Germans tend to be overly cautious, and healthcare in Germany reflects this fact. Generally, locals and expats report that this central European nation offers good primary health care, good hospitals and also capable dentists.
Medical professionals commonly speak English, though different levels of proficiency exist.
Health insurance in Germany
Since 2009, Germany has instituted a system of compulsory health insurance, which comes along with statutory nursing care insurance.
Expats who have a residence permit or a fix-term permit for more than twelve months come under this law. In light of the law, you have to sign up instantly for a health insurance, either through a private health insurance provider or through the statutory health insurance system (state-provided).
Health insurance in Germany consists of three segments: Outpatient, in-patient and dental.
Expats from both EU nations and non-EU nations can take advantage of the state insurance plan, if they are employed by a formal company.
However, those expats who are self-employed or freelancers are legally obliged to take out private insurance, if they are not eligible for statutory insurance (which most are not). That said, most private insurance providers will only grant coverage to expats with a residence or a work permit, a document that many self-employed or freelancing expats do not have. Furthermore, to get a residence or work permit, it is required expats have health insurance fulfilling German standards (thus a Catch-22 occurs).
Expats in the situation above should request help from an experienced consultant to deal with the situation.
Statutory health insurance vs. private insurance
In Germany you have two main systems for health insurance, but not every person is free to choose between the two.
For most professionals the following guidance applies:
An employee has to be insured in the statutory system, unless his or her revenue exceeds a specific amount. By reaching a particular yearly gross income, expats qualify to choose whether to stay in statutory insurance, or to sign-up for a private health insurance scheme.
Employers share the burden of health insurance costs with their employees, usually paying half of the insurance; though, employer contribution does have a ceiling limit.
A self-employed person or a freelancer is free to choose either a statutory scheme or a private scheme regardless of their annual gross income. Though, only those self-employed individuals formerly registered with statutory insurance (as a student, with a company, as a child) can engage in this option once self-employed. If you want to check your situation, the best way to do this is to ask your consultant for a status-check.
Self-employed individuals will also need to be aware of the laws surrounding their status (i.e. Having an employee changes your status).
Differences between statutory and private insurance
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Statutory Insurance |
Private Insurance |
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Costs |
Contributions related to your income but capped (solidarity principle) (in 2011: 15,5%; monthly cap: 3712,50 Euro) |
Contributions related to plan and risk of individual (cost-of-service principle) |
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Benefit |
Standard benefit (suitable, necessary and economical) |
Customers choice (medical necessary but higher standards and according to the customers’ requests) |
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Legal Basis |
Social security statutes part 5 |
General business terms and particular treaty |
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Institution |
Statutory health insurance |
Insurance companies |
Statutory insurance
Expats insured with statutory insurance will receive the standard benefits.
A big advantage of statutory insurance is that your family (non-working husband/wife and your children up to a certain age) is covered for free. Private health insurance schemes generally require that extra paid protection is taken out for children.
Do note that children are insured under the same plan of the parent with the higher income, if both parents are working.
Benefits of statutory insurance
Outpatient
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Free to choose your doctor if he/she is working with the statutory insurance (you have to pay a small practice fee for a medical round each quarter and doctor; you can avoid paying for the second doctor in a quarter by being referred to him/her from the first one)
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Regular check-ups
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Medication (not free to choose and you may have to make out-of-pocket payment)
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Standard immunisation
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Therapy of protracted illness and results of an accident (including after-care)
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Med clinical substance (physiotherapy) with an excess of 10 percent and 10 Euro per receipt charge (for patients older than 18 years).
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Therapeutic appliances, simple design and cost limits
Inpatient:
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Multi-bed rooms
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Regular doctors
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Patients older than 18 years have to pay an extra fee of per day for the maximum of 28 days a year.
Dental:
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100% dental treatment but using simple materials
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50% artificial teeth (percentage can be raised up to 80% by proving a check-up once a year) but also using ordinary materials
A person insured with the statutory insurance might increase the level of coverage by establishing some extra protection coverage with a private company.
Private health insurance
The benefits of a private insurance depend on the plan you choose. Different coverage schemes allow you to choose the quality of the professional from which you will receive treatment, and the quality of the materials being used (for example: in-patient-treatment from a senior consultant having a room on your own, premium restoration and implants if it comes to dental treatment, valuable medication and therapies in out-patient-care).
Costs also vary depending on the plan you choose. There are no minimum or maximum premiums – it varies based on the company you select. Besides the extended coverage, the most important advantage to being insured privately is that you will have access to more privileges in a hospital or from a doctor/dentist.
What is the statutory nursing care insurance?
This insurance covers the eventuality of becoming dependent on care. It is also compulsory and is associated with the health insurance. When signing up for a health insurance you are automatically insured with the nursing care insurance.
It doesn´t matter if you have statutory or private insurance – the benefits from statutory nursing care insurance are the same in both cases.
In case of becoming dependent on care, the nursing service classifies the assistance-grade. There are 4 levels reaching from 0 (assistance isn´t needed regularly) up to 3 (minimum of five hours assistance a day and other criteria). Payments depend on the grade and whether you´ll be treated inpatient or at home.
As is the case with the statutory health insurance, it is suggested to have some additive private cover to extend your protection.
