Understand how the state social security fund operates, with information on the options for health insurance...
Employees are registered once they have signed an employment contract with an employer; the employer is responsible for notifying the appropriate branches of social security. An insurance registration number (Versicherungsnummer) is issued to the employee, after which a social security identity card (Sozialversicherungsausweis) is issued.
EU citizens resident in Germany are generally eligible for social security and unemployment benefits as well as income support, but need to submit evidence of prior contributions in their previous country of residence (E-forms). There is no minimum qualifying period for health insurance, but claimants need to have worked at least 360 days over the last three years. Previous periods of employment in another EU country are taken into consideration, if recorded on form E301.
As of 1 January 2009, all citizens and residents of Germany were required to have health insurance. There are three options for coverage:
- Statutory (state-provided) health insurance (Gesetzliche Krankenversicherung - GKV): mandatory for employees making less than €48,600 gross per year (as of January 2010)
- Private health insurance (Verband der privaten Krankenversicherung - PKV): for higher-income individuals, the self-employed (though not artists), civil servants and those working part time
- A combination of state and private health insurance
All contributors to the public statutory health insurance system pay a flat percentage (15.5 percent as of January 2010) of their income up to a certain income cap. Household dependants may be included under the employee's coverage at no extra cost.
In order for an employee to bypass statutory insurance and opt for private insurance only, they must contact their employer to opt out of the government statutory insurance scheme. The government will require proof that they have exceeded the minimum income requirement for three consecutive calendar years.
It may be possible for those choosing private insurance coverage to receive an insurance subsidy from their employer. This subsidy is the same amount the employer would have paid if the employer had chosen statutory insurance instead of private insurance.
Insurance card and coverage
On joining a Krankenkasse, workers are issued with a health insurance card which is used for all health matters. Present this card to the doctor to receive all types of medical assistance.
The health insurance card carries the name, date of birth and insurance company of the holder. A health card with a data chip has been proposed by the German government, however they were not widespread as of January 2010. The "electronic" card holds both administrative and health data of the insured as well as a photograph of the holder (except for children under 16 and people requiring constant medical attention). This card also acts as a European Health Insurance Card entitling holders to health care in other EU member states.
The state health insurance scheme is administered by local health insurance funds (Krankenkasse) and the following treatments are provided by health professionals under contract with these funds (Kassenarzt):
- Medical and dental treatment
- Hospital treatment
- Drugs, dressings, complementary treatment such as massages and aids such as hearing aids and wheelchairs
- Home help if the insured person has a child under 12 living in their home and must go into hospital and is thus unable to look after the household
- Home nursing care if this helps to avoid or shorten a stay in hospital
- Orthodontic treatment up to the age of 18
- Preventive measures and rehabilitation
Patients make small additional payments towards certain health costs and medical bills (approximately 10 percent and €10 per quarter for consultations), such as prescriptions, hospital expenses and transport costs (in the case of ambulance transfers for broken bones and so on) or when consulting their doctors (Praxisgebühr); the health professional bills the relevant Krankenkasse directly for the remainder of the fee. Children under 18 are exempt from this fee and where the patient receives social benefit payments, the fee is much reduced.
Dental care is partially covered; from 20 to 70 percent may be paid by the government, however certain procedures and materials are not covered.