How health insurance works in Germany
The compulsory health insurance regulates that everyone in Germany must have a statutory or private health insurance. Thus, there are two different systems that coexist and each of the variants brings individual advantages as well as disadvantages. The fact is, however, that not everyone has the free choice, but up to a certain income limit, employees are required to have statutory health insurance. Accordingly, only those who earn more or are self-employed may join a private health insurance fund. Further exceptions apply to civil servants, temporary soldiers and judges. They are free to decide whether to remain in the statutory health insurance scheme voluntarily or to take out private insurance - but they must choose one of the two options.
Now, there are quite a number of people who do not belong to any of the above categories and who are therefore in danger of falling through the cracks, as often happened in the past. This is precisely why compulsory health insurance was introduced and, accordingly, such exceptions are now also strictly regulated: Trainees, interns, students, recipients of unemployment benefits, pensioners, artists, publicists, agricultural and forestry entrepreneurs, and persons without any other entitlement to benefits in the event of illness must also join the statutory health insurance scheme. However, those who are voluntarily or compulsorily insured in the statutory health insurance fund enjoy the freedom to choose which insurance carrier to select.
Benefits can vary considerably
The health insurance system in Germany is correspondingly complicated, which makes it difficult to make blanket statements when it comes to benefits, for example. These can, in fact, vary greatly depending on the health insurance provider, which also applies to the contributions. This is especially, but not only, the case between private and statutory providers. However, this does not necessarily mean that higher premiums also mean that more services are included in the insurance cover. It is therefore important to look at the policies in detail and compare them carefully. In particular, those people who have a choice between statutory or private health insurance can benefit greatly financially. But even between the statutory providers there are notable differences that must be taken into account when making a decision.
Many insurance companies therefore entice customers with additional benefits in order to stand out from the competition - or they offer the same benefits at lower prices. However, it is important to read the insurance contract in detail, because some traps can lurk in the fine print, especially in private health insurance (PKV). It is also important to know that the two types of insurance work in fundamentally different ways: The equivalence principle applies to private health insurance, while the so-called solidarity principle applies to statutory health insurance. Nevertheless, both PKV and GKV (statutory health insurance) are now legally regulated as to the minimum benefits they must cover. Only then do they finally offer sufficient protection, which is to be fulfilled by the health insurance obligation.
These achievements take over the legal health insurance
Because the statutory health insurance and the private health insurance function according to different principles, the just mentioned, legal requirements for the assumption of costs also differ. In private health insurance, the insured have more choices and in most cases also receive more benefits for higher premiums. In the case of statutory health insurance, on the other hand, the level of contributions is based on income, whereas all policyholders of the same provider are entitled to the same benefits. This applies at least to the mandatory benefits, which are often also referred to as standard benefits. Accordingly, every GKV member is entitled to the following
- medically necessary treatments
- including the associated diagnostics
- and rehabilitation.
This means that, if medically necessary, the statutory health insurance pays for the entire treatment, diagnostic measures, preventive care, follow-up care, medications, and remedies and aids. Furthermore, patients have a right to payment of sickness benefits. All this applies regardless of the contribution paid. The Social Code also defines that all these measures must be "sufficient, appropriate and economical". As a rule, anything that exceeds what is necessary is not paid for. However, as is well known, there are exceptions to every rule.