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Krankenkasse vs Privat
COMPULSORYVS.PRIVATE HEALTH INSURANCE
Paying NIC in Germany you will come across two different health care systems. 90% of the population here are members of the compulsory health care system. It is know under the name Gesetzliche Krankenversicherung – GKV (statutory health insurance). The rest is insured through the private health insurance, Private Krankenversicherung – PKV). Unlike in many other European countries the PKV is a stand-alone full cover scheme and members of the PKV are not paying anything into the statutory health insurance at all. Supplementary Private cover is, however, available to anybody who pays contributions to the statutory scheme and quite a few do so to cover certain things that wouldn't be by the statutory scheme. (e.g. dental care, private room in hospitals, etc.). It is therefore not uncommon to combine statutory health care with a supplementary coverage. In consequence not every private health care policy is actually a FULL private coverage.
All insurance companies will provide you with a health insurance card that looks like a credit card. Upon entering a hospital or doctor’s surgery for treatment, the insurance card
(“Versicherungskarte”) has to be presented. As a GKV member, you are not billed directly by doctors, hospitals or any other health provider. The patient pays a modest fee per day for a hospital visit, or quarterly for a doctor’s visit.
A non-German resident will not be covered by the health insurance (“Krankenkasse”) unless he/she qualifies through a German employer.
OUTLINE OF THE STATUTORY (COMPULSORY) HEALTH INSURANCE (GKV)
Everybody who is resident in Germany or liable to pay national insurance contributions there (e.g. pilots based in Germany in accordance with EU regulation 465/2012) have to prove Health Care insurance. There are two systems co- existing in Germany: compulsory and private. But even the compulsory system is not state owned but is provided by hundreds of independent and private companies. The government is only maintaining the legal framework. In consequence the coverage through the compulsory health care scheme is to 95% identical among the providers.
An insured individual can change between different providers within the compulsory health care scheme. It is easy and typically possible after a minimum membership period of 18 months. The differences are only little, but depending on your individual situation a change might allow you some savings and/or better service. However, in order to increase competition health care provider are allowed to offer to the insured person to pay for some extras beyond the legal framework (such as back therapy, life healthy programs, inoculations for travellers etc.) Furthermore, bonus schemes may be offered. If you go regularly to check your health status or attend sport and life healthy courses you might get some cash back. Retention programs are another way to get certain amount of your contributions back if you are insured in compulsory health care scheme. Details can be found on the health care provider's website and the programs might vary between the different providers.
In addition, some check ups or medical examinations that are offered by your doctor are not covered through the compulsory scheme but the individual has to pay for them him/herself. This program is called IGEL and many practices are offering it to their patients. Furthermore you are also expected to pay some money towards prescriptions of pharmacies yourself.
PRIVATE HEALTH INSURANCE CHOICES (PKV)
As the name compulsory indicates certain groups are mandated to be members of that system. Regularly, employees are mandated to be insured in the compulsory health care system. They are only exempted if the income is below or above a certain income threshold. For 2013 the relevant upper threshold is set at €52,200 of annual income. Should you earn above that you can choose to either stay in the compulsory system as a volunteer member (with all it's pros and cons) or to leave the system completely and seek private full coverage.
In Germany the private health care is a full coverage scheme. The extent of the benefits and services provided by the insurance companies are also governed by the legal framework set by the government. Foreign providers are principally allowed but there scheme must be accepted by the authorities in Germany. As each European country is different you must check with your provider of choice if their program would meet the requirements set in Germany, too. If it does you could 'import' your foreign private health care scheme. However, there will always be the option to join a German private health care provider. Don't get confused. Since the vast majority are members in the compulsory system, many 'private coverage' are supplementary to your compulsory coverage and are not a stand alone option. The scheme provided by DHL Air is such one. The German authorities will not accept your membership in there to 'release' you from paying health care insurance contributions in Germany.
So as an employee you either have the choice between compulsory insurance (“Gesetzliche Krankenversicherung”, GKV) or a private (“Privatversicherung”). This depends on your level of income. Employees whose salary regularly exceeds a specific amount are not bound any longer to compulsory insurance, but become a voluntary member of the health insurance system. Another mandatory insurance plan for German employees is the long range nursing insurance (“Pflegeversicherung”). GKV members are automatically enrolled in this insurance plan. Both health and long range nursing insurance is subsidised by the government and employers contribute to the premiums, which are set by salary.
OUTLINE OF THE PRIVATE HEALTH INSURANCE (PKV)
The compulsory system is solely based on income. Your age or health status doesn't matter. The more you earn the more you pay. However, your contributions are caped at a set income level. For 2013 this is set at €47,250 of annual income. For any income above that you will not pay higher contributions. In addition, in the compulsory system family members, whose income doesn't exceed a certain limit (children or married partner) will typically also be insured with no extra charges (Familienversicherung). The single, income based contribution of you usually covers your whole family.
Private insurance companies base their premiums on age entry, gender and pre- existing conditions and are usually more costly. Medical pre-examinations or records will be required and the application process may be complicated. Although it should not officially be the case, a privately insured patient will be favoured with quicker appointments or more thorough medical advice. Private companies bear the expenses for homeopathy or traditional Chinese medicine and more preventative checkups than with the national health insurance. Again, your employer will contribute to the premiums.
The premiums of private health care companies look cheaper on paper, but you will need to pay premiums for each of your family members, who would otherwise be insured for free in the compulsory system. Since your private premiums are not based on income you might also well face increasing premiums despite stagnating or reducing salary (retirement, unemployment). A return to the compulsory health care scheme is difficult and almost impossible for those older than 55 years of age.
In addition, and opposite to the compulsory scheme, it is difficult to change your provider as the reserves accumulated during your membership are usually not carried over, hence the change might financially be very bad.
In 2013 the maximum compulsory premium for health care will be at the approximately €400 a month. This is the only potential for savings, as pension and unemployment contributions are still mandatory to pay by each employee in Germany. Going private will very likely result in a saving in the short term, but mid and long term a prediction is difficult to make.
FAMILY MEMBERS
In the compulsory insurance system spouses and children are insured at no extra cost, provided that they have no extra or only a little income of their own. This applies to family members who live in Germany or in a country with which a health insurance treaty exists. There are varying age limits for children. Should your spouse hold employment in Germany, he or she has to take out insurance by her/ him self.
In the private health insurance system, each member of your family has to be insured individually.
Usually, your company will complete the necessary formalities.
