Health insurance is not just a “good to have” in Germany; it’s a legal requirement. Whether you’re a student, a working professional, or someone exploring life in Germany, understanding the health insurance landscape is crucial. Thankfully, you’re not alone in this journey. This article aims to be your comprehensive guide to health insurance in Germany, clarifying options, processes, and what you might expect.
Germany boasts one of the world’s oldest and most efficient social health insurance systems. Established in the 1880s, the system has been finely tuned to serve the needs of its population. It provides a range of coverage from basic medical care to more specialized treatments. Knowing how it works can not only help you comply with the law but also take full advantage of the healthcare services available to you.
So, let’s dive into the essentials and demystify health insurance in Germany.
- Health insurance is mandatory for everyone residing in Germany, including foreigners.
- Germany offers two main types of health insurance: public and private.
- The process of getting insured involves registration, choosing a provider, and making contributions.
- Special insurance options are available for students, freelancers, and self-employed individuals.
- Tourists and those on short-term stays also have specific insurance options.
- Costs vary depending on income and the type of insurance you choose.
- Family members can often be included in your health insurance at no or minimal extra cost.
- Non-EU citizens generally require health insurance for visa and residency approval.
Types of Health Insurance in Germany
When it comes to health insurance in Germany, you generally have two main options: Public Health Insurance (Gesetzliche Krankenversicherung) and Private Health Insurance (Private Krankenversicherung). Each has its own set of features, benefits, and drawbacks, which we’ll explore in detail below.
|Public Health Insurance
|Standardized coverage, employer contributions
|Anyone earning less than €64,350 (as of 2021)
|Private Health Insurance
|Customizable plans, no employer contributions
|Anyone earning more than €64,350, or self-employed individuals, or students
|Insurance for Students
|Lower rates, limited benefits
|Enrolled university students up to age 30
|Fixed low rates
|Insurance for Freelancers and Self-Employed
|Flexible plans, varying costs
|Self-employed or freelance workers
|Insurance for Short-term Stays
|Limited coverage, short duration
|Tourists or temporary residents
Public Health Insurance (Gesetzliche Krankenversicherung)
Public Health Insurance in Germany is a state-sponsored system that provides a comprehensive range of healthcare services, including doctor visits, hospital stays, and even some forms of alternative treatments. The system is designed to be accessible and affordable, with premiums based on your income level.
Who is Eligible?
Almost everyone residing in Germany is eligible for public health insurance. This includes students, employees earning below a certain income threshold, and retirees. If you are a new arrival, you’ll generally be placed into this system by default unless you opt for private insurance.
- Wide range of coverage
- No discrimination based on age or pre-existing conditions
- Lower premiums for lower-income individuals
- Family members can be included at no extra cost
- Limited choice of doctors in some areas
- Longer waiting times for certain medical procedures
- Less flexibility in choosing healthcare providers
Private Health Insurance (Private Krankenversicherung)
Unlike the public system, Private Health Insurance companies in Germany are for-profit entities. They offer a variety of plans with different levels of coverage, which can be tailored to your needs. These plans often provide quicker access to specialists and offer the possibility of more luxurious hospital stays.
Who is Eligible?
Private Health Insurance is generally available to employees earning above a certain income threshold, self-employed individuals, and freelancers. Students may also opt for private insurance under specific conditions.
- Faster access to medical specialists
- Customizable coverage options
- Potential for more luxurious hospital stays
- Direct billing, eliminating out-of-pocket expenses for certain services
- Potentially higher premiums, especially as you age
- Pre-existing conditions may not be covered or may raise your premiums
- Family members are not automatically included and require separate plans
The Process of Getting Insured
One of the most pressing questions you might have is, “How do I actually get health insurance in Germany?” Whether you’re leaning towards public or private insurance, each has its own set of steps and documentation requirements. Rest assured, the process is relatively straightforward once you know what to expect.
Registering for Public Health Insurance
- Choose an Insurance Provider: The first step is to select a public health insurance provider. Companies like TK (Techniker Krankenkasse), AOK, and Barmer are among the popular choices.
- Fill Out Application: Once you’ve selected a provider, you’ll need to complete their application form. Some providers offer online applications, which can be more convenient.
- Submit Documentation: Along with the completed form, you’ll need to submit certain documents, usually via mail or in-person.
- Confirmation and Health Card: Once your application is processed and approved, you’ll receive a confirmation letter and a health insurance card, which you should always have on you when visiting any healthcare facility.
- Proof of residence
- Passport or Identification document
- Bank account details
- Employment contract (if applicable)
Where to Apply
Applications are generally submitted directly to the chosen insurance company. Some companies have physical offices, but many also offer online platforms to facilitate the application process.
Opting for Private Health Insurance
- Research and Comparison: Given the variety of plans available, take time to compare different private health insurance providers and their offerings.
- Contact the Provider: Once you’ve narrowed down your options, you can usually get a quote online or speak with an insurance consultant for a more tailored package.
- Complete Application: Similar to public insurance, you’ll need to fill out an application form, but it may be more detailed to assess your health risks.
- Medical Examination: Some providers require a medical check-up or a detailed medical history.
- Finalize Contract: Once approved, you’ll receive your insurance contract, which you should review carefully before signing.
- Passport or Identification document
- Proof of residence
- Employment contract or proof of income (if applicable)
- Medical history or examination results (if required)
Where to Apply
Most private insurance companies provide multiple avenues for application, including online platforms, phone consultations, and physical offices where you can speak to an insurance consultant.
Health Insurance for Students, Freelancers, and Self-Employed Individuals
While the process of getting insured is generally uniform, there are some special considerations to be aware of depending on your employment or educational status. The health insurance landscape can differ significantly for students, freelancers, and self-employed individuals. Below we explore the tailored options for each.
Health Insurance for Students
For students in Germany, health insurance is mandatory, just like for everyone else. However, students often have access to more budget-friendly public insurance plans specifically designed for them.
Who is Eligible?
Generally, students who are enrolled in a state-recognized university up to the age of 30 are eligible for the student rate in public health insurance.
Students are encouraged to avail of the public health insurance student tariffs, which are less expensive than standard rates. Private insurance is also an option, but it’s important to weigh the pros and cons carefully.
Health Insurance for Freelancers and Self-Employed Individuals
Freelancers and self-employed individuals do not have an employer to share the cost of health insurance premiums, making it all the more essential to find a cost-effective solution.
Who is Eligible?
Freelancers and self-employed individuals are eligible for both public and private health insurance but need to handle all the premium payments themselves.
Public insurance can be expensive for freelancers and the self-employed, but it does offer comprehensive coverage.
Private insurance offers the chance to customize your coverage to fit your needs, but it can be more expensive in the long run, especially as you age.
Special Considerations for Freelancers and Self-Employed
- If you are considering opting for private insurance, think about the long-term costs, including how your premiums might increase with age or health conditions.
- Certain professions might have access to specialized “professional guild” insurance plans that offer specific benefits tailored to their field.
Health Insurance for Short-term Stays and Tourists
If you’re planning a brief visit or a short-term stay in Germany, you might be wondering whether you need health insurance at all. The answer is yes, even short-term stays require some form of health coverage. Fortunately, there are specific options tailored to fit the needs of tourists and short-term visitors. Below, we outline what you need to know to ensure you’re adequately covered.
Travel Insurance vs. Health Insurance
Travel insurance is a short-term solution that usually includes coverage for emergencies, accidents, and sometimes even routine medical care. Health insurance for short-term stays, on the other hand, is more comprehensive but generally involves a longer application process and higher premiums.
Who is Eligible?
Tourists and individuals visiting Germany for a short period (usually less than 90 days) can opt for travel insurance. For those planning a longer stay but less than a year, specific short-term health insurance plans are available.
Recommended Options for Short-term Stays
- Generally easier to apply for and can even be purchased after arrival, although buying it before is advisable.
- Consider policies that offer at least €30,000 coverage, including medical repatriation.
Short-term Health Insurance Plans
- Offer more comprehensive coverage compared to travel insurance but usually at a higher cost.
- Useful for individuals involved in work assignments, internships, or extended vacations.
Costs and Coverage
Travel insurance is typically more affordable but offers limited services. Short-term health insurance plans are costlier but provide broader coverage. Costs vary widely depending on the provider and the individual needs, so it’s advisable to shop around.
How to Apply
Application processes for short-term insurance plans and travel insurance are generally simple, often requiring just your identification, travel dates, and sometimes, medical history. Many providers offer online applications, making it convenient to secure coverage even before you arrive in Germany.
Emergency Medical Situations
In the case of an emergency medical situation, it’s essential to have some form of insurance. Both travel insurance and short-term health insurance plans will generally cover emergency medical services, although the extent of the coverage can vary.
Costs and Contributions
Affording health insurance is a common concern, but understanding how costs and contributions work can make it more manageable. Whether you opt for public or private health insurance, each has its unique cost structure, dependent on factors like age, income, and health condition.
Costs in Public Health Insurance
In the public system, premiums are calculated as a percentage of your gross income, up to a certain income ceiling. The percentage is predetermined and generally ranges from 14% to 16%. Employers contribute about half of this percentage, significantly reducing the amount you pay out of pocket.
If you’re unemployed, a student, or a low-income earner, your contributions will be adjusted accordingly, often resulting in lower premiums.
Co-payments and Additional Costs
Public health insurance generally covers a wide range of services with minimal co-payments, such as a nominal fee for prescription medicines or certain specialist visits.
Costs in Private Health Insurance
In private insurance, your premium is calculated based on a risk assessment that includes factors like age, gender, and pre-existing medical conditions.
Private insurance offers a wide range of plans with varying costs. A basic plan may be less expensive initially but can become costlier in the long run due to additional services or increasing age.
Co-payments and Deductibles
Some private insurance plans have deductibles and co-payments. This means you’ll have to pay a portion of the medical expenses yourself, up to a certain limit.
For Students, Freelancers, and Self-Employed
- Students generally benefit from lower premiums in public insurance schemes.
- Freelancers and self-employed individuals need to bear the full cost of the premiums, whether in public or private insurance.
For Short-term Stays and Tourists
The costs for travel insurance and short-term health insurance plans can vary widely, depending on the provider and the extent of the coverage. Premiums can range from a few euros per day to more substantial amounts for more comprehensive coverage.
Ensuring that your family is well-protected is likely a top priority when considering health insurance options in Germany. The good news is that both public and private insurance systems offer pathways for family coverage, albeit with different structures and benefits.
Family Coverage in Public Health Insurance
One of the notable advantages of the public health insurance system is that it often allows for family members to be included in your coverage at no extra cost. This is known as “family co-insurance” (Familienversicherung).
Who is Eligible?
Spouses and children (up to a certain age) who do not have an income above a specific threshold can be covered under your public health insurance policy.
To add family members to your policy, you’ll need to notify your public health insurance provider and submit relevant documentation, such as birth certificates or marriage certificates.
Family Coverage in Private Health Insurance
Unlike public insurance, each family member in a private health insurance scheme typically needs to have a separate policy. This often results in higher total premiums for the family.
Who is Eligible?
Any family member can be added, but each will undergo their risk assessment, affecting the cost of their individual premium.
To add a family member to your private insurance plan, you’ll have to fill out separate application forms for each person, and they may require medical check-ups or historical records.
Considerations for Expatriates
If you’re an expatriate with family members residing with you in Germany, most of the above options apply. Some providers offer specialized expatriate family plans that might suit your needs better.
Special Cases: Newborns and Pregnant Family Members
- For newborns, it’s crucial to register them for health insurance coverage shortly after birth.
- Pregnant family members may require additional coverage options, so reviewing your policy for maternity benefits is advisable.
If you’re a non-EU citizen planning to live, work, or study in Germany, you might be wondering how the health insurance system applies to you. The rules can be somewhat different, but with the right information, the path to securing your coverage can be clear and uncomplicated.
Health Insurance Requirements for Non-EU Citizens
Visa and Residency
Health insurance coverage is generally a mandatory requirement for obtaining a German visa or residency permit. Without adequate coverage, your visa application is likely to be rejected.
Types of Coverage
You can opt for either public or private health insurance. Some visas might require certain types of insurance coverage, so it’s essential to check the specifications of your particular visa.
How to Apply as a Non-EU Citizen
Steps for Public Insurance
- After arriving in Germany and registering your residence, choose a public insurance provider and complete the application process, as outlined in the section on public insurance.
- Once approved, you’ll receive a social security number which will be useful for various administrative purposes, including healthcare.
Steps for Private Insurance
- Research and compare different private insurance plans that meet your visa requirements.
- Complete the application process, which may involve a medical questionnaire or even a medical check-up.
- Once approved, your provider will issue a certificate that you can use to support your visa application or renewal.
Special Health Insurance Plans for Non-EU Citizens
Some insurance providers offer special health insurance packages designed to meet the specific requirements of different visa categories, like student visas, work visas, and family reunion visas.
Working in Germany
If you’re employed in Germany, the same general rules apply for both EU and non-EU citizens when it comes to employer contributions to your public health insurance. In private schemes, you’ll need to handle the premiums yourself or negotiate contributions with your employer.
- Visa or residency permit
- Proof of income or employment contract
- Any additional documents specified by your chosen insurance provider
Dependents and Family Coverage
Non-EU citizens can also extend their coverage to include family members, but the rules and procedures will depend on whether you opt for public or private insurance.
Emergency Medical Situations
Navigating any medical emergency is stressful, but facing one in a foreign country can add an additional layer of complexity. Knowing what to do in emergency medical situations in Germany can provide not just practical guidance but also much-needed peace of mind.
What Constitutes an Emergency?
An emergency is any situation that poses immediate risk to health, life, or well-being and requires urgent intervention. This could range from severe injuries to acute illnesses.
Common emergencies include, but are not limited to, chest pain, difficulty breathing, severe bleeding, and sudden, intense pain.
How to Seek Emergency Help
- For medical emergencies, dial 112.
- For non-emergency medical assistance, you can call 116 117 to speak to a healthcare professional.
Hospital Emergency Rooms
In case of severe emergencies, it’s advisable to go directly to the nearest hospital emergency room (‘Notaufnahme’ in German).
What to Expect in the Emergency Room
Upon arrival, a triage nurse will assess the urgency of your condition. You’ll likely have to present your ID and health insurance card. If you don’t have your insurance information with you, treatment will not be withheld, but you’ll need to provide it as soon as possible.
Costs of Emergency Services
If you’re insured under the public health system, emergency treatment costs are usually covered. You might have to pay a nominal fee, but this is generally affordable.
Private insurance often covers emergency treatment, but the specifics depend on your individual plan. Some may require you to pay upfront and seek reimbursement later.
After receiving emergency treatment, you might be referred to a specialist for follow-up care. In such cases, consult your insurance policy to understand your coverage and any necessary steps for referrals or further treatment.
Don’t worry if you’re not fluent in German. Many healthcare professionals in Germany speak English, especially in larger cities. However, it might be helpful to keep a list of key medical terms or use a translation app for easier communication.
Changing or Canceling Your Insurance Plan
Life is full of changes, and your health insurance needs can shift along with them. Whether you’re considering switching providers, altering your coverage, or leaving Germany altogether, it’s essential to understand the proper procedures for changing or canceling your health insurance plan.
Changing Your Public Insurance Provider
Conditions for Change
In Germany’s public health insurance system, you’re generally bound to your chosen provider for a minimum period of 18 months. After that, you’re free to change providers if you wish.
Steps to Change
- Notify your current provider in writing, adhering to the notice period specified in your contract.
- Receive a cancellation confirmation and then apply to your new chosen provider.
Upgrading or Downgrading Your Plan
Within the public system, your options for altering your coverage are relatively limited, given that services are standardized. However, you can opt for supplementary private insurance for additional benefits like private rooms during hospital stays.
If you’re with a private provider, you usually have more flexibility to change your coverage options, although this may affect your premiums.
Canceling Your Insurance
If you’re leaving Germany, it’s mandatory to cancel your health insurance. The process typically involves notifying your provider in writing and presenting proof that you’re leaving the country, such as a de-registration certificate from the local authorities.
Switching from Public to Private
If you decide to switch from a public to a private provider, ensure you meet the eligibility criteria for private insurance first. Once confirmed, you can cancel your public insurance.
Be mindful of any penalties or notice periods when canceling. Failing to adhere to the contract terms could result in additional charges.
Whether you’re changing or canceling your plan, make sure to keep all relevant correspondence and confirmation documents. This could be essential for resolving any disputes or issues that might arise later.
What Happens If I Don’t Get Health Insurance?
In Germany, health insurance is mandatory for all residents, including foreigners. Failure to secure coverage could result in penalties and make it difficult to renew your visa or residency permit.
Can I Choose Any Doctor or Hospital?
Public Insurance – Under public insurance, you’re generally free to choose among doctors who accept public insurance, which is most of them. However, some specialized treatments may require referrals.
Private Insurance – With private insurance, you usually have broader options, including specialists who may not accept public insurance.
Do I Need Additional Dental Coverage?
Public health insurance provides basic dental care, but more complex treatments might only be partially covered. If dental care is a priority for you, consider supplementary dental insurance.
Can I Continue Using My Foreign Health Insurance?
Some foreign insurance plans are recognized but often only for short stays. For longer stays, you’ll likely need to get a German health insurance plan that meets legal requirements.
How Do I Transfer My Health Records?
Contact your previous healthcare providers to obtain your records, which you can then provide to your new doctor in Germany. Some providers might even offer digital transfer services.
What If I Lose My Job?
If you’re covered by public insurance and become unemployed, your insurance will generally continue, and the Federal Employment Agency may cover your contributions. With private insurance, you’ll need to discuss your options with your provider.
Are Pre-Existing Conditions Covered?
Public Insurance– Pre-existing conditions are generally covered under public health insurance without additional charges.
Private Insurance– Coverage for pre-existing conditions under private insurance depends on your plan and may result in higher premiums.
Is Pregnancy and Childbirth Covered?
Both public and private insurance plans usually cover pregnancy-related medical care and childbirth, but the extent of coverage can vary, especially in private plans.