parallax background

German social law

Health insurance

Everyone in Germany is obliged to have a proper health insurance, most of the people are covered by a public health insurance (Gesetzliche krankenversicherung), and one of the main advantages of this solution is the fact, that the responsible public entities are not supposed to make a profit. The revenues, in the first place contributions abstracted from an employee’s salary and employer’s statutory contributions, all depending on a salary level.

One has a right to choose a public health fund one wants to belong to.

Not everybody can join a fund, as the statute ruling this points (Sozialgesetzbuch Band V – The social statute part V) aims also at excluding people wanting to join the solidary contributions system having serious health problems. The profit oriented private health funds/health insurance companies rise their contributions depending on age level or aspects regarding health problems or even the cost of specific health problems. The rise can be also based on the growing general expenses. It is attractive only to young and healthy people aiming at saving some health insurance costs and wining a bigger financial freedom in their current situation. People not planning a longer future in Germany and being aware of risks connected to contracts with a private health insurance company could regard it as an option.

Contributions depend on the income level and some groups of people working based on their own business are also obliged to contribute, especially if they were public health fund members by law before starting their own business.

It is very important to deliver sufficient documents regarding one’s income level, because otherwise one can be condemned to pay contributions based on the highest statutory level.

The coverage contains a provision of non-monetary services and financial aid. Members of the fund who joined it by choice, are practically excluded from financial aid (exception: financial aid in case of pregnancy or directly after birth).

A treatment provided contains methods in most cases of physical or mental health problems or diseases. Such treatment’s level must be adherent to the current state of in medicine – as it is defined and accepted by most publications in medical sciences.

Financial aid in case of health problems is limited to 72 weeks. It can be also demanded in case of staying or living in other EU-member countries, as long as following requirements are fulfilled: the existence of an insurance duty (mostly by being employed in Germany), the existence of sick leave notices issued by a physician/doctor, no time without coverage by a corresponding sick leave notice, no sick leave time with a sick leave notice backdated more than 2 days back, delivering information of being on a sick leave notice (containing the duration of the sick leave or sick leave extension) within 7 days from issuing a new sick leave notice.

The public health insurance fund has a right to – and in practice, it often uses this right – to consult existence and possible duration of a health problem with an independent expert institution with physicians and medical experts taking specific symptoms and test – or other results under the … (untersuchen)