Health Insurance

There are over 100 different health insurance companies in Germany. Some of them are statutory health insurances, and others are private. These two main types of insurance differ in terms of accessibility, amount of personal contributions and benefits. In principle, you can choose your health insurance company freely- there are some limitations, but only in the case of private health insurances: private health insurance schemes admit only certain occupational groups (civil servants, self-employed professionals, students) and high-income workers. The statutory health insurance schemes, however, accept everyone regardless of the professional group and income level.

In a statutory health insurance scheme, your health insurance contributions depend on your salary, i.e. the more substantial your income, the higher your monthly dues. That means the low-income members of statutory health insurance schemes pay less. The idea behind the difference in contributions is that all the members of society bear the costs of health insurance collectively. A significant advantage of the statutory health insurance is that, under certain circumstances, you can also include your spouse and children in your health insurance scheme. To learn more about the topic, read the section "Family Insurance".

In private health insurance schemes, the amount of your health insurance contributions does not depend on your income, but your insurance risk. Every individual's insurance risk is calculated based on the age, gender, pre-existing conditions and, to some extent, type of lifestyle. But it is safe to say that in the case of private health insurance, the contributions are usually higher than statutory health insurance schemes. That is why private patients are often treated preferentially, and, e.g. can book a doctor’s appointment quicker than others. Furthermore, privately insured individuals are usually entitled to more benefits than statutory insured individuals. However, as a member of a private health insurance scheme, initially, you must pay all the costs of doctors' visits and medications in person- your health insurance company then compensates you afterwards.

If you work in art- or media-related professions, you can apply for admission to the German Artists' Social Security Fund ("Künstlersozialkasse", a.k.a KSK). If admitted, you pay only half of the designated insurance contributions, and the Künstlersozialkasse covers the remainder.

Most people in Germany are members of statutory health insurance schemes. If you are unsure which health insurance company is right for you, consult the Consumer Protection Centre ("Verbraucherzentrale"). You can also compare the different insurance policies and their benefits or shortcomings at www.krankenkassen.de. Every insurance company -whether private or statutory- offers various insurance schemes. Some of these schemes, for instance, cover the costs of glasses or alternative medicines, but others not.

Please note: Switching from a private health insurance scheme to a statutory one is often very difficult, even impossible. Before joining a private insurance scheme, you should carefully examine if this is the right choice for you. 

You can register at a health insurance company as soon as you have decided which one to join. In principle, you can initially sign up online- the membership applications are available on the websites of different health insurance companies. You can also find a branch of your chosen health insurance company nearby and register there personally. To join a health insurance scheme, you usually need to submit a passport photo, your registration certificate and our proof of income (or a certificate of assistance from the Jobcentre or the social welfare office). After a successful registration, your health insurance card will be sent to you via post. You always have to carry the card with you when you visit a doctor or a hospital.

If you are a member of a statutory health insurance scheme, under certain circumstances, you can also include your spouse and children in your health insurance without any extra fees. Including your family members in your health insurance scheme is known as family insurance ("Familienversicherung"). However, family insurance is only available as an option when your spouse and children have little or no income. Ask your health insurance company how much you can earn at the most to be able to benefit from family insurance. Try to communicate in writing so that all agreements are documented. If any problem occurs later, you will be able to introduce some proof for your possible claims.

In the case of children, furthermore, the age plays a crucial role: Until the 18th birthday, children are always to be covered by their parents' statutory health insurance scheme. The coverage will be extended until the 23rd birthday if the children do not work. Young individuals may also remain insured via family insurance until their 25th birthday when they:

• go to school,
• take part in a vocational training programme and do not earn money,
• study, or
• work voluntarily for one year (i.e. youth volunteer service abroad or voluntary social or ecological year).

The children who have a disability are covered by their parents' statutory health insurance for life.

Monthly contributions by members cover the health insurance expenses. If you receive unemployment benefit or social assistance, the Employment Agency, the Jobcentre or the Social Welfare Office will take over the health insurance costs for you. If you work in a job which is subject to the deduction of social insurance contributions, your health insurance contributions will be transferred by your employer to the health insurance company directly. Half of these monthly payments are deducted from your salary, and your employer pays the other half. Usually, your job is considered to be subject to the deduction of social insurance contributions when you earn more than 450 € per month. If you have a mini-job, are self-employed or a student, you have to cover the costs of your health insurance personally and transfer the designated amount to your health insurance's bank account every month.

Please note: You cannot save any money by going without health insurance coverage for a period. If you do not pay your monthly dues for a while, you will have to pay the whole amount later.

Statutory health insurance companies do not pay for cosmetic surgeries, vaccinations for private overseas trips or medical superintendent treatments. In principle, dentures are only partially covered, so it is worth to have a bonus booklet ("Bonusheft"). In a bonus booklet, your dentist confirms that you come by for regular check-ups (every six to twelve months). If you collect these confirmations in your bonus booklet over the years, your health insurance company will take part in the expenses if you eventually need a denture. You can obtain a bonus booklet from your health insurance company. 

When you stay in a hospital, you will be charged 10 € per day, and your health insurance scheme covers the remainder of your medical expenses.

In principle, patients have to personally pick up the medicines they have been prescribed by a doctor from a pharmacy. You can search for a pharmacy nearby online. Whether you have to pay for the medication yourself depends on several factors:

• If you are privately insured, you initially have to pay for your medications at the pharmacy. Then, as soon as you send the prescription and the receipt to your health insurance company, you must, in principle, receive a full refund.
• If you are a member of a statutory health insurance scheme, the amount of payment depends on whether or not the medicine in question is a prescription medicine. The prescription medicines are those which you can only obtain if a doctor prescribes them for you, i.e. you cannot buy them without a prescription. Pink prescription papers always include prescription medicines. For non-prescription medications, you will be handed a green paper. In principle, you have to personally pay the full costs of any non-prescription medication you require. In the case of prescription medications, you have to contribute partly, which means you must pay a small part of the price to the pharmacy. But your share of the costs must not be higher than 10 € per medicine. Prescribed medicines for children and adolescents are usually fully covered, i.e. you do not have to pay anything at the pharmacy.

Please note: There is a limit to personal contributions when it comes to medications' costs. If you have already spent more than 2% of your annual gross income on medication and in-patient treatments, you will be exempted from further charges for the remainder of the year. If you are chronically ill and in need of multiple medications, you will be exempted from personal contributions once you spend 1% of your annual gross income for medications. In case you are unemployed and receive 416 € per month from the Jobcentre, your income does not extend 5000 € in a year. As a result, your contributions to your medications' costs must not exceed € 99.84 (or € 49.92, if you have a chronic illness) per year.

Once you reach the limit (1% or 2% of your annual gross income), you can submit an application to your health insurance company to demand exemption from any additional payments for medications for the rest of the year. To do this, you must send the health insurance company all the relevant payment receipts and your proof of income. After reviewing the documents, your health insurance company will send you an exemption certificate. By showing this certificate to pharmacy staff, you will be released from the obligation to contribute personally. The respective exemption is valid for the remainder of the current year.

In principle, health insurance companies also cover psychiatric treatments' costs. Members of a statutory health insurance scheme, however, can only choose therapists who are approved by the statutory health insurance ("Kassenzugelassene Therapeuten"). When looking for a suitable therapy, pay attention to the keyword "Kassenzulassung ("health insurance admission"). In order to be able to start therapy, a doctor or a psychotherapist must first make a so-called "suspected diagnosis". This diagnosis will then be sent to your health insurance company, which, after evaluation, will accept or reject the therapy application.

Since January 2021, it has become much easier to switch to another health insurance company. All you have to do is choose a new health insurance company and register there. You do not need to first terminate your old health insurance contract. However, this only applies if you switch from one statutory health insurance to another. If you want to switch to private insurance or move abroad, you have to cancel your old health insurance.

In principle, you can only change your health insurance company after 12 months of membership. If you start a job with a new employer, however, you can also switch your health insurance company even if you have been covered by your current health insurance company for less than 12 months.

If your health insurance company suddenly demands more money from you, you are entitled to a so-called "special right of termination" ("Sonderkündigungsrecht"), which means you can cancel your contract before 12 months of membership and find a new health insurance scheme.

Please note: Switching from a private health insurance company to a statutory one is often very difficult, even impossible. Before joining a private insurance scheme, you should carefully examine if this is the right choice for you. 

When a health insurance company rejects your membership application or refuses to pay for a doctor's visit or medication, you can contact the Independent Patient Counselling (“Unabhängige Patientenberatung”) to complain. They can be reached from Monday to Friday (10 am-6 pm) at 0800-0117722. You will not be charged for the call or the counselling service, but keep in mind that the staff mainly speak German. you can also file your complaint at the Regulatory authorities of the statutory health insurance.