First, all Germans are insured with the compulsory health insurance and have to be part of it if not insured privately. The compulsory health insurance covers certain pre-selected benefits and is quite extensive. Every compulsory insurance company has to cover these basic benefits. Since the reformation of the health care system in 2009 it is allowed for compulsory insurance companies to offer individual add-on benefits, it is therefore also possible to match the compulsory insurance to one’s personal needs.
The compulsory health insurance is based on a solidary system, the monthly fees are not calculated by age and health status but by personal income. Those earning more money cover some of the costs of those earning less- Also the employer pays part of the insurance for his employees. The amount is calculated by the pre-tax income of the insured person. Since January 2011 it is 15,5% of the pre-tax income divided into 8,2% for the employee and 7,3% for the employer. To get the pre-tax income one has to count the following points:
- Salary/ wage
- Income from capital investment
- Rent income
- Compulsory pension payment
- Others (as supply benefits)
There are some exceptions for example when unemployed or disabled. The highest border is 47.250 Euro per year and 3.937,5 Euro per month.
Searching for the perfect health insurance company can be difficult because they are not as similar as one may think. The tiny differences have to be found and this is not easy.
An argument to change the insurance company can be saving money and spending less on the insurance. This can be possible when the insurance companies offer bonus payments or self-payment rates. It is important to look to every detail of these offers, though.
Those being in contact with their insurance company very often may like to have a good service and a personal contact person with good counseling. In this case it can be decisive that there is an agency in one’s hometown with friendly and capable staff.
The most important reason to change the insurance are the offered benefits. Some insurances offer more benefits than others and these extra benefits can be compared. Sometimes you don’t even have to pay much more.
Insurance companies can impose a special fee but it is not obligatory to pay this. If the company charges this fee for the first time or rises the fee it is possible for the insured person to quit the contract exceptionally. This is even possible if the minimum of 18 months with the company is not over.
There is a list of benefits that should be offered by the compulsory health insurance. It can be found in the fifth Code of Social Law ad is no detailed numeration but a guideline. Normally the compulsory insurance covers medical and dental treatment as well as psychotherapeutic treatments. It also includes early diagnosis measures and prevention methods. Furthermore it has to cover nursing practice and rehabilitation as well as some medicines.
In course of the Heath System reformation the competition between the insurance companies has increased. This leads to a broader offer of extra benefits and bonus programs. These programs normally provide benefits or discounts when doing certain prevention courses or other offers. The insurance companies hope to help the insured persons to a healthier lifestyle and to increase the health in the long term. This also means less cost for the insurance companies in the future. They often offer health or fitness courses besides the bonus program. It can be worth looking through those offers because it can lead to cheap fitness classes.
The extra benefits of some insurance companies offer extra dental treatments for example artificial dentition which is only insufficient covered by most compulsory insurances. Furthermore they can offer packages for insurance abroad, long term care insurance and other additional insurances. With these extra benefits one can for example get benefits like chief physician treatment as member of a compulsory insurance, too.
The compulsory insurance has some advantages compared with the private insurance for some people, like:
- The fee is not dependent from age and health status so old persons or persons with chronic disease are not disadvantaged
- You do not pay fees during maternity protection or while getting sickness benefits
- Ancient disease do not matter
- Every insurance company offers the basic benefits and there are no difference between those benefits
- Families with many children, old or chronic disease persons and student with low or without income have advantages because of the social system
Since some years the former insurance card was replaced by the electronic sanitary card (German: eGK). The introduction was very controversial and has some Pros and Cons.
An Argument against the electronic sanitary card is the protection of data privacy. With this card all the information about the insured person and its health can be called. There are also voices complaining about the break-up of medical confidentiality. There are also special technical devices and software applications that have to be bought for the introduction of the eGK. By now the card is used all over Germany so these arguments are no longer loud.
The advantages with the EGK are in an improvement of medical treatment and less abuse of medical cards. In case of emergency all relevant data is saved on the card as well as important medicine. After the system has been introduced the availability of data is now faster and cheaper than before.
In case of a long disease the compulsory insurance also pays sickness benefits called “Entgeltersatzleistung” bin Germany. You get 70% of your pre-tax income for 72 weeks. One also doesn’t have to pay the monthly fee for the insurance during this time. There is an exception for children that are covered by the insurance of their parents or students. Those who do not become disabled to work do not receive these benefits. There is another special case with self-employed persons that are insured in the compulsory system, the payment here can differ from case to case.
The topic compulsory health insurance is not so easy and static as it seems. It is possible to get individual benefits and there is some freedom. But mainly it offers a solid and basic health insurance and is cheap for families, students and persons with los income.