Health Insurance

German Statutory ("Public")

Are you aware that yet again your statutory health insurance is most
likely to have increased by 0.2% as of Jan. 2021???
-
Did you know that "public" insurers
differ in price up to 2% ???
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What all this actually means in money-terms ...
... ask ERICON broker.

Of the approximate 84.7 million people registered in Germany at the end of 2023, more than 74.3 million were insured with one of the 96 statutory ("public") health providers.

The number of actual contributing (paying) members increased from 57.22 million in 2021 to 58.14 million (+1.61%), and their dependents, in other words those insured 'free of charge', numbered at 16.16 million, a slight increase of 0.37% since 2021. The remaing difference are members with a different status, e.g. students or pensioners.

Taking a closer look at those 58.14 million members enforced by legislation to be insured with the statutory system, these reason why they make up 78.20% of the statistics is because they were employed receiving salaries that did not exceed the so-called 'general Annual Income Threshold' (German: allgemeine Jahresarbeitsentgeldgrenze) of gross 66,600€, a legal requirement to opt-out of statutory health insurance and a "financial hurdle" that increases on a yearly basis, set at 69,300€ in 2024.

Source: Statista GmbH (link)

Legislation

In Book V of the German Social Security Statue book (SGB V) the legislator has defined the benefits to be provided by the statutory health system (GKV). Contrary to what one would expect though - a list of treatments & benefits - §12 reads: „Benefits must be sufficient, functional and economical; these are not allowed to exceed a measure of necessity. ... “.

Treatment & Benefits

Although Book V of the German Social Security Statue Books (SGB) is dedicated to the intricacies of the German "public" health system (GKV), contrary to what one would expect, a detailed listing of treatments & benefits is to be found nowhere. Scrutinising the legislative texts, §2 begins with pointing to the benefits in chapter III but in the same sentence anticipation is subdued by hinting that §12 that gives us an idea of what people should really expect: „Benefits must be sufficient, functional and economical; these are not allowed to exceed a measure of necessity. Treatment not necessary or uneconomical, the insured cannot claim for, service providers cannot ensure, and health providers will not grant“.

So, let us take a closer look at what the German legislator has defined as necessary for over 73 million people, nearly 88% of the German population. Chapter III §11 lists the following benefits:

  1. Pregnancy and maternity
  2. Prevention of illnesses and their worsening, as well as contraception, sterilisation, and abortions
  3. Detection of health risks and early diagnosis of diseases
  4. Treatment of a disease
  5. Personal budget, according to § 29 of the XI Book

 

It then goes on to state:
The insured are also entitled to medical rehabilitation benefits and those to maintain their livelihood along with other supplementary benefits that are necessary to prevent, cure, relieve, counterbalance, prevent the worsening, or mitigate the consequences of a disability or need for long-term care.

General

  • In-Patient, Day-Patient & Out-Patient medical and dental treatment
  • Free choice of registered doctors and dentists
  • Prescribed medicines, dressings, therapies and aids such as hearing/ vision aids, crutches or wheelchairs
  • Measures for the prevention and early detection of certain diseases
    • Children in the first six years of their life and at the beginning of puberty
    • Adults every two years from the age of 35
    • Annual Cancer-Screening for women from the age of 20 and men from the age of 45
    • Preventive inoculations, excluding immunisations for private travels, as provided for in the articles of the relevant health insurance funding plan
  • Expenses for necessary preventive and rehabilitation treatment are fully or partial reimbursed
  • ‘Sickness per diem Allowance'
    • By law the employer has to continue to pay the salary for 6 weeks when the employee is unable to work due to illness. After this period the statutory health insurers will pay up to approx. 70% of the person's regular gross wage but only up to the Contribution Assessment Ceiling (2016: 50,850 € pa or 4,237.50 € pm) and no more than 90% of your most recent salary. The sickness allowance can be claimed for up to 78 weeks within a 3 year period.

Dental

  • Orthodontic treatment
    Usually only for children and adolescents up to the age of 18, however adults may receive funding if a severe jaw abnormality is present that requires oral surgery.

    German statutory medical insurers do however not pay for all kinds of treatments, therefore have categorised symptoms into 5 Orthodontic Indication Groups, German: "Kieferorthopädische Indikations-Gruppen (KIG)":
     
    • Groups 1 & 2 are considered minor anomalies; therefore treatment is not refundable. Should the orthodontist certify that medical treatment is necessary, private Top-Up Dental plans are helpful.
       
    • Groups 3 - 5 are paid in full, yet an initial 20% co-payment is required that is reimbursed once treatment has been successfully completed.
       
    Good to know:
    In any case, all German statutory health providers pay for an initial orthodontic consultation without needing a referral from a dentist!

     
  • Preventive dentistry
    In particular individual and group prophylactic measures to prevent dental disease

In Vitro Fertilisation (IVF) treatment

IVF treatment is a medical technique to help those with fertility problems to have a baby.
Having removed the egg from the ovaries and fertilised it with sperm in a laboratory, the then called embryo is planted into the womb to grow and develop. Who the egg/sperm donors are is not important for the success rate.

Insurance requirements

  • The couple must be married and only the eggs and sperm of the spouses may be taken.
  • Both partners must be at least 25 years old.
    The woman must be younger than 40, the man younger than 50.
  • A doctor not performing the artificial insemination must give detailed consultation to the couple in advance.
  • A HIV test must be available from both partners.
  • The woman must have extensive immunisation protection.
    Important are: rubella, chickenpox, and whooping cough.

Insured costs:

As legally obliged, 50% of the costs for artificial insemination are covered by all German statutory providers.
Many insurers have even increased their contributions, and some cover the costs in full.

Preferred German statutory providers for IVF treatment:

ProviderContribution
BKK24300€ allowance per cycle, max. 4 cycles
BKK Akzo Nobel Bavaria1,000€ allowance per cycle, max. 3 cycles
BKK excklusiv250€ allowance per cycle, max. 3 cycles
BKK firmus500€ allowance per cycle, max. 3 cycles
BKK FreudenbergPer married couple 2,000€ for 1 cycle within 24 months
BKK Pfaff100%
BKK Scheufelenif both parents insured with BKK, 500€ allowance per cycle, max. 9 cycles
IKK Classicif both parents insured with IKK, 500€ allowance per cycle, max. 3 cycles. If one parent not insured with IKK, 250€ per cycle
IKK Nordmax. 3 cycles
IKK Südwest1,000€ allowance per cycle, max. 3 cycles
Salus BKK250€ allowance per cycle, max. 3 cycles
Viactiv500€ allowance per cycle, max. 3 cycles

Financing

German statutory ("public") health insurance is financed by its members' contributions and federal subsidies.

What the individual contributes on a monthly basis is a percentage of their income, consisting of those sources of capital that are subject to contributions, These can be the person's salary, state pension (except orphan's pension) and even provident fundings, such as a Company Pension Scheme. Also, additional self-employed income too is taken into consideration once it reaches a certain amount!

For self-employed or freelancers their contributions are not only based on the before-mentioned, but also included revenue generated from capital-investments, rent or lease income.

Contributions / Payments

Contributions for medical and long-term care insurances are set across the board for all providers, of which there are currently 96 in 2023. On top the provider load the contribution with their own 'Additional Fee', varying between 0.80% - 1.90% depending on the insurer and currently averaging at 1.30%.

Link to all providers and their Additional Fee

Fortunately for all members there is an absolute payment limit, the so-called 'Contribution Assessment Ceiling' (German = Beitragsbemessungsgrenze), a cap that limits the amount of income subject to contributions at 4,987.50€ per month, respectively 59,850€ per year (2023).

Insurance TypeEmployedSelf-employed
Medical:14.60%14.00%
Long-term Care:3.05%3.05%
Maximum contribution:880.29€850.37€
23 years of age or older and without children
Medical Insurance:14.60%14.00%
Long-term Care Insurance:3.30%3.40%
Maximum contribution:892.76€867.83€


Employment:
Premiums are split 50/50 between employer and employee, apart from for those 23 years of age and without children who must pay an additional 0.25% for Long-term Care insurance.

Kinds of people covered by the statutory scheme

The German statutory health scheme primarily insures employed people, whoms earnings restrict them in their choice to obtain cover with a more comprehensive German private insurance health plan or those who even become a voluntary member of the statutory scheme, as family members need to be included. The hurdle to overcome the "shackles" of statutory health insurance is dependent on whether of not income exceeds the 'general Annual Income Threshold', set at 69,300€ gross yearly income in 2023.

Students, self-employed, freelancers, pensioners, jobseekers and also people without any occupation sign up with a statutory provider for all kinds of reasons and quite often it makes sense to join the "public" health scheme, especially for people with pre-existing conditions or families. Hence, families in which just one person is earning or students up to the age of 25 with little to no income, will benefit from a system predominately funded by everybody obliged to contribute towards German Social Security Insurance.

'Worth Knowing'

Spouse has private health insurance

If you are self-employed (freelance) and have the oportunity to contribute towards the German statutory health scheme, thus become a voluntary member, it is extremely important to know that should you partner, married or common-law, be privately insured, his/ her income will be taken into consideration to determine the payable amount due on a monthly basis, for both medical and long-term care insurance.

Exemptions:
Only if one of the following conditions applies, will your spouse's income not be taken into consideration.

  • You live permanently separated
  • You earn more than you privately insured spouse
  • Your income is at least 2,268.75€* per month

To asses the situation the provider will ask the member to provide a copy of your last Income-Tax-Return (all pages!).

Allowance for children:
For each dependant child the provider can possibly deduct 623€* per month from the joint income.

Contribution Thresholds:

  • Minimum = 1,038.33€* per month
  • Maximum = 2,268.75€* per month

*year: 2019

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We Recommend:

Techniker Krankenkasse, also simply known as 'TK', is currently the largest statutory health insurance provider in Germany. Founded in 1884, TK has a long history and currently insures approx. 8 of the 57 million paying members.

 

Additional Fee: 1.2%

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