The largest pillar in the German healthcare system is statutory health insurance (Gesetzliche Krankenversicherung - GKV). It is one of the world’s oldest social health insurance systems, dating back to the late 1880s. Over time, the system has gradually widened, so that in 2019 around 90% of Germany’s population is covered by statutory health insurance.
The statutory health insurance system (Gesetzliche Krankenversicherung - GKV)
If you have a job in Germany, and earn less than 59.400 euros per year, you will be automatically enrolled in the statutory health insurance system. Your employer will usually register you with a local health insurance company, although you can state a preference for a specific insurer, if you wish. After the first 18 months, it is also possible to change your health insurance provider (see below). If you are a student, you can also register for student health insurance with GKV at a discounted price.
Every worker is obliged to contribute to a statutory health insurance scheme. You are only able to choose which type of health insurance you would like if:
- You earn more than 59.400 euros per year.
- You are self-employed (e.g. you are a freelancer or run your own business).
- You are a civil servant.
If any of the above apply to you, you can choose to voluntarily opt-in to statutory health insurance, or take out private health insurance, which, depending on your income, may work out cheaper for you.
GKV is administered by around 110 non-profit organisations known as Krankenkasssen (sickness funds). All of the Krankenkassen are obliged to provide the same minimum level of care; they are also not allowed to refuse anyone membership.
What treatment is covered by statutory health insurance?
German statutory health insurance offers fairly comprehensive coverage, including:
- Hospital treatment
- Visits to GPs and doctors
- Rehabilitation, such as home care or physiotherapy
- Health checks from the age of 35
- Cancer screening
- Medicines, dressings, therapies and aids such as hearing aids or wheelchairs
- Dental check-ups
- Dentures and crowns
- Orthodontic treatment up to age 18
Statutory health insurance premiums
The sickness funds all charge the same basic rate of 14,6% of your gross salary (up to a maximum limit of 4.4250 euros per month in 2019). This contribution is split equally between you and your employer (7,6% each) and topped up with government subsidies.
If you are self-employed, you will generally have to pay the full contribution yourself. However, freelancers working in areas like art, PR or writing can apply to have 50% of their contributions covered by the Künstlersozialkasse (KSK). Students are offered specially discounted rates.
Additional contribution (Zusatzbeitrag)
Depending on your provider, you may also be charged an “additional contribution” (Zusatzbeitrag) of up to 1,1%, which is not covered by your employer. This extra contribution sometimes entitles you to extra treatments not covered by statutory health insurance, such as:
- Additional dental care such as professional tooth cleaning or dentures
- Flu and travel vaccinations
- Cancer screening under 30
- In vitro fertilisation (IVF)
Your Krankenkasse is obliged to inform you of any changes to your contribution rate, in order to give you the chance to change health insurance provider.
Additional charge (Zuzahlung)
To help cover the costs of the statutory healthcare system, patients are expected to make small excess payments (Zuzahlungen) towards the cost of their healthcare. This includes:
- 10% of prescription costs (minimum 5 euros and maximum 10 euros)
- 10 euros per day for hospital stays (up to a maximum of 28 days per year)
- 10% of home help costs (minimum 5 euros and maximum 10 euros per day)
- 10% of travel costs (minimum 5 euros and maximum 10 euros per journey)
Additional insurance (Zusatzverischerung)
It is also possible to purchase additional insurance (Zusatzversicherung) from health insurance providers, such as Deutsche Familienversicherung, to “top-up” the care you receive from your statutory insurance. This might include:
- Foreign travel health insurance
- Additional sickness benefit (your statutory health insurance already entitles you to some; see below)
- Additional long-term care benefits
- Better hospital treatment, including higher doctor’s fees and private hospital rooms
- Additional dental care
- Alternative medicine
German statutory health insurance comparison
You can compare the different Krankenkassen’s coverage and optional extras by visiting Krankenkasse Deutschland or Tarifcheck (websites in German).
One of the big advantages of statutory health insurance is that it can also cover your family and kids at no extra cost. This includes:
- Spouses / partners
- Children up to age 23 if they are not in employment
- Children up to age 25 if they are in school or vocational training
- Stepchildren, grandchildren and foster children (up to age 23 or 25, as above)
To qualify, your dependents must not earn more than 435 euros per month.
Health insurance for pensioners
Pensioners are also obliged to take out health insurance. If you have been contributing to a statutory health insurance scheme for 90% of the second half of your working life, you must contribute to a statutory health insurance for pensioners (gesetzliche Krankenversicherung der Rentner) scheme.
The premiums will be deducted from your pension (approximately 14,6% of your statutory pension and any additional income, including private or company pensions). Your pension fund will contribute 50% of the premium taken from your statutory pension.
If you do not meet the criteria, you can voluntarily contribute to GKV, but your premiums may be higher. Alternatively, you can take out private health insurance for pensioners, and your pension insurance fund will usually supplement your contributions.
Health insurance card (Gesundheitskarte)
Once you have registered for health insurance in Germany, you will receive a health card (Gesundheitskarte) from your provider in the post. You will need to supply this every time you seek medical treatment so that your health insurance company can be invoiced, rather than you having to pay upfront.
Changing your health insurance provider
Everyone covered by statutory health insurance has the right to change their insurance provider after 18 months (or less, if your provider changes their additional contribution (Zusatzbeitrag) rates).
Once you have chosen your new Krankenkasse, you will need to write to your previous provider to cancel your subscription. You must give them two months’ notice. You can then apply for insurance from your new provider and let your old Krankenkasse know that you have taken insurance out elsewhere.
Usually, if you are unable to work due to illness, your employer will cover your salary for six weeks. After that, anyone who is covered by statutory health insurance is eligible for sickness benefit for up to 78 weeks.
Long-term care insurance
Long-term care insurance funds are usually operated as an arm of statutory health insurance funds; therefore if you are covered by GKV, you can also claim long-term care benefits in the event of sickness and old age.