German Health Care System
Important things to know about the German health and care structures
Health insurance in Germany
It is part of a comprehensive social security system, which consists of sickness and nursing care funds (= statutory health insurance), a pension fund and unemployment benefit. Instead of being a state-run public health service, our system is characterised by a close cooperation between the health insurance funds, the medical professions, hospitals and other related services. The state provides the necessary statutory framework. The statutory health insurance funds play a very significant role, since their mandate by law is to provide comprehensive coverage to their members if they should fall ill.
Your employer automatically registers you and deducts your contributions to the state social security system from your wages. The choice of statutory health insurance fund is up to you – but you have to inform your employer of your choice within two weeks of starting work, so that your contributions can be paid.
Statutory health insurance
All forms of statutory health insurance funds are self-governing, non-profit organisations by law, and are legal entities under public law. Each of these forms is responsible for balancing its own budget between member contributions as income and services to members as expenditure.
Various forms of statutory health insurance funds
- The oldest form is the company health insurance fund (“BKK”, such as the SBK); some of these funds are over 100 years old.
- General local health insurance funds (“AOK”), formally for blue-collar workers,
- Substitute health insurance funds (“Ersatzkassen”), formally for white collar employees not covered by a company fund,
- Miscellaneous forms cover other sections of the working community, such as guilds, the merchant navy or agricultural sectors.
Since 1996 these restrictions governing the choice of fund no longer apply.
Your health insurance contribution
Statutory health insurance is contribution-based (i.e. not levied via risk-premiums or taxes). The contribution rate itself is calculated as a percentage of your income, currently 15.9%. Your part of the contribution is 8.6%, the rest is paid by your employer.
Nursing care insurance
In addition to your statutory health insurance, you are also obliged to pay nursing care insurance. This nursing care insurance is linked to your health insurance, for example the SBK-Pflegekasse for the SBK. The obligatory nursing care insurance contribution rate is 2.55% for any fund, of which 50% is also paid by your employer.This contribution rate applies to all persons insured who have children. If you do not have children you have to pay an additional premium of 0.25%. The services are rendered in kind or in cash including home care orcare in nursing homes.
Statutory health insurance also covers any dependent children or spouse (who are not earning themselves) at no extra cost.
Service structures of statutory health insurance
The services provided by the statutory health insurance funds are predominantly rendered in kind, such as out-patient services, hospital care, pharmaceuticals and remedies & rehabilitation services. Insured parties are entitled to any services and benefits within the legal parameters set by German law (Social Security Code, Book V). There are no geographical limits to accessing these benefits within Germany, but there are differences between the service levels offered by individual health insurance funds.
Free choice of health care provider
Under statutory health insurance, you are free to choose your health care provider and hospitals.
Main health care providers
All insured parties have access to all accredited health care providers. The main health providers are as follows:
- Doctors/dentists: general practitioners and specialists can be consulted, although usually the GP will be responsible for referring the patient to a specialist or hospital
- Hospitals: all levels of hospital care (primary highly specialised care) are covered; hospital care is usually provided on referral by a GP or a specialist, or directly in case of emergency
- Pharmaceuticals and prescription medicine are available in pharmacies only, with a contribution of 10% of the price (min. €5.00, max. €10.00).
- Almost all health care providers and institutions are accredited by the statutory health insurance funds.
- Alternative health providers are not covered by statutory health insurance.
Private insurance cover
Private insurance cover (i.e. non-statutory health insurance) is by law only available to those whose income is above the national average (in the year 2018 = €59,400.00 annually). This can take the form of supplementary or comprehensive insurance, which is provided by profit-based insurance companies, and is based on a cost reimbursement principle. This does not cover any further family members, and once you have signed up for private health insurance, you are by law no longer allowed to become a member of a statutory health insurance fund.