What is public health insurance?

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72 mil­li­on

Num­ber of insu­rees in the GKV [1]

The public health insuran­ce (GKV) sys­tem has its ori­gin in the soci­al laws intro­du­ced by Otto von Bis­marck at the end of the 19th cen­tu­ry. All “workers” (today: employees) had to insu­re them­sel­ves in the GKV, in order to recei­ve a mini­mum amount of pro­tec­tion.

Mean­while, the tasks have beco­me more diver­se, but the basic idea remains the same: ensu­ring ever­yo­ne ade­qua­te, basic medi­cal care at a cost that is direc­t­ly rela­ted to the inco­me.

Health care insuran­ce today is man­dato­ry in Ger­ma­ny, i.e. ever­y­bo­dy who lives in Ger­ma­ny has to have health insuran­ce. That natu­ral­ly inclu­des expa­tria­tes.

Every employee (who­se inco­me is below a cer­tain annu­al limit) is com­pul­so­ri­ly insu­red in the GKV. Addi­tio­nal­ly, the­re are vol­un­ta­ri­ly insu­red employees who can choo­se bet­ween public and pri­va­te health insuran­ce.

Thus, cur­r­ent­ly almost 90% of the popu­la­ti­on in Ger­ma­ny are in one way or ano­t­her insu­red in the public health care sys­tem!

The GKV is a cen­tral pil­lar of the wel­fa­re sta­te and despi­te the mista­kes and ina­de­quaci­es that it tru­ly has, it is a major tri­umph of the modern wel­fa­re sta­te.

What are the benefits of public health insurance?

Lis­ting all bene­fits would and does fill ent­i­re books. The task of the GKV is “to main­tain the health of the insu­red, to res­to­re or to impro­ve their health” and this has direct con­se­quen­ces for the bene­fits and pro­ce­du­res.

By law, bene­fits must be “ade­qua­te, appro­pria­te and eco­no­mic and must not exceed what is necessa­ry”.

Thus, the pro­ce­du­res that are cove­r­ed are deri­ved. At regu­lar inter­vals the­se pro­ce­du­res get review­ed or new ones get added. This pro­cess is stric­t­ly regu­la­ted by law. To gene­ra­li­se, the GKV pays for all medi­cal­ly necessa­ry and com­mon pro­ce­du­res inclu­ding things such as reha­bi­li­ta­ti­on.

The method used for reim­bur­se­ment is the so-cal­led “Sach­leis­tungs­prin­zip”. It means that the insu­red per­son does not have to pay anything (except for cer­tain man­da­ted addi­tio­nal pay­ments) to phy­si­ci­ans, hos­pi­tals, phar­maci­es, etc. or other insti­tu­ti­ons that offer health care ser­vices.

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217.83€ bil­li­on

Total GKV expen­dit­ures in 2017 [2]

Who should get public health insurance?

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356.19€ / month

Average pre­mi­um for man­dato­ry insu­rees [3]

In con­trast to many other types of insuran­ce, belon­ging to the GKV is regu­la­ted very stric­t­ly. In addi­ti­on to the men­tio­ned annu­al limit of inco­me, the­re are a num­ber of other pro­vi­si­ons that deter­mi­ne whe­ther someo­ne has to be in the GKV or can choo­se pri­va­te insuran­ce.

Howe­ver, GKV does not equal GKV. The­re are cur­r­ent­ly 110 orga­ni­sa­ti­ons that offer public health insuran­ce ser­vices and they all offer dif­fe­rent tariffs, spe­cial con­di­ti­ons and prio­ri­ties.

Ever­yo­ne has the right to choo­se his or her health insu­rer, which means that all pro­vi­ders at your place of resi­dence or employ­ment are open to you. The dif­fe­ren­ces in terms of pri­ces and ser­vices as well as custo­mer ser­vice or reim­bur­se­ment rates can be very high.

A switch can the­re­fo­re be worthwhile in many ways, espe­ci­al­ly if you have spe­cial needs or if cer­tain ser­vices are par­ti­cu­lar­ly important to you.

Howe­ver, swit­ching should be well con­si­de­red, and the most important fac­tor should always be good medi­cal care.

We help you in under­stan­ding the public health care sys­tem and in fin­ding the best solu­ti­on that fits your needs.

Questions? We have answers.

Public health insuran­ce as the basic medi­ci­nal coverage.

We will get back to you wit­hin 24 hours — wit­hout any com­mit­ment from you and in your pre­fer­red way.