What you need to know about health insurance Germany

There have been changes in recent years to the health insurance Germany benefits from and people can take advantage of the government’s public health insurance (also known as the statutory system) as well as opt for private health insurance.

Features of statutory health insurance

Those who have health insurance cover through the country’s statutory system (known as Gesetzliche Krankenkasse) need to make small co-payments (contributions) every time they visit a doctor and/or obtain a prescription. This also applies to hospital visits. When visiting a doctor or a hospital, patients should take their health insurance card with them. Patients need to make a payment of 10 Euros every 3 months, which entitles them to their initial visit as well as subsequent visits to a doctor or hospital within the same period. A referral doesn’t entail any additional payment to the new doctor, as long as an official referral letter has been issued from one doctor to another.

Prescriptions incur a charge from the pharmacy, although some medications are exempt from charges. Those who have statutory insurance to cover their prescriptions can expect insurers to reimburse the costs of most generic drugs but not necessarily branded medications. Medications sold over the counter without a prescription aren’t covered by the majority of insurers.

If a patient needs to stay in hospital for a period of time, the usual charge is 14 Euros a day. Additional charges are made for using the television and telephone during the stay.

The statutory system doesn’t fully reimburse dental costs and patients can expect to pay 20-70% towards their bills, depending on the type of insurance they have.

Although patients are responsible for making co-payments and paying for a variable percentage of their dental bills, they don’t have to worry about funding the rest of their treatment. The statutory health insurance system pays for this. Patients are advised to obtain a copy of their medical bills and to contact their insurer with any queries about fees and the scope of their insurance cover.

Features of private health insurance

Private health insurance is known in Germany as Privat Krankenversicherung. The majority of private health insurers provide a card featuring a smart chip. Patients can use this for their medical treatment, e.g. when they need to stay in hospital. Bills are usually sent straight to the insurer but patients receive a copy and are liable for costs outside of the treatment, such as paying for the television and telephone while in hospital.

Patients can initially pay their own bills for outpatient visits. However, their insurer will reimburse them once they receive the original invoice. This is common practice when paying for prescriptions. The other option for patients is to send the bill directly to the insurer for payment, without paying it themselves.

Most doctors, dentists and health care providers will provide patients with a copy of their bill and send the original to the insurers. Pharmacies can also provide copy prescriptions. Patients are always advised to retain copies of their bills and prescriptions for future reference.

Government guidelines set out costs for different medical treatments and procedures. Some health care providers, typically dentists, offer additional treatments and it’s always sensible to check if a specific treatment or procedure is covered by private health insurance before going ahead.

When forwarding a bill to a private insurance company, it’s a good idea to send a covering letter summarising the details of the treatment, such as the dates, the name of the provider and the full amount. Reimbursement can take up to 3 weeks and the preferred method is usually by bank transfer.

If an insurer refuses to cover the costs of treatment, the patient should always ask why. The private health insurance Germany enjoys is regulated by an ombudsman who can help with disputed claims. Those who go through an independent insurance broker can also get advice about reimbursements without having to contact their health insurer directly.