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)
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. ... “.
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:
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.
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.
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:
| Provider | Contribution |
|---|---|
| BKK24 | 300€ allowance per cycle, max. 4 cycles |
| BKK Akzo Nobel Bavaria | 1,000€ allowance per cycle, max. 3 cycles |
| BKK excklusiv | 250€ allowance per cycle, max. 3 cycles |
| BKK firmus | 500€ allowance per cycle, max. 3 cycles |
| BKK Freudenberg | Per married couple 2,000€ for 1 cycle within 24 months |
| BKK Pfaff | 100% |
| BKK Scheufelen | if both parents insured with BKK, 500€ allowance per cycle, max. 9 cycles |
| IKK Classic | if both parents insured with IKK, 500€ allowance per cycle, max. 3 cycles. If one parent not insured with IKK, 250€ per cycle |
| IKK Nord | max. 3 cycles |
| IKK Südwest | 1,000€ allowance per cycle, max. 3 cycles |
| Salus BKK | 250€ allowance per cycle, max. 3 cycles |
| Viactiv | 500€ allowance per cycle, max. 3 cycles |
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 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 Type | Employed | Self-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.
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.
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.
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:
*year: 2019
The answer to this question is: "Yes, but with exemptions!"
For this to make sense, one must understand the difference between the following 2 categories.
Exemptions:
Unfortunately, this is the case and depending on the provider thus, when they send out their questionnaire to assess family circumstances, a cancellation can go as far back as more than 2 years, resulting in substantial amounts of back payments.
To understand to whom in general, how and why this can happen, one must have studied the German Social Security Statute Book V, a cumbersome undertake and a type of legislation lawyers specialise on.
SGB V §10 (3) is the piece of legislation that enables the “removal” of contribution-free children when e.g. the member has a spouse.
"Children are not insured if the member's spouse or common-law partner related to the children is not a member of a statutory health provider and their total income regularly exceeds one twelfth of the ‘Annual Income Threshold’ per month and is regularly higher than the member's total income; in the case of pensions, the amount paid is considered."
Link to official source (German)
Thanks to cross-border digital data exchange switching from one EU statutory (“public”) health company to another requires in most cases nothing more than submitting an application to the German provider of your choice.
The procedure:
The same procedure applies to those few countries not connected to the data exchange system too, yet in written form.
No. When visiting a doctor, dentist, public hospital or any other non-private medical facility, presenting your membership card you will not be billed.
Invoices are only ever issued when treatment, consultation or service exceed the scope of "public" health cover, hence the patient needs to be billed privately. Latter requires preliminary clarification and the patient's written consent.
Although nowadays one would not think, gender reassigment is still a very complex subject, and especially in Germany.
Due to the German Constitutional Court ruling in 2011, that a person needs neither sex reassignment surgery nor sterilization in order to legally change their gender, and because of the immense expenses involved in gender reassignment surgery, ultimately carried by the insured community as a whole, the following requirements are needed for a statutory health provider to give their approval.
Requirements:
On top of the total 243.5 billion Euros that providers of "public" health insurance paid out in 2018, members made additional co-payments of approx. 4.2 billion Euros for treatments, services, benefits, medication and the below mentioned. Compared to 2017, this is an increase of 108 million Euros!
Here are just a few examples of the co-payments that people must expect with German "public" health insurance.
| Scenario: | Comment: |
|---|---|
| Contraceptives and Abortions | |
| Hospital stay and treatment | |
| Medicines & Dressings | "waived if a minor" |
| Prevention and Rehabilitation benefits | |
| Remedies and Aids | |
| Transportation with an ambulance | 10€ per trip |
| Treatment Care and Home Nursing |
For adults co-payments are limited to 2% of their gross annual income and for those who have to see a doctor more often or need frequent medication, i.e. chronically ill people, the co-payment limit is lowered to 1%.
The amount self-employed/ freelancers must contribute towards the German statutory health insurance scheme is a fixed percentage, plus the providers own 'Additional Fee', both based on income.
Income is defined as turn-over minus expenses, includes other possible sources of income, e.g. capital yields, rent, etc. and is to be proven to the provider every year by presenting the most recent Tax-Income Assessment.
To prevent contributions being infinite the so-called "Contribution Assessment Ceiling" (German: Beitragsbemessungsgrenze) is applied, which makes sure contributions are capped at an amount that is reviewed on an annual basis. In 2024 it is set at 62,100€ per year, resp. 5,175€ per month.
Finally, the system then differentiates between two types of members, consequently slightly different percentages are applied.
Standard Membership:
14.60% Medical insurance
x% 'Provider's Additional Fee' (current market: 0.50% to 2.70%, depending on provider)
3.40% Long-Term Care insurance
Total = 14.6% + x% + 3.40%
Member is 23 years or older and has no children:
14.60% Medical insurance
x% 'Provider's Additional Fee' (current market: 0.50% to 2.70%, depending on provider)
4.60% Long-Term Care insurance
Total = 14.6% + x% + 4.60%
With the average 'Additional Fee' currently at 1.70%, self-employed members can calculate with 19.10%, resp. 18.70%.
In the event that self-employment has only just started, thus a tax-declaration is yet to be submitted, the health insurers fall back on reliable economic evaluations (German: Betriebswirtschaftliche Auswertung [BWA]) or try to make their own estimates, in expectation to make amendments once the first Tax-Income Assessment can be presented.
Regardless however of the amount of income the self-employed might expect and declare towards the provider, monthly contributions are generally calculated in accorance with 2 thresholds.
In principle, statutory health insurance comes with a twelve-month commitment period, yet depending on any optional tariffs that may be included, the binding period can be extended up to three years.
The notice period required to terminate the contract at the end of the month is two full calendar months.
Employees in a German "Midijob" are those whose monthly salary is periodically within the transition bracket of 538.01€ - 2,000€, as of January 2024.
The advantage of a "Midijob" is that less contributions need to made towards the social insurances, consequently the employee has more of their salary at their disposal.