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National Health Services for Expats in Germany

Submitted: September 2013

As per the continental corporatist tradition, Germany’s public healthcare system is primarily insurance-based rather than tax-financed. There is no universal entitlement to healthcare benefits, at least in theory. Accordingly, healthcare in Germany is not free unless you are an insured person.

The German welfare system is one of the oldest in the world. It is also fairly conservative. As a general rule, the system does not reward instability, and family solidarity is encouraged.

Health insurance is often compulsory in Germany. For most Germans, insurance is socialised (Gesetzliche Krankenversicherung) and contributions are income-tested. However, civil servants, employees with a yearly income above €52,200, as well as the self-employed may choose to opt out from social insurance and rely on private health insurance instead.

This section explains how Germany’s social insurance system works. If you are healthy and/or wealthy, you might wish to read our section on the private health insurance system in order to improve value for money.

Insured persons

All employees in Germany, along with employers, must contribute towards public health insurance. Employee contributions are deducted from pay.

Any employee who pays his/her social insurance contributions is an insured person. His/her spouse or dependants are also treated as insured persons, unless their income is too high.

Since 2007, all individuals living in Germany, regardless of their working pattern, must have health insurance.

Premiums

In 2013, employee and employer must pay 14.6% of gross pay towards health insurance. An additional 2.05% (employee) and 1.025% (employer) must be paid towards care insurance (Pflegeversicherung). Only income below €47,250 is taken into account. In other words, employee health insurance premiums are capped at €3,449.25 p.a., or €6,898,50 p.a. if combined with employer contributions. Employees must pay also pay 0.9% towards dental prostheses.

Do not expect your own social insurance premiums to actually match your real healthcare costs. This is because:

  • Social insurance is a matter of redistribution, from the healthy to the medically vulnerable (such as the elderly, the disabled or individuals with a pre-existing condition), and from high-income to low-income households
  • Social insurance is also financed by employer contributions and, to a small extent, taxes.

Benefits

Under public health insurance, an insured person is entitled to “economically viable, sufficient, necessary, and meaningful healthcare services”. The concept of necessity accordingly excludes any services of a sumptuous or purely cosmetic character.

Care insurance is designed to fund certain services for the long-term disabled, i.e. those cannot or can no longer carry out day-to-day tasks for themselves. These services include daily care at home (häuslische Pflegehilfe) or nursing homes (vollstationärer Pflege).

International agreements

If you are an EEA resident travelling temporarily to Germany, you should apply for a European Health Insurance Card (EHIC) in your home country. EHIC is designed to grant you access to subsidised state healthcare on the same basis as German residents. You can use EHIC only for medically necessities arising whilst you are in Germany.

Germany has also concluded bilateral social security agreements with the following countries: Australia, Bosnia and Herzegovina, Brazil, Canada (including Quebec), Chile, India, Israel, Japan, Kosovo, Macedonia, Montenegro, Morocco, Serbia, South Korea, Tunisia, Turkey, United States.

International agreements may exempt you from being subject to German social security legislation if you are on secondment in Germany. In such cases, you remain subject to the social security legislation of your home country.

Excluded services

Many healthcare services are not covered by social insurance. These include, but are not limited to:

  • Unregistered private doctors
  • Hospital private rooms
  • Dental implants
  • Eye care appliances
  • cosmetic surgery

 

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