Health Insurance

German Statutory

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. ... “.

So let us take a closer look at what the German legislator has defined as necessary for over 70 million people, more than 85% of the German population.

General Treatment & Benefits

  • 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 Allowance per Diem’
    • 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 Treatment & Benefits

  • Preventive dentistry and in particular individual and group prophylactic measures to prevent dental disease
  • Orthodontic treatment up to the age of 18

Financing and contributions

German statutory health insurance is financed by its members contributions and federal subsidies.

Contributions are based on a percentage of each individual's income that is subject to contributions.
So, if you are compulsorily insured then the rate will be calculated based on your wage, state pension (except orphan's pension) and any provident fundings, e.g. Company Pension Schemes. Also any additional, self-employed income a compulsory insured person receives is taken into consideration.

Self-employed or freelances pay their contributions not only based on the before-mentioned, but also revenue generated from capital-investments, rent or lease income is added.

Luckily for all there is a limit, the so-called 'Contribution Assessment Ceiling' (German = Beitragsbemessungsgrenze), which caps the income that is subject to contributions at 4,425€ per month, respectively 53,100€ per year. (2018)

Pricing amongs providers

Generally contributions across the board for all providers are set at 14.6% of an individuals gross income, of which an employer pays 7.3% of.

On top of this every of the  approx. 110 providers at present time is allowed to load the contribution with their own additional rate, which varies between zero and 1.7%.
Commonly this additional contribution ranges between 0.8% - 1.2%.

Kinds of people covered by the statutory scheme

The German statutory health scheme primarily has employed people insured, whose earnings restrict them in their choice to be insured as a voluntary member or obtain cover with the more comprehensive private plans. The hurdle to overcome the "shackles" of statutory health insurance is dependent on the 'Annual Earning Limit', which is currently set at 4,950€ per month or 59,400€ per year gross income. (2018)

Students, self-employed, freelancers, pensioners, job-seekers and also people without any occupation sign up with a statutory provider for all kinds of reasons and quite often it makes sense, mainly however then money-wise. Hence whole families, with just one person contributing towards the system, or students up to the age of 25, with little to no income, will benefit from a system predominately funded by all obliged to contribute towards German Social Security.

'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