Healthcare / Doctors
All new arrivals to Germany should take good advice as to the services available to them regarding health care in Germany, there are various options depending on salary levels, and personal requirements, the following are the three main healthcare categories in Germany:-
Compulsorily Insured (Pflichtversicherung):
Any individual earning less than the set monthly earnings cap (see Taxation/Statutory Deductions) must be insured with a State Health Insurance categorised as "Compulsorily Insured". (Please note that it is also possible to arrange private healthcare insurance to top-up your Compulsory State Health insurance).
Voluntarily Insured (Freiwillige Versicherung):
If gross monthly earnings are more than the set monthly earnings cap (see Taxation/Statutory Deductions) individuals have the choice of either joining a private healthcare scheme or opting for the State Healthcare. If you decide to join the State healthcare, there is no real difference from "Compulsory/Pflichtversicherung" - above, apart from just being categorised as "Voluntarily insured". (Please note that it is also possible to arrange private healthcare insurance to top-up your Voluntary State Health insurance).
Privately Insured / Private Top-Up Insurance:
If gross monthly earnings are more than the set monthly earnings cap (see Taxation/Statutory Deductions), you can then choose private as your main health insurance you have various options to the level of cover from basic to comprehensive for which each individual has the personal choice of their specific level of coverage and the monthly cost reflects this.
Whether you choose private or state health insurance, it is very important to check if your required treatment is covered and if newly joining the scheme, to check whether there is any "waiting time" for treatment costs after initially joining (both medical and dental treatments).
The German State Health Insurance system is set up quite differently to the UK National Health Service. In Germany there are a number of "companies" who form the State system (for example GKV, TK, Barmer, AOK, BKK, DAK and KKH etc), none of which are profit-making organisations. They all follow the Government regulations on the
services and benefits they can provide, but (at present) the actual % contribution required by each company varies. Nonetheless, every employee has the choice of which State "company" they join for the whole family.
There are no restrictions to entry to applicants, no pre-existing illneses are considered and non-working accompanying family members are covered at no extra cost, however please refer to details below on Accompanying Family Members below.
State Healthcare provisions in Germany could be described as being of a much higher standard than in UK, there are usually minimal waiting lists when seeking specialist treatment and appointments can usually be arranged with the minimum waiting time. See below on Finding a Doctor/Dentist. If individuals have a specific ailment and are unsure if this is covered under the healthcare provisions, we would always recommend discussions take place with the medical insurance company prior to treatments being undertaken, to ensure approval of costs. In general, the following are the standard treatments accepted by the State Health Insurances (in addition to the normal medical consultations with your GP):-
Assistance Abroad (24 hour phone helpdesk/Vaccination advice/E111 documentation)
Choice of Doctor (free to choose your doctor, as long as not private)
Contact lenses (where medically required)
Death benefit (funeral costs, only if insured from 01.01.1989)
Dental Treatment (for "adequate and appropriate treament") please check coverage
Dentures and Dental Crowns (50% paid) please check coverage
Family Insurance (at no extra charge)
Family Planning (medical counselling/examinations)+ Abortion/Sterilisation
Hospital Treatment (where medically necessary)
Maternity (if employed maternity allowance paid, if not employed a "birth-benefit" of €77 paid)
Orthodontic treatment (coverage of 80% of the cost of insured persons under 18 years).
Pregnancy (for entire duration of pregnancy, during delivery and in the time that follows, special assistance is given; doctors and midwife, prenatal classes, medication and medical supplies, home-care and domestic help plus cost of in-patient delivery
Psychotherapy (contractoral doctor/registered psychological psychotherepist)
The first and most visible difference with private insurances are the premiums charged, in that they are based on an individual's age at the time of entry, gender, family members and whether there are any pre-existing illnesses. Private health insurance companies vary with their healthcare coverage therefore individuals should take good advice in selecting their private healthcare insurance company. Whether you choose Private as your main healthcare or as a top-up to your State Scheme, you can personalise the benefit cover from the basic minimum to very comprehensive.
For State health insurance, monthly contributions are deducted from your salary at source and contributions are split between employee and employer. The percentage deduction varies depending on your chosen insurer and the amount you pay is also capped, see Taxation/Social Security for latest figures and average percentage deductions for health insurance.
For private health insurance, monthly contributions must be made direct to the private health insurer from the individual, however the employer pays 50% of the premiums required* and this will be paid with salary on a monthly basis to the individual. Premiums vary vastly as they are based on an individual member's age at the time of entry, gender, family members and whether there are any pre-existing illnesses, please see Taxation/Statutory Deductions for latest figures and average percentage deductions for private health insurance.
*Please refer to your local Personnel Office for contractual agreements on the level of contributions the Company will pay towards Private Healthcare Insurance, for example, this may be set at a maximum threshold based on one of the State Healthcare Insurers.
The Nursing Care insurance is a statutory deduction linked with the health insurance contributions for both private and state insured persons, and split again between employer and employee. Please see Taxation/Statutory Deductions for latest figures and average percentages.
Accompanying marital partners and dependant children are automatically included in the employee's membership of State Health Insurance on application at no extra cost to the employee (they can also be included in the Private health insurance but at cost).
However it is not possible to include an accompanying "Partner" with an employee's State Health Insurance.
If a spouse or dependant child decides to take up own employment, (full/part-time or on a temporary/short-term basis) the current rulings are if an individual works for more than a certain number of hours per week and/or earns more than a set monthly threshold, then that individual must become "self-insured". Please also refer to 'Taxes/Statutory Deductions' - Accompanying family members.
One area of the German State Health Insurance system discovered is in a situation where a partner may be accompanying an employee to Germany (i.e. not legal spouse). It is not possible for any partner to join an employee's State Health Insurance membership if they are not legally married. The following are the main options:-
Short-term temporary emergency healthcare cover (E111) can be applied for from UK, however this would not be sufficient or satisfactory for any length of stay as is only intended for short-term holiday emergency healthcare cover.
One alternative UK benefit, which may be applied for from UK for a partner's stay in Germany to receive full medical assistance, is form E106. However this benefit is not automatically given and is only awarded to an individual based on their actual UK NI contribution record, so if records are not considered as adequate this form of medical cover from UK may not be awarded.
If a partner finds employment then an application to join the State Health Insurance can be made in the person's own name (depending on earnings can of course also join a Private Healthcare scheme).
If a partner is not intending to work, then an independent healthcare application must be made to either State or Private Healthcare.
Further enquiries regarding an application for form E106, or any enquiries regarding benefits and related healthcare cover whilst overseas: -
Benefits Agency
Pensions and Overseas Benefits Directorate
Department of Social Security
Tyneview Park, Whitley Road
Benton, Newcastle upon Tyne NE98 1BA
TEL: 44 191 218 7777/FAX: 44 191 218 7293
If you are in the State Health system, you should present the doctor or hospital with a health insurance card, looking much like a credit card which is provided by your health insurance company. Your medical practioner will then liaise directly with your State Health Insurance company and you should not have to pay any fees (if receiving normal/accepted treatments).
For privately insured individuals, you should also present your insurance card provided by your insurer, however following treatment you will be sent the invoice for medical services, this invoice should be sent to your health insurance organisation for them to consider for full repayment to you. There may be some time delay between your private insurance company organising payment and the required pay-date from your medical practitioner, so you should be prepared to initially pay this bill whilst waiting for the decision from your private health insurance.
If you are not insured with either a German State Health scheme, or a German private health scheme, you should be aware that most medical practitioners and hospitals expect payment immediately. If you have an E111 (recriprocol healthcare arrangement between European countries), this document should cover you for emergency treatments, your medical practitioner may accept this E111 alone, but more likely you will be required to have this document >approved first for treatment in Germany:-
Form E111 should be taken to any of the German State Health Insurance companies, to receive an "abrechnungsschein" / Settlement form, which basically confirms that a particular State Health Insurance company agrees to pay for the emergency treatment required. This is a standard procedure and can be easily administered by visiting any of the State Health Insurers, (either in person, or by a 3rd party), one State Insurer is Techniker Krankenkasse:
Rosenheimer Str 141
Tel +89 490690
Opening Times:
Monday to Wednesday -- 0830 - 1600
Thursday -- 0830 - 1730
Friday -- 0830 - 1300
You should not use your normal health insurance scheme for payment of treatment occurring from an accident at work (also including accidents taking place on way to or from work). All companies should have statutory accident insurance to cover the cost of these treatments and any medical treatment costs should be claimed from this Company insurance. Usually in any medical emergency your doctor or administrator will ask if your illness or accident was as a result of any work-related situation, or if it occurred on the way to or from work, and they will require information of your employer's address. Please inform your personnel department in the event of an accident of this nature.
Choosing a doctor in Germany can be an intimidating process because of the language differences, but it doesn't need to be. Medical care in Germany is said to be comparable to that in UK in
just about every way and some feel it is better. The decision in choosing your doctor is of course as important as was choosing your doctor in UK but it can be handled in a different way. In Germany you do not necessarily have to have a "GP" to refer you to see a specialist, it is quite acceptable to see the specialist for your ailment directly without a referral. The only one area patients should be aware of is if they are insured with the State Healthcare (not Private), your State Healthcare may not cover the full cost if you see a private medical practitioner. If your medical practitioner advertises for "Allen Kasse" this covers State Insured persons.
You can refer to the yellow pages (Gelbe Seiten) in which doctors can be found by medical specialty. Or, ask BAESG for a copy of their English-Speaking Practitioners. Also please refer to the 'Emergency Numbers' in this publication.
Unlike UK, it is common for doctors here to have a private practice and be on a hospital staff list. That is why office hours (Sprechstunden) may be more limited. Doctors in private practice usually have office hours Monday to Friday from 8 a.m. to 1 p.m. and then from 3 p.m. to 6 p.m., except Wednesday afternoons when most doctors' offices are closed. Although, you may have an appointment most doctors still serve patients on a first come, first served basis and you may wait a long time to be seen.
When making an appointment either by telephone or in person, the first person you will speak to is the Arzthelferin or doctors assistant. She may not speak English but won't ask many questions about why you want to see the doctor but may well ask what type of health insurance coverage you have if it is your first visit. Usually you need only to request a day and time for an appointment. If it is for an extraordinary reason you may want to specify the reason for your visit. Otherwise, you can give your medical history to the doctor.
Pharmacies (Apotheken) are generally closed evenings, Saturday afternoons, Sundays and holidays. Each of them has a list on the door of pharmacies that have remained open to handle emergencies.
