Understanding the health insurance system

This is the time of year when many new people are arriving in Frankfurt so here is an overview of everything you need to know about health insurance. When you have a look at the free comparison website for health insurance like Check24, you will see that insurance is pretty complicated (and all in German) so I had some help from the nice people at SBK insurance to fill in the gaps!

First though, you are probably aware since you have found this post that you have to have insurance. After you have sorted out a few of the basics like registering at the foreigners department, getting into your accommodation (even if temporary) and opening a bank account, your next step is getting health insurance. Even though you won’t be able to do this immediately, the insurance will be back-dated to the date you arrived. Therefore, if you get sick early on you will need to pay upfront and then claim the money back later once you have the insurance sorted.

Although there are many different providers of insurance, you have two choices – private or state insurance. You will only get the choice of private though if you earn above €57,600 before tax annually. Otherwise you will be automatically registered for state insurance which is often cheaper and has the benefit that unemployed spouses and children are free.

A key disadvantage of state insurance though is that many clinics prioritise privately insured patients due to the higher returns and some doctors only take private patients. In Frankfurt, due to the high volume of people coming to the city for work, there is a bit of a shortage of doctors and this can lead to long waiting times at popular or specialist clinics. In satelite towns, you will find it a lot easier to get an appointment short notice.

When choosing insurance it is a really good idea to choose one of the big providers like SBK who have a fully English language service and advisors in Frankfurt. This means that setting up will be explained in full and support late will be easy. For more information about the SBK benefits take a look here.

And here are some more key points to bear in mind:

  • Statutory (or public) health insurance providers are part of the German social system and are legally bound to insure every person, regardless of health status, employment, age, or income. Everyone is free to choose their preferred statutory health service provider.
  • Every employee pays a percentage of their gross salary for insurance coverage in case of illness, accident, unemployment, during retirement, and for nursing care.
  • While you‘re employed, your employer will take care of deducting and paying the contributions for your coverage. This is automatically done in the course of wage accounting. Employer and employee each pay half of the total contribution (14.6 % of your gross income). In addition, each provider charges a supplemental additional premium (currently 1.1 % on average). Self-employed persons and students benefit from a special kind of insurance coverage.
  • Family insurance allows family members without any income of their own to be co-insured at no extra cost.
  • You can freely choose between all medical providers authorised by statutory health insurance providers.
  • Every insured person will automatically receive an electronic healthcare card. All services your insurance covers (doctor‘s visits, hospital stays, prescription medicines, etc.) are billed to this card – the bill will be sent directly to the insurance company. Advance payments are generally not required. In defined cases, co-payments maybe required: for example for prescription medicines (€10 max.), hospital stays (€10/day), remedies and medicinal sundries (€10 max.) or travel costs to outpatient or hospital treatments (€10 max./trip).
  • In case of illness, employees’ wages will continue to be paid by the employer for up to six weeks, if the employment relationship has continued at least four weeks without interruption. After that period your health insurance provider will take over and pay sick benefits until recovery, but not longer than 1½ years.
  • The statutory health insurance is valid in Germany and in the European Union.

 

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