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Health insurance

© Roger Richter, Wiesbaden
Germany has one of the best healthcare systems in the world, offering all citizens general and comprehensive health insurance. About 85% of the population are insured through the state health insurance scheme, while the rest take the option of private insurance
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Statutory health insurance

The majority of Germans are insured through statutory health insurance (GKV). Employees with a gross annual salary under €52,200, or €4350 per month, are obliged to enter the GKV scheme. The monthly rate is currently 15.5% of gross income. The maximum contribution is €610 per month. The employee pays 53% of the monthly contribution, and the employer the remaining 47%. Contributions remain the same even if your gross annual income lies significantly above the threshold of €50,850. This is one of the advantages of the German system. Students too, are required to take out health insurance, though they pay only €77 per month.

Once every quarter, a practice fee of €10 is required from the patient upon their first visit to a doctor or dentist. In addition, €5-10 are charged per prescription for medication, and €10 daily for the first 28 days of a hospital stay (if you were hospitalised due to an accident, this fee does not apply).

The most important advantage of the GKV is that non-working kin (e.g. spouse or children) living at the same residence, are likewise insured in Germany at no further cost. Many people have themselves and their families insured though the GKV and take out additional private insurance. This might, for instance, cover costs for homeopathic or alternative treatment, single rooms in hospitals, or more extensive dental care.

All GKV providers in Germany are self-governing statutory corporations; they represent the statutory health insurance. Some are large corporations with millions of members (e.g. AOK, BEK, DAK); others only have a few thousand (many guild and company health funds). But that does not mean that their basic services differ, as all GKV providers are obliged to follow the statutory provisions. Should your statutory health insurance provider increase your contributions, you can terminate your membership giving two months’ notice and move to another. The minimum term of membership is 18 months.

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Private health insurance

If your gross annual income is above €50,850, you can take out private health insurance. There are about 50 German insurance companies offering different services. Contributions depend on the services chosen, age and sex, and any previous illnesses.

In general, contributions charged by private funds to people over 40 are higher than those of statutory funds. (However, it is possible to lower contributions by opting for a higher excess.) Also note that separate contributions must be paid for all family members, unlike in the state system, which automatically insures non-working family members. Contributions are gradually increased depending on the current situation; the level of the initial payments is defined by your age at joining.

Private health insurance providers cover the costs of a variety of medical and dental treatments in Germany and abroad. With private insurance, you can usually count on preferential treatment when visiting a doctor or dentist, who will take more time and give you an earlier appointment. Private patients are welcomed by doctors and hospitals, who depend on them to a degree in order to raise their income.

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Health insurance for travel abroad

State health insurance provides limited cover for travel within the European Union. If you require medical help while travelling abroad within the EU, any costs arising must initially be met by you. These can then be reclaimed from your German healthcare fund upon filling in the relevant EU forms. Reimbursement will equate to the sum which your fund would have covered, had the treatment been carried out within Germany – which can sometimes be only a fraction of costs abroad. If you are planning to travel abroad within or outside the EU, it is therefore advisable to take out health insurance for foreign travel beforehand. Here, you should be aware that some insurance policies do not cover a patient’s transport back to Germany. Be sure to read the small print carefully. If you are insured with a private health fund, you should enquire as to what specific cover you can claim while abroad.
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Sick pay

Should you become seriously ill, your employer will usually continue to pay your full salary for six weeks. After this time, your health fund will provide sick pay of up to €2340 per month, for up to 78 weeks. If your salary is above this maximum rate, it is advisable also to take out income replacement insurance, which is available at affordable contributions. This is particularly important if your living costs amount to more than €2340 per month. If you take out private health insurance, you should therefore also consider adequate income replacement insurance. Also bear in mind that neither statutory nor private income replacement insurance plans will cover lasting damage to your health.
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Dental care

Dental care provision is very good in Germany. For comprehensive dental treatments such as bridges, crowns or orthodontics, a treatment and cost schedule must be drawn up and presented to your insurance provider for approval, before the treatment can begin. If you have any queries about a suggested treatment, you should seek a second opinion. Those with statutory health insurance through the GKV bear 50-100% of their dental care costs, unless they have additional private insurance. In some cases, treatment of conditions known before joining a scheme is not covered, or the insurance may only take effect after a six-month period. Private health insurers cover up to 80% of dental care costs in total.
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Visiting a doctor

Once you have decided on a health fund, you will automatically be sent an insurance card, the back of which you should sign without delay. Every quarter, a practice fee of €10 is required from the patient upon their first visit to a doctor or dentist. Preventive examinations are exempt from this fee, as is the treatment of children. The fee does, however, apply to Accident and Emergency visits. Please keep the receipt for payment of the practice fee, as you may otherwise have to pay again on a later visit. Your employer is required by law to give you time off if you fall ill and need to see a doctor.
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How to choose a doctor

Although most patients choose a doctor whose practice is near their home or workplace, it is a good idea to ask friends and acquaintances for recommendations – doctors’ personalities and working methods can vary widely. Keep in mind that the German system does not tie you to a specific doctor.  If you are unsatisfied, you can change doctors at any time and even have the same condition treated by another doctor, should you think the first doctor’s treatment insufficient.

With most health problems it is advisable to visit a general practitioner first and only then to seek treatment from a specialist – should your general practitioner think this necessary. You will then be given a referral and, in many cases, recommendations for relevant specialists. Some doctors only treat private patients. This means that a patient with statutory insurance must look elsewhere or bear all costs for the treatment.

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Treatment outside surgery hours

If you require medical help outside surgery hours, you should first call your general practitioner – sometimes the answering machine will tell you how to contact them personally. If they cannot be reached, contact the medical emergency service. The telephone number for these services depends on your place of residence. The emergency service will tell you whom to contact, or even send out a doctor. If your emergency seems very serious or even life-threatening, however, you should call the police or fire brigade immediately.
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Pharmacies

Almost all medication you may need is available through your pharmacy. Even non-prescription medications are usually available only in pharmacies. Vitamins and similar health products can also be found in supermarkets or at a chemist’s.

If you are insured through the GKV, the cost of medication is in the great majority of cases covered by the fund. Depending on how expensive the medication is you will, however, have to pay a €5-10 fee. Prescription medications are free for children.

If your pharmacy does not have the required medication in stock, you can usually order it for the next day; sometimes it can even be obtained on the same day. Pharmacies are generally open until 6.30pm.

You can also collect prescriptions outside business hours through the pharmacy emergency service. Pharmacies take turns to be on emergency standby; a schedule in the window will inform you which pharmacy will be on duty when

When you have found the duty pharmacy, ring the bell and a pharmacist or assistant will serve you over a narrow counter near the door (doors are usually kept locked outside opening hours). This service is useful for minor complaints such as headaches, hangovers or upset stomachs. However, you can also collect prescriptions if you have been busy during the day (assuming that the pharmacy has the medication in stock). Statutory health insurance funds will usually also cover the cost of prescription-only generic drugs, though the surcharge already mentioned applies.

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Hospitals

If you need to go to hospital, your doctor will arrange a bed and refer you to the appropriate specialist. Naturally, this is not the procedure if you are taken to hospital in an emergency. Depending on your health insurance plan, you will be accommodated in a room with one or up to four beds.