|
| |
Health insurance in Germany
Statutory
health insurance (Krankenversicherung) safeguards you and your family in case of
illness:
• It pays for necessary medical treatment. The only exceptions are benefits you
claim after an occupational accident or because of an occupational illness. In
these cases you are covered by statutory accident insurance.
• It pays sickness benefit if your employer does not continue to pay your wage
or salary while you are unable to work.
Until the end of 1995, which health insurance scheme you were in depended on
your profession or who you worked for. As of 1 January 1996, anyone in a local,
company, guild or other statutory health insurance fund is free to choose which
fund they wish to be insured with (company and guild funds can only be chosen if
they have changed their statutes to accept outsiders). Special conditions apply
for entry into certain statutory health insurance funds like the Miners Social
Security Fund (Knappschaft) or the Maritime Health Insurance Fund (See-Krankenkasse).
It often pays to compare their rates.
Anzeigen
- What statutory health insurance
covers
- Who is insured
- Family insurance
- Patients’ contributions
- Funding
- Health
insurance for everyone. An opportunity for everyone to obtain coverage.
- Health
insurance for everyone is mainly a right to health protection for everyone
- Access
to the statutory health insurance (gesetzliche Krankenversicherung -GKV)
- Access
to the private health insurance (private Krankenversicherung -PKV)
-
Community works best if everyone shares in it
- Where you can get
information
What statutory health insurance covers
As an insured person you can claim:
• Measures for the prevention and early detection of certain diseases (children
in the first six years of their life and –new – at the beginning of puberty;
adults every two years from the age of 35). Women from the age of 20 and men
from the age of 45 are entitled to annual cancer screening)
• Preventive dentistry and in particular individual and group prophylactic
measures to prevent dental disease
• Preventive inoculations, excluding inoculations for non-work foreign travel,
as provided for in the articles of the relevant health insurance fund
• Orthodontic treatment, as a rule up to age 18
• Medical and dental treatment, with free choice among panel doctors and
dentists
• Medicines, dressings, therapies, and aids such as hearing aids and wheelchairs
• Medically necessary provision of dentures and crowns
• Hospital treatment
• Some or all the cost of necessary preventive and rehabilitation treatment
• Sickness benefit (Krankengeld): Normally, your employer will continue to pay
your wage or salary for six weeks when you are unable to work. After that your
health insurance will pay 70% of your regular wage or salary before deductions
up to the contribution assessment limit, though not more than 90% of your most
recent take-home pay. You can claim sickness benefit for a maximum of 78 weeks
in a given three-year period. If you are a farmer, you will receive an upkeep
allowance instead of sickness benefit, though agricultural health insurance
funds also pay sickness benefit to seasonal workers who are insured with them.
• Sickness benefit for up to ten days a year for each insured child under 12 who
you have to care for, subject to presentation of a doctor’s note and provided
that no other person living in your household is able to supervise, care for or
look after the child. If you are a single parent, your entitlement doubles to a
maximum of 20 days. If you have several children, your entitlement is limited to
a total of 25 working days, or as a single parent 50 working days per calendar
year. The entitlement extends beyond the age of 12 for sick children who are
disabled and in need of help.
• Home help if you have to go into hospital or undergo in-patient or
rehabilitation treatment, are unable to look after your home as a result, and
have a child living in your household which has not reached the age of 12 when
home help begins or which is disabled and in need of help
• Home nursing care if this helps avoid or shorten a stay in hospital or aids
your medical treatment
• Home nursing care for women when needed because of pregnancy or childbirth
• Social therapy for insured persons who have a severe mental affliction that
prevents them from accepting or taking medical treatment
• Maternity benefit (Mutterschaftsgeld) and maternity allowance (Mutterschaftshilfe)
during pregnancy and after childbirth. As a member of a health insurance fund
you usually receive child benefit for six weeks before and six weeks after the
birth (the statutory period of maternity leave), extended to twelve weeks after
the birth in the case of multiple or premature births. The amount depends on
your average wage over the last three months, or the last 13 weeks before the
benefit period. Your health insurance pays a maximum of €13 a day. Your employer
pays the difference between this and your average take-home pay for the duration
of the benefit period.
Who is insured
As an employee you are automatically and compulsorily insured if
your regular income before deductions does not exceed €400 per month and remains
below a set annual limit. The annual income limit up to which employed people
are automatically and compulsorily insured officially ceased to be linked to
pension insurance on 1 January 2003 and is now a general annual income limit,
with a separate annual income limit for privately insured workers. The general
annual income limit for 2006 is €47,250 and thus remains at 75% of the pension
insurance contribution assessment limit for blue and white-collar workers in
western Germany. For reasons of fairness, a reduced annual income limit of
€42,740 in 2006 applies for workers who were exempt from compulsory health
insurance because they exceeded the contribution assessment limit on 31 December
2002 and switched to an alternative private health insurance fund. This amount
is identical to the annual income limit applied in the state health insurance
scheme.
The following are also compulsory members of the state health insurance schemes:
• Students at state and state-approved universities
• People on work experience or in second-chance education
• Old-age pensioners who have been in a statutory health insurance scheme or
insured as a family member for most of the latter half of their working life
• Disabled people employed at an approved workshop or on employment promotion
schemes
• Unemployed people receiving benefits from the Federal Employment Agency (Arbeitslosengeld
and Arbeitslosengeld II)
• Farmers
• Members of farming families who are primarily employed on the farm and are at
least 15 years old or are in training
• Retired farmers who have claimed Altenteil (the right to continue living on
the farm after making it over to their children)
• Artists and members of the publishing professions as provided in the Artists
Social Insurance Act (Künstlersozialversicherungsgesetz)
You can within a period of three months join a state health insurance scheme
voluntarily if you:
• Have been a compulsory member, your membership is terminated and you have
certain qualifying insurance periods
• Are an employee and your income in your first job exceeds the limit, as long
as you apply for membership within three months of starting work
• Are severely disabled (subject to certain other requirements)
• Have been insured through a family member for a specific minimum period and
this insurance has expired
Please remember that the three-month restriction is an exclusion deadline after
which time later entry is no longer possible.
Voluntary members lose their health insurance cover by statute on expiry of the
next payment due date if for two consecutive months the payable contributions
have not been paid despite reminders being issued. Another requirement is that
once membership is terminated, voluntary membership of another state health
insurance scheme is not possible and that under the provisions of Book 12 of the
German Social Code, responsibility for payment of health insurance contributions
may be assumed by the agency paying welfare benefit. If you have difficulty
paying your contributions, please submit an application to your state health
insurance fund without delay, asking them to defer payment of the outstanding
amounts.
Voluntary members who wish to switch to a private insurer should consider the
fact that a later return to the state health insurance scheme is only possible
in very exceptional circumstances and should seek advice from their state health
insurance fund.
Family insurance
State health insurance also covers your family at no extra charge. Your spouse
or civil partner and, up to a certain age, your children are covered by your
insurance, provided among other things that their collective income does not
exceed € 345 a month and they do not have their own insurance (figures for
2005). If you are in marginal employment, the allowable collective income is €
400.
From 1 January 2004, health insurance meets the cost of medical treatment for
social assistance recipients who lack statutory health insurance. Their equal
status with members of the statutory health insurance schemes brings recipients
of social assistance under the statutory guarantee of appropriate and affordable
healthcare provision. The expenses incurred by health insurance funds are
refunded by the social assistance agencies.
All members of state health insurance schemes should report changes in their
working, financial and personal circumstances to their health insurance fund.
Those receiving unemployment benefit (Arbeitslosengeld and Arbeitslosengeld II)
must also report the changes to the local employment agency to prevent any
inadvertent loss of insurance cover.
Patients’ contributions
Health insurance has to be paid for in one way or another. This is why we cannot
expect it to help with every minor complaint; otherwise, it would soon become
unaffordable.
The insured share the responsibility for their own health. For this reason they
are required to contribute towards the cost of certain items. This is laid down
in the law on health insurance, which encourages people to be cost-conscious and
responsible in its use.
These contributions are necessary – but they must not be allowed to overstretch
your budget. The law takes account of this, so that in certain circumstances you
pay less or nothing at all.
Exemption from patients’ contributions:
Children and young people under the age of 18 are exempt from patients’
contributions except in the case of dentures and travel expenses
Contribution limit:
The limit for patients’ contributions is 2% of assessed gross disposable income.
The assessed income figure is arrived at by deducting an exempt amount for each
family member from family gross income and so depends on how many people are in
the same household and live off the income total. Larger amounts are deducted
for children than for adults. The deduction of exempt amounts from family gross
income means that the contribution limit varies according to the size of the
household. The exempt amount for the first dependant living in the same
household is 15% of an annual reference figure and comes to € 4,410 in 2006. The
exempt amount for each subsequent dependant is 10% of the same reference figure,
or € 2,940 in 2006. The amount for each child is €3,648 except that the first
child of a single parent is subject to the higher, first dependant’s exempt
amount of € 4,410. The older 10% rule for other dependants now applies in health
insurance for farmers only.
Family gross income means family disposable income before deductions: the sum of
all income that accrues to the insured and any live-in dependants and is
available for meeting living expenses. This includes rental income and capital
gains – types of income on which compulsory members of a health insurance scheme
do not pay any contributions.
Health insurance law is founded on the gross income principle. That is, a
person’s ability to pay into the system is generally measured by looking at
their income before deductions. A person’s health insurance contributions
likewise depend on their income before deductions. Accordingly, the same
measure, rather than net income, is used to set the limit for patients’
contributions.
The insured and the insured’s spouse or civil partner and any children for whom
the insured can claim must keep a record of all patients’ contributions paid
over each year. If the contribution limit is reached in a given year, the health
insurance fund must issue the insured with an exemption note for the remainder
of the year.
In departure from the law applying until 31 December 2003, the contribution
limit applies for all patients’ contributions, including those paid for hospital
treatment, in-patient preventive care and rehabilitation, none of which used to
be covered.
Concessions for chronically ill patients:
Special rules apply for chronically ill patients in acknowledgement of their
special situation.
Patients in ongoing treatment for the same illness have a lower contribution
limit of 1% of annual income before deductions. The Federal Joint Committee of
medical practitioners and health insurance funds is required by law to issue
directives defining what constitutes a chronic illness.
The Federal Joint Committee issued such a directive defining serious chronic
illness at its meeting of 22 January 2004. According to this definition, an
illness is deemed to be a serious chronic illness if it is medically treated at
least once a quarter for at least a year and at least one of three criteria is
met:
• The patient requires Level II or III care.
• The patient has at least a 60% disability under severe disability law/pensions
law or at least a 60% incapacity to work under accident insurance law.
• Continuous medical care is required (medical or psychotherapeutic treatment,
drug treatment, technical nursing, and provision with therapies and aids)
without which, on a professional medical appraisal, a life-threatening worsening
of the illness, a reduction in life expectancy or a lasting impairment of
quality of life is to be expected as a result of the illness.
The task of deciding if a patient has a serious chronic illness as defined in
the directive falls to the health insurance fund. From 1 January 2004, patients
who reach their contribution limit in the course of a year need to obtain a note
from their insurance fund exempting them from all patients’ contributions from
then on. The exemption applies for all family members living in the same
household.
Concessions for social assistance recipients and other groups:
Under prior law, recipients of welfare benefits under the Federal Social
Assistance Act (Bundessozialhilfegesetz), war victims welfare benefits or
benefits under the Pension Supplement Act (Grundsicherungsgesetz) were wholly
exempt from patients’ contributions. Recipients of these benefits are still more
favourably placed than other insured persons under the Statutory Health
Insurance Modernisation Act (Gesundheitsmodernisierungsgesetz), in that their
household assessable gross disposable income for the purpose of establishing
their contribution limit is equated with only the standard benefit rate for the
head of a household as specified in the Regelsatzverordnung – the ministerial
order in which the standard benefit rates are laid down (Book V of the Social
Code (SGB V), Section 62(2)).
Such benefit recipients must pay the patients’ contributions matching the
standard benefit rate themselves. The standard benefit rate is not upgraded. The
rate in western Germany is currently €345 a month excluding non-recurring items,
amounting to €4,140 a year. As of 1 January 2005, the corresponding patients’
contributions to be paid for the household by social assistance recipients each
year are as follows:
• 1% contribution limit (chronic illness): €41.40
• 2% contribution limit (without chronic illness): €82.80
This concession also applies for people whose costs of accommodation in a home
or similar establishment are met by a social assistance agency or war victims
support fund, and for the groups named in SGB V, Section 264 (social assistance
recipients for whom healthcare is provided by the statutory health insurance
scheme and recipients of regular benefit payments under Section 2 of the Asylum
Seekers Benefits Act (Asylbewerberleistungsgesetz)). That is, gross disposable
income for the entire household is equated with only the standard benefit rate
for the head of a household as specified in the Regelsatzverordnung. Social
assistance recipients in in-patient care can take out a loan to cover the
patients’ contributions. The loan is repaid by a reduction in the monthly
benefit payments.
For social assistance recipients living in homes, a standard statutory procedure
has been put in place (in an amendment to the law integrating social assistance
law into the Social Code) for helping in cases of – temporary – hardship. Under
the new provisions, the social assistance agency grants the affected individuals
a loan in the amount of the applicable contribution limit and pays it out
directly to the responsible health insurance fund. The latter issues the
affected pocket-money recipients a note exempting them from patients’
contributions.
The pocket-money recipients repay the loan to the social assistance agency in
fixed amounts over the entire calendar year.
Special hardship clause for dentures:
For dentures, there is a sliding scale in case of hardship. Please ask your
health insurance fund for details.
Information:
For further information, please contact your health insurance fund. They will
also give you a receipt book for payments you make towards the cost of
treatment.
Funding
Statutory health insurance is funded from contributions.
You pay half of the insurance contributions as an employee, and your employer
pays the other half. The same applies for pensioners who are compulsorily
insured and for their respective pension insurance funds. From 1 July 2005,
members of the statutory health insurance scheme also pay an income-linked
contribution of 0.9% to which employers and health insurance funds do not
contribute. Likewise from 1 July 2005, all statutory health insurance funds must
reduce their contribution rates by 0.9 percentage points. Recipients of
Unemployment Benefit II and those insured through a family member are exempt
from the additional contribution.
If you are a salaried employee and are voluntarily insured because you exceed
the income limit, you are responsible for paying your contributions yourself
although your employer will pay you a supplement amounting to half of the
contribution that would normally be paid to your insurance fund for a
compulsorily insured employee, the amount being restricted to exactly half of
the actual amount payable. Old-age pensioners who are voluntarily insured in the
statutory health insurance scheme or who are insured with a private health
insurance fund receive a contribution supplement from their respective pension
insurance fund.
The amount of your insurance contributions depends on your income and the
insurance contribution rate applied by your health insurance fund.
Note that your contributions are subject to a contribution assessment limit. In
2006 this is €3,562.50 a month. It is the maximum amount from which your
statutory health insurance contributions are calculated, even if your income is
higher.
From 1 April 2003, there is an additional concession for employees with a
monthly income between €400,01 and €800. Special rules now apply under social
security law for employees who fall within this income band. If your income is
within the band, the new rules provide for part of it to be exempt from social
insurance contributions. Employers are still required to pay their normal
contribution on the amount you earn. The arrangement is purely intended to
relieve the financial burden on employees. The employee contributions due on
earnings rise on a straight-line basis within the band. On average, employees
with an income of € 400.01 pay 4% of their total social insurance contributions.
The employee contributions to social insurance then rise over the income band,
starting from around 4% and finishing at the full employee’s half of the
contributions at the upper end of the range, when earnings reach € 800.
Welcome to solidarity.
Health insurance cover for all of Germany
Health insurance for
everyone.
An opportunity for everyone to obtain coverage.
We ultimately realise how important health care coverage is,
when we fall ill and have none. This could have happened to many people in
Germany at any moment in the past. To prevent this from happening in the future,
everyone will now be given the opportunity to become insured. All uninsured
persons will be given the right to re-enroll.
At the same time, however, no-one will be allowed to get a free ride on the
health insurance system by enrolling only when the health emergency has already
occurred. Consequently, from now on, everyone will be required to take out
insurance protection.
|
»My wife
and I have been living abroad for 30 years. Now we are pensioners and would
like to return to Germany. Will any health insurance take us in?«
Yes. Whether you come within the remit of the statutory or the private
health insurance system depends, among other things, on how you were last
insured in Germany. You can have this examined by a statutory health
insurance fund. If you come within the remit of the statutory health
insurance system, you will be able to enroll there from 1 April 2007. If you
are eligible for private health insurance, you can enroll there at the
standard premium from 1 July 2007. |
Health insurance for
everyone is mainly a right to health protection for everyone
All citizens who do not have health insurance protection will
be given access to health insurance again. Whether they fall under the statutory
or private system depends on how they were insured before.
Persons who were never enrolled, in either the statutory or private system, will
be included in the system for which they qualify as a result of their latest
occupation. Person working, for instance, as workers or employees can become
members of the statutory health insurance. Self-employed persons who were never
insured have, in any case, access to private health insurance.
|
»I am
self-employed and currently not insured.
My statutory health insurance fund disenrolled me because I was unable
to pay two months of contributions. Will I be able to get coverage again,
now?«
Yes. Since you were last enrolled in a statutory health insurance fund, you
must be insured in the statutory system again from 1 April 2007. Please
contact the health insurance fund you were last insured with. And there's
more good news: the monthly minimum contribution for self-employed persons
will be lowered from 1 April 2007 from about 250 to about 170 euros.
|
Access to the statutory
health insurance (gesetzliche Krankenversicherung -GKV)
From 1
April 2007, coverage in the statutory health insurance system (GKV) will be
mandatory. From that date, uninsured persons formerly insured in the GKV must be
re-enrolled in their previous health insurance fund. The fund may not turn such
persons down. Persons returning from abroad will also be re-enrolled in their
former fund or its legal successor.
Access to the private
health insurance (private Krankenversicherung -PKV)
1 July 2007 will see the introduction of the extended
standard rate in the private health insurance (PKV). It will be also opened up
to persons who have lost their private health insurance coverage. This also goes
for returning expatriates who do not have access to the GKV. For insurance at
the standard rate, the personal health status is irrelevant. There will be no
risk surcharge or carve-outs. Doctors are under the obligation to treat. From 1
January 2009, the requirement to take out insurance will also apply to the PKV.
At the same time, the new basic tariff that all private health insurers must
offer will be introduced.
|
»I am
divorced, living on maintenance and currently not health insured. Via my
husband, I had a derived entitlement to the healthcare scheme for civil
servants while I was married, and had taken out private health insurance.
Will I now be able to enroll in the statutory health insurance?«
Since you were last privately insured, you come within the remit of the
private health insurance system. From 1 July 2007, you will be able to take
out private insurance at the standard tariff. From 1 January 2009, you will
be required to take out private health insurance of a certain minimum scope.
|
The same will apply to insurance at the basic tariff: there will be no risk
surcharges or carve-outs. In terms of type, scope and amount, the services and
benefits provided under the basic tariff are comparable to those of the GKV's
service package. Standard tariff contracts will be automatically changed into
basic tariff contracts.
For privately insured persons, too, the affordability of health insurance will
now be ensured. After 1 July 2007, standard tariffs and basic tariffs may not
exceed the average maximum contribution payable in the GKV. If the insured can
prove that this will exceed their means, the contribution will be halved.
Persons who cannot afford even these rates will be granted a subsidy from the
social security office.
Community works best if
everyone shares in it
The introduction of mandatory insurance means that everyone
will contribute towards financial protection against personal illness. It also
prevents people from deliberately refusing to insure themselves on the
assumption that, when it comes to the crunch, the general public will have to
pay their medical bills, after all.
In the future, nobody can have their insurance protection fully withdrawn - for
instance as a result of contribution arrears. On the other hand, those who
insure themselves too late, for example when illness has already struck, will
have to pay unpaid contributions retroactively.
Make good use of this opportunity - for the sake of your own health, for our
solidarity-based community.
|
»I am
self-employed and lost my private health coverage because I was temporarily
unable to pay my contributions. Later on, no private health insurance would
take me on owing to a pre-existing condition. Do I stand any chance now?«
Yes. In the future, they cannot turn you down. From 1 July 2007 you will be
able to insure yourself at the standard tariff of the private health
insurance and, better yet, you can do so without any carve-outs or risk
surcharges. With the introduction of the basic tariff from 1 January 2009,
you will be subject to mandatory insurance. |
Where you can get
information
Were you last statutorily insured? If so,
please contact your former statutory health insurance fund or its legal
successor.
Were you last privately insured? If so, please also contact a
statutory health insurance fund for further information or a consumer
counselling centre.
Were you neither statutorily nor privately insured? In this
case you can contact any statutory fund to find out whether you fall under the
statutory or the private health insurance.
Federal Ministry of Health's citizens' hotline
With the citizens' hotline, the Federal Ministry of Health offers all citizens a
competent port of call for any questions they might have on health insurance
cover, the 2007 health reform and the statutory health insurance in general:
01805/996601* Questions on health insurance cover
01805/996602* Questions on the statutory health insurance
system
Independent patient counselling Germany
Neutral and independent information and support for all patients on all health
policy issues can be obtained at: 01803/117722**
* The fee is 14 cents per minute from a German landline.
Lines are open Mo – Thu from 8 a.m. to 6 p.m., Fri 8 a.m. – 12 noon.
** The fee is 9.9 cents per minute from a German landline.
Open Mo - Fri from 10 a.m. – 6 p.m..
Source:
www.bmg.bund.de
, 2007
Federal Ministry of Health
Disclaimer
1. Content
The author reserves the right not to be responsible for the topicality,
correctness, completeness or quality of the information provided. Liability
claims regarding damage caused by the use of any information provided, including
any kind of information which is incomplete or incorrect,will therefore be
rejected.
All offers are not-binding and without obligation. Parts of the pages or the
complete publication including all offers and information might be extended,
changed or partly or completely deleted by the author without separate
announcement.
2. Referrals and links
The author is not responsible for any contents linked or referred to from his
pages - unless he has full knowledge of illegal contents and would be able to
prevent the visitors of his site fromviewing those pages. If any damage occurs
by the use of information presented there, only the author of the respective
pages might be liable, not the one who has linked to these pages. Furthermore
the author is not liable for any postings or messages published by users of
discussion boards, guestbooks or mailinglists provided on his page.
3. Copyright
The author intended not to use any copyrighted material for the publication or,
if not possible, to indicatethe copyright of the respective object.
The copyright for any material created by the author is reserved. Any
duplication or use of objects such as diagrams, sounds or texts in other
electronic or printed publications is not permitted without the author's
agreement.
4. Privacy policy
If the opportunity for the input of personal or business data (email addresses,
name, addresses) is given, the input of these data takes place voluntarily. The
use and payment of all offered services are permitted - if and so far
technically possible and reasonable - without specification of any personal data
or under specification of anonymized data or an alias. The use of published
postal addresses, telephone or fax numbers and email addresses for marketing
purposes is prohibited, offenders sending unwanted spam messages will be
punished.
5. Legal validity of this disclaimer
This disclaimer is to be regarded as part of the internet publication which you
were referred from. If sections or individual terms of this statement are not
legal or correct, the content or validity of the other parts remain uninfluenced
by this fact.
|
