Gauss-Telegraph: How To… Understand the German Health System

Gauss-Telegraph: How To… Understand the German Health System

by Hui Lin Kong

As a foreigner living in Germany, the German healthcare system may not be what we used to. The cost of the German public health care scheme is immense and constantly rising. Hence, it is better to be well informed and have careful planning.

Mandatory insurance

Health insurance is required even for short-term stay in Germany; otherwise, no visa will be issued. Statutory health insurance (GKV/SHI) and private health insurance(PKV/PHI) were made mandatory. While SHI is accessible to the most people, certain conditions apply to private health insurance.

Particularities of the German health insurance system

Citizens from countries of the European Economic Area (EEA) and foreign nationals from countries with which Germany has a social security agreement can be insured in the health insurance system of their home country. The insurance benefits of other countries can differ considerably compared to Germany. The insured party may thus have to make a financial contribution or take out supplementary insurance.

Statutory health insurance(GKV/SHI)

Statutory health insurance contributions are dependent on income. Some groups of people must be members of a statutory health insurance fund.  They include:

  • Employees whose gross income is below the income threshold for compulsory insurance
  • Pensioners
  • Recipients of unemployment benefits

Private health insurance(PKV/PHI)

You can choose to opt for private health insurance cover if you are :

  • Employee earning more than certain amount
  • Self-employed
  • Part-timer earning less than 450 Euro/month
  • Civil servant

PKV often covers a much wider range of medical and dental treatments than GKV.

As an employee :

If you are employed in Germany and are subject to social security contributions, you will usually be member of five statutory social security organisations :

  1. Statutory health insurance
  2. Statutory long-term care insurance
  3. Statutory pension insurance
  4. Statutory accident insurance
  5. Statutory unemployment insurance

As a student :

All foreign students who start their studies at a German college or university must have health insurance coverage.

Depending on the purpose of stay, country or origin and the student’s age, different conditions apply. In principle, the students fall into one of the following 5 groups of people.

  1. Students from EEA countries that have signed a social security agreement with Germany
  2. Students from all other countries
  3. Students aged 30 or above
  4. Participants in preparatory language courses
  5. Foreign doctoral students and scholarship holders

Health insurance for EU citizens under 30 years old

Students from EEA countries and countries with a social security agreement can be exempted from compulsory health insurance in Germany by submitting proof of health insurance in their home country.

Health insurance for non-EU citizens

Students from all other countries take out either statutory or private health insurance in Germany during their stay. From the age of 30, students in Germany no longer have statutory coverage; they must take out private insurance. The same also applies to people who are taking preparatory language courses in Germany.

What is a health insurance card ?

If you become ill, the health insurance covers the cost of medical treatment. The benefits are as followed :

  • Outpatient medical treatment, e.g. in a clinic or physician’s office
  • Inpatient medical treatment, e.g in a hospital
  • Dental care
  • Medication and remedies

As soon as you sign the health insurance contract, you will receive an electronic health insurance card documenting your membership. It must be submitted whenever you visit your doctor so that your visit can be billed. The health insurance card is valid in all EU countries as well as some countries like Iceland and Norway. However, it is advisable to contact your health insurance company to find out what to do when travelling abroad.

Visiting the doctor

First of all, you may choose your own physician. When you find one through the website of your insurance provider, call directly to their office and make an appointment. Walk-in without an appointment is unfavorable unless an emergency occurs. For life-threatening situations, dial the emergency number 112.

Pharmacies

The pharmacies in Germany are recognized by a big red “A” which stands for Apotheke. No matter whether you are publicly or privately insured, the medication will normally be covered, as long as you have a prescription.  However, do not expect to be reimbursed by either the government or the private health insurance systems for over-the-counter remedies.

Going to the dentist?

In Germany, dental care can be extremely expensive. For major dental work  involving bridges or crowns, you must get a cost estimate (Heil- und Kostenplan), present it to your insurer and get their approval prior to treatment. Otherwise you could be paying the bill out of your own pocket.  Furthermore, even private insurers won’t fully reimburse for all treatments. If you are insured, you will usually only be covered for routine procedures, including dental hygiene and simple fillings. When it comes to private health insurance, you need to be extra careful when selecting the right plan, as most medical insurance providers restrict the coverage that new policyholders can get.

What is private liability insurance?

Private liability insurance covers personal injury, property damage and financial losses up to the contractually agreed insured amount. It is strongly recommended for everyone because a mishap happens quickly and can have long-term financial consequences.

When I arrived in Germany after a few months, my friend who had stayed in Germany for more than 3 years advised me to take private liability insurance which costs around 60 Euro annually. This has come handy when I accidentally lost my keys. The costs for replacing a new key in Germany can be ridiculously high, up to 300-400 Euro. Fortunately , I have the insurer to cover my bills.

Further insurances : Social security & Retirement benefits

As an employee, a fixed percentage of your work income will go to pay your membership of the social security funds. Your employer also pays a fixed proportion. For example, the statutory pension insurance fund pays employees the pension once they are retired. If your home country is part of the EU, EEA or Switzerland, you will not lose the entitlements you earned while in Germany. When you reach the age of retirement, you can be paid a pension from any EU or EEA country in which you have worked. The same applies if you live in one of the countries which Germany has signed an agreement on social security: Australia, Canada, Japan, South Korea, Morocco etc. If your home country is a third country, you should submit your request to the German embassy or a consulate to get back the entitlements you earned through the payment of contributions.

Useful phrases

  • I need an ambulance – Ich brauche einen Krankenwagen
  • I need a doctor – Ich brauche einen Arzt
  • I need to go to a hospital – Ich muss zum Krankenhaus gehen
  • There’s been an accident – Es gab einen Unfall
  • I am allergic to… – Ich bin allergisch gegen…
  • Hospital – Krankenhaus
  • Patient – Patient
  • Sick – Krank
  • Ear(s): Ohr(en)
  • Eye(s): Auge(n)
  • Head (ache): der Kopf (schmerzen)
  • Heart (attack): Herz (infarkt / -anfall)
  • Mouth: Mund
  • Tooth (teeth): Zahn (Zähne)

 

If you still have questions about the German Health System, you can send an email to our contact person at Barmer Krankenkasse.

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