Germany has maintained comprehensive employee insurance covers and one of the above standard health care insurance systems in the world, providing its population with sick pay, health, and long-term nursing care insurance coverage.
At least, 90% of German residents and employees are mandated to have a voluntary public health insurance scheme and the rest are on private insurance health schemes.
WHAT THE LAW SAYS ABOUT EMPLOYEE INSURANCE
Being an employee or self-employed in Germany simply means you must be under one of the insurance covers, either public health or private insurance cover.
The 2007 health insurance reform mandated everyone living in Germany to be insured for at least hospital and outpatient medical treatment. Not being insured in Germany is an illegal act that attracts heavy penalties.
There are three insurance options available to you if you’re working or residing in Germany:
- We have the public insurance scheme (gesetzliche Krankenversicherung – GKV).
- Private health insurance from a German or international insurance company (PKV) and
- A combination of GKV and supplemental PKV.
The type of health insurance you can get depends on your salary:
- If you earn less than €64,350/year, you are mandated to enroll in the public (statutory) health insurance scheme (GKV).
- While those who earn less than €64,350/year like freelancers, you can choose not to stay with statutory insurance (GKV) and enroll in a private insurance plan instead (PKV).
- While those who earn more than €64,350/year, can either stay on public insurance (GKV) or switch to private insurance (PKV).
UNDERSTANDING THE GERMAN EMPLOYEE INSURANCE SYSTEM
Since there are many options available for you to get insurance cover, it is pertinent that you understand how Germany’s employee insurance operates to be able to filter out unnecessary plans. At the same time, you live and work in Germany.
It is important to note that switching between public and private health employee insurance schemes at will is not practicable in German. There are some conditions attached that could enable you to switch.
Government Health Insurance System (GKV)
As stated above, most German residents (approx. 78 million people) are registered with the government health insurance system. If your gross salary is €64,350 per year or €5,362 per month in 2022, then there’s a mandatory membership in the GKV.
The GKV is administered by 97 Krankenkassen and also charges the same introductory rate of 14.6% with a possible average supplemental rate of 1.3% of your eligible gross salary with a cap set at a maximum monthly income of €4,837 (2022 figures).
While you earn higher than this income threshold which figure is usually set each year, you won’t pay a higher insurance premium.
If a monthly health insurance premium is pegged at €770, as an employee earning at or above the income threshold, you are regarded as a voluntary member and your premium contribution will be approximately €385 with your employee paying the balance of €386.
If you have nonworking persons living at your address in Germany, they’re automatically insured at no additional cost. All you need to do is to register them with the same Krankenkasse while you’re still the only paying member.
PRIVATE HEALTH INSURANCE (PKV)
As an employee in Germany, you may not find suitable employee insurance cover from the government. Due to that, you may decide to find out the benefits of being on private insurance cover.
PKV plans cover a wider choice of medical and dental treatments which the GKV doesn’t usually cover. With PKC, you’re regarded as a private patient and should expect improved service provisions from the medical profession.
Since doctors depend mostly on the private patient to augment their income and therefore welcome and offer their best service to those with PKV.
While you might find the PKV appealing, it’s important to note that the GKV covers you as an employee and also your household who are not gainfully employed while PKV covers only you, or you would have to pay for each of your households to be covered.
ADDITIONAL INFORMATION FOR EMPLOYEE INSURANCE
As an employee in Germany, your employee is expected to pay 50% of the total health insurance premium.
If you earn above €64,350 per year, you can change to private health insurance with two months’ notice since you’re no longer a mandatory member of GKV.
If you arrived in Germany with your work Visa, and you wish to be privately insured, you will need to write to your company’s HRM within 14 days of your employment.
This is done so that you won’t be automatically registered in the government system. The option to choose whether PKV or GKV is your right and your employer can’t restrict your choice.
Sick Pay Insurance
Eventually, if you fall ill while at work, your employer will pay six weeks’ full salary, after which the government scheme health fund (Krankenkasse) pays up to 70% of your gross income if you are registered with GKV, (up to a maximum of approximately €3,386 per month) as statutory sick pay (Krankengeld) for up to a maximum of 78 weeks.
There will be social security deductions on your salary also which you would be left with approximately €2,970 to finance other of your needs.
In Germany, dental care can be expensive. As some dental treatments involve bridges, crowns, or orthodontics, it’s smarter you get an estimate and present it to your insurer or employee before treatment; otherwise, you could be the only one paying all the bills. If you’re a foreigner, you should seek wider advice as most dentists are dubious of new foreigners.
There is an extensive network of pharmacies (Apotheken) in Germany and could be found at every corner of town. They’re mostly marked with a big red ‘A’ or a green cross for easy identification.
The GKV usually reimburses employees for generic drugs, though with a co-payment, which the scale depends on the cost of the medication.
It is illegal to be uninsured if you reside in Germany. If you have sound health, it’s essential you purchase suitable benefits plans from private health insurance (PKV) that accepts non-german.
There is an experienced insurance broker specialist in expatriates who could help you find the best cover.
Where you’re self-employed and we’re formally covered by an international insurer before the cutoff date of April 1, 2007, you should see that your insurance cover is still effective for living in Germany.
You may be required to prove this by providing some certification in the German language to the visa authorities.
If you just arrived in Germany, you should be wary of those simple incoming tracks health plans valid for 3 months, as most of them are traps if you do not find suitable insurers cover before it elapses.