Health Insurance in Germany

In Germany, the concept of social health insurance is well established. It applies to all citizens and covers all basic medical expenses not covered by private health insurance. However, there are some exceptions: Employees must join an employer-based pension fund instead of social insurance; children in public schools don't have to pay for their treatment; retired people with a monthly income of less than € 1,285 have to self-fund their treatment costs up until the end of their life or until they stop working.

So what are your options? This article will explain how you can get around these dilemmas by making use of supplementary insurance plans offered mainly through employers and offer a glimpse into other measures including emergency aid funds and migrant support programs.

Basic health coverage is provided by the AOK—the general health insurance organization of the Federal Republic of Germany. It is a nonprofit, cooperative society that offers universal health care to German citizens. By joining an employer-based pension fund, you get access to private health insurance and additional perks, such as medical and dental care in your place of residence, hospitalization cover abroad and so on. The core benefit includes preventive medicine ("Prevention") as well as hospitalisation ("Inpatient"), which are fully reimbursed—even if you use private doctors or hospitals. There is no deductible—with a parental policy covering the whole family.

(1) How to get a private health insurance plan from your employer?

The main possibilities are: "private" and "public":

In addition, there is also a third type of private health insurance:

(2) Where to find out more about health insurance in Germany ?

There's almost no need to do your own research on this topic, because all employer-provided pension schemes provide detailed information about their work-related health insurance plans. They'll take you through the plan's details, including exclusions and benefits. You can also contact your pension fund directly. However, it is advisable to do so only if you are interested in the additional plans—otherwise, you could be wasting your time.

(3) Who's eligible for supplementary health insurance?

You need to be a member of an employer-based pension fund and work for one of the following employers:

a federal government agency; a state government agency; a federal or state governmental home office; or a political party.

(4) What are the benefits of supplementary insurance?

Whether you have an employer-supplied pension plan or not, you can still get private health insurance to supplement the basic coverage. However, the following additional insurance plans are only available through a pension fund: Before- and After-Death Cover (PAD), Critical Illness and Disability Cover (KID), Emergency Aid Fund (EAU), Maternity Benefit, and the Health Promotion Scheme for Adults. The rest of the basic plans are only available if you join an employer-based pension fund.

(5) How do I get supplementary health insurance?

There's no need to contact your pension fund directly. You can contact AOK directly. However, the organization has a relatively limited customer-service staff, which means you'll have to get through a lot of bureaucracy to get your questions answered. The more comfortable option is to contact an insurer or broker, Affiliated Brokers for AOK Coverage (ABK), which lists all the carefully chosen, reliable insurance companies offering supplementary health insurance plans (Eldepot).

(6) How much does supplementary health insurance cost?

You can choose from two different options: fixed-benefit plans or contribution plans. In the first case, the coverage amount is determined by your pension fund and depends on how many years you've worked there as well as your income level. In the second case, you can choose between a fixed-amount plan or a contribution plan and make your own contribution.

(7) What's the minimum benefit amount for supplementary health insurance?

In the question of minimum benefit amounts, as in many other countries, German laws also have an "escape clause". In this case, every employee gets an additional benefit that is called "immerhinkeitsausgleich". The value of this benefit is determined by your pension fund and depends on your income level. This additional benefit can be used to cover only a specific number of days every year (e.g., 2–3 days). However, this additional benefit can't be used to cover any additional medical expenses.

(8) What are the main benefits of supplementary health insurance?

If you work with an employer-based pension fund, it will automatically provide you with private health insurance and additional perks including medical and dental care in your place of residence, hospitalisation cover abroad and so on. Since supplementary insurance is by default a part of the employee's pension fund, there's no need to pay extra taxes—which makes this type of health insurance one of the best deals on the market currently.

(9) Are there any age restrictions for supplementary plans? (e.g. maternity plans)

Yes, the following age restrictions apply:

(10) Are there any restrictions for supplementary plans?

The following restrictions on supplementary insurance plans also apply:

As a rule, supplementary health insurance (PAD, KID and EAU) can't be stacked—that is, it doesn't make sense to add them to basic coverage. However, if you'd like to add one of these plans on top of an employer-provided pension plan and private health insurance, you can do so. If you're not sure whether a particular plan is suitable for you or not, you should contact your pension fund or a broker. In contrast, you can also add all kinds of supplementary insurance plans to your employer's basic health insurance.

(11) What other benefits are there?

Supplementary health insurance plans not only provide medical and dental care in case of illness or injury. The following additional benefits are included: 

There is another benefit called "KardiaVorrat" (heart reserve), which covers costs caused by an unexpected heart attack, stroke or other life-threatening event. Your policy will cover the cost of hospitalisation and treatment to restore your normal heart rhythm with the help of medication and a pacemaker. However, this plan is part of supplementary insurance and shouldn't be used in combination with a basic health insurance plan.

Conclusion: Supplementary health insurance is highly recommended and part of every good pension plan. If you work for an employer, it is automatically provided. All you have to do is make sure you choose the right supplementary plan—and that's where a broker can help you.

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https://www.deutsche-pflegeversicherung-zusatzversicherung.