Roughly 90% of the population in Germany is in one form or the other insured through the public health care system. That this represents a major triumph of the modern welfare state is easily forgotten. Generally speaking, if you are employed in Germany, you probably have to be in the public health care system.
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.
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.
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.
Number of insurees in the GKV