FAQ ABOUT THE GERMAN HEALTH SYSTEM

Health consultations are regular because health is the basis of your wealth.?

We have mostly 3 types of health care consultation:

• When you just moved to Germany and need insurance to be insured. State or private health insured.?
• When you want to switch from state insurance to private healthcare.
• When you stay in statutory health insurance but want to upgrade with some of the benefits the private provides (dental health care, private hospital room or you want special treatment for a head physician or travel abroad).

For you I wrote this article with our 6 FAQ from our consultation for expats and international people.

1.What is the main difference between PKV (private) and GKV (statutory)?

?In Germany, it is mandatory to be health insured since 2009. Everyone can be in the statutory health system, but only a few can enter the private one.

You must be earning over the JAEG (Jahresentgeldgrenze, English compulsory insurance limit). This amount increases almost every year. Now in 2021, you must earn 64.500€ yearly gross income to be able to switch. As a freelancer, a student, or an officer (Beamte) you can choose as well. I would say for freelancers and officer’s private health insurance is in most cases the best choice.?

The statutory health insurance is financially dependent on the citizens' contributions and regulated by health funds. Private health insurance is a private insurance company that regulates your fee for your health care.?

GKV works with the "Umlageverfahren". Easy explained :The pay-as-you-go system is a method of financing social insurance, especially old-age provision, but also pensions and unemployment insurance. The contributions paid are used directly to fund the beneficiaries.

This means when you are young earning good money you are paying a lot more for financially vulnerable people (families, older people, students). In 2021 the maximum of health insurance you must pay is around 770€ plus your daycare insurance (Pflegepflichtversicherung) maximum of about 150€ and it's split between you and your employer. That's a total of 920€ per month.?If you are lucky to earn up to 58.050€ per year (gross) this is your health insurance fee per month!

?2.Does the employer pay a subsidy towards the private health insurance contribution?

?Employees who have compulsory private health insurance receive a subsidy from their employer. The subsidy is equivalent to what the employer would contribute if the employee were covered by social health insurance - but no more than half of the total contribution to private compulsory long-term care insurance. The subsidy of your employer is about 385€ in 2021. This means that your health insurance may cost up to 770€ per month until you must pay the rest of the contribution yourself.

The employer does not pay the subsidy automatically. You must provide him with proof of insurance. This can usually be obtained easily from your insurance company.?

Your health insurance fee on your paycheck will be extinguished. The private health insurance contribution will be deducted from your account monthly, and your employer will transfer the tax-free amount directly to you.

If you have not exhausted the maximum subsidies of your employer for your contribution, you can use the rest, for example, for your child or partner, if they must take out private health insurance.?

?3.What is better GKV or PKV?

?Both are companies and work on their terms. It is no good and bad game!

I noticed that statutory health insurance is a company like one other when we switched a client to private health insurance. The client had a 2-month consultation and private insurance was just a perfect match for his situation. After I canceled his insurance, his former statutory health insurance (I will not name it here, but if we ever meet or have a consultation, I will tell you in person) send him a PDF with very weak information about the disadvantages of private health insurance. I am not pro or against any system. But this customer recovery strategy gets a big "thumb down".?

As mentioned above PKV and GKV are two individual systems. I do not like to compare the services, because it feels like the only way to be health insured will be private. GKV is a social system. It has to cover most of the population, and because right now there are more vulnerable (older generation) people to cover there are limited budgets.?

And still, I believe in Germany we are well covered in Germany compared to other countries, right??

Pensions and health systems are difficult to maintain the way there were before. Private health insurance is tailored to your needs and what you pay is what you get. You are only providing for yourself! This means all the monthly fee is for your health care. So normally in private health insurance are treatments included that the social system is not able to provide. Also, the cost of the dentist, private hospitals, and treatment by a head physician is included.?

?4.Once I move to PKV can I ever change to a statutory once again?

There are situations that you must go back to statutory insurance even you do not want it. Normally once you change to one system you are not meant to go back, it should be a long-term decision. And well planned.?

In principle, a return to statutory health insurance is not possible. However, there are exceptions to this rule:

?1.Your income falls below the compulsory insurance limit (JAEG)

You must switch back to the statutory health insurance fund if your income as an employee falls below the compulsory insurance limit - for example, due to a change of job that involves a drop in salary.

2.The compulsory insurance limit is raised, but not your income

If your salary falls below the compulsory insurance limit only because it has been raised by the legislator, you can apply for exemption from compulsory insurance. However, you must apply within three months of the increase in the compulsory insurance limit.

?3.You become unemployed

If you become unemployed, a return to compulsory health insurance is unavoidable. However, there is an exception: you can be exempted from compulsory insurance if you have had private health insurance for at least five years. Your health insurance contribution is covered by the Federal Ministry of Labor within certain limits

5.When do you recommend staying in a GKV even I match all the requirements??

• When you just matched the top of your 64.500€ gross income and you are still on probation time. That means for me your income is not secure yet.
• When you are the main provider of a family and paying health insurance for the whole family becomes a fianncially obstacle for your budget.
• When you have several or chronic diseases

?6.How am I protected when I travel?

?If you are traveling abroad and have statutory health insurance, you need to have travel health insurance for abroad. Otherwise, you will have to pay at least part of your treatment costs yourself in case of illness.?

A good travel health insurance for short vacations costs about 11€ per year.?

Within the European Union, in Iceland, Liechtenstein, Norway and Switzerland, as well as in countries with which Germany has a social security agreement, the statutory health insurance pays part of the medical costs.

You will only be reimbursed what the citizens in the country receive from the local health insurance.?The statutory health insurance in Germany does not pay for private medical bills abroad. This applies to the visit to a private doctor, as well as the stay in a private hospital or for medication.?

You will be stuck with these costs if you do not take out additional insurance. What can also be very expensive, medical return transports to Germany. These costs about 25.000€ and more. Such costs would take over the travel health insurance.

?If you have private health insurance it depends on the contract and tariff you have. In some insurances it is included. But with a foreign health insurance makes nothing wrong. Check your situation and enjoy your vacations!?

If you need guidance on your personal situation, contact me for a free or charge consultation. This article is a guidance and should not replace a personal one to one consultation.

Alicia