the reimbursement of costs applies; i.e. whoever is privately insured must pay the costs of treatment and medicines in advance and the latter are refunded by the private health insurance fund.

Insurance cover abroad

The costs of treatment abroad are only assumed by statutory health insurance funds if intra- and supra state agreements exist with the relevant state in connection with this. Such agreements exist with Member States of the European Union and a number of other states.

The health insurance fund will then provide you with a health insurance certificate or an expanded insurance card. Irrespective of this, it can also make sense to take out private foreign health insurance.

TIP: Before you travel abroad, find out from your health insurance fund whether relevant social insurance agreements have been concluded with those countries in which you will be staying.

Freigabevermerk

Sächsisches Staatsministerium für Soziales und Verbraucherschutz; Quelle: Health Guide for Migrants in the Free State of Saxony 17.04.2024