Health insurance is one of the statutory social insurances and is mandatory for every German citizen within Germany. Every citizen has to choose private or statutory health insurance. The differences are great and the advantages and disadvantages must be weighed individually.
Every citizen who is not covered by private insurance receives statutory health insurance. However, private health insurance is only available to employees with an annual income of over € 56,250 (As of 2016), as well as self-employed and civil servants. This also explains why citizens with private health insurance only make up around 10% in Germany. Most students and retirees are also compulsorily insured by law.
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In the case of statutory insurance, the monthly contribution amount is based on the solidarity principle. Only the amount of the salary determines the contributions. Private health insurance works according to the principle of equivalence. The contribution is mainly composed of the personal risk factors for illnesses such as age or potential previous illnesses, but also according to the desired insurance benefits.
The main disadvantages of private health insurance result from the principle of equivalence. People with previous illnesses and advanced age have to expect high contributions, which is irrelevant for statutory insurance. In some cases, insurance can even be refused if there are high health risks. The contributions also rise steadily in old age. Even without health reasons, the provider can increase the premiums for no reason. A change of provider is then possible. A major disadvantage here, however, is that it is difficult to switch to statutory health insurance. Statutory insurance can only take a privately insured person back under certain conditions after they have previously opted for private insurance.
$config[ads_text2] not foundFor those with private insurance, one of the main advantages is the range of services offered to those with statutory insurance. Privately insured people often receive more expensive services, shorter waiting times, benefits in practices and hospitals, as well as the free choice of doctor and treatment by chief physicians and alternative practitioners.
The entry-level premiums for private health insurance can still be very low. They are sometimes lower than the equivalent contributions from statutory insurance. Additional services can be booked for additional payments. For above-average earners, private health insurance provides the incentive that the premium amount is not based on income.
The private health insurance contribution is not calculated from the monthly income, but is based on three factors. The health classification is the biggest factor. Equally important is an administrative cost component, which the insurance company largely finances itself through, as well as a savings component, which is also referred to as a retirement provision. The latter ensures that a certain contribution is paid in extra at a young age so that the contributions do not increase further after retirement. Due to the unforeseeable length of life of the insured and the demographic development, this savings component is a variable which means that the contributions cannot always remain stable despite old-age provisions. The individual contributions remain extremely variable and depend on the benefits and the deductible in the event of illness that you choose. Women pay higher amounts on average.
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$config[ads_text2] not foundCivil servants belong to a professional group who can join private health insurance regardless of their annual income. This affects all professional groups that are “eligible for subsidies”. This means that the employer, i.e. the state, reimburses around 50-80% of the costs incurred for treatments in the health sector, depending on the situation.
This includes civil servants, soldiers and judges, as well as their children and spouses. The remaining costs are covered by private health insurance for civil servants. This is then referred to as the "supplementary tariff". For civil servants, private health insurance is almost always financially worthwhile, especially if children are also insured. Children receive 80% of the allowance for medical expenses. Private health insurances also offer many packages with special services for civil servants.
Private health insurance can be canceled easily. However, given deadlines must be adhered to. The insurance can be terminated at the end of an insurance year, but with three months' notice. Termination is also possible after premium increases. The customer then has the right to change health insurance when the increase occurs. Since there is a permanent compulsory insurance in Germany, the change of insurance must be planned in such a way that one is never not insured. You have to provide proof of this to the old insurance company.
However, caution is advised when switching back to statutory insurance. The change is only possible in exceptional cases. The main conditions for this are falling below the earnings limit of € 56,250 and age. After 55 years it is almost impossible to switch back.
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In a statutory health insurance scheme, the assessment ceiling describes the amount up to which statutory health insurance contributions must be paid. The current limit is € 50,850 per year. Health insurance contributions must be paid up to this salary limit. The income that is above the limit is not taken into account when calculating the contribution amount. This means that the contributions to the health insurance are capped. An increase in the contribution assessment limit means a higher maximum amount for statutory health insurance for earners above the limit.
There has also been a basic tariff in private health insurance since 2009. It is linked to the same income threshold. The premium in the basic tariff for private insurance varies with age, but is limited to a maximum of € 665.29 per month (As of 2016).
The income threshold is adjusted every year. It is calculated from the development of income and is adapted to society.
Switching from one private health insurance to another can happen at any time. Depending on whether tariffs are changed within an insurance company or the insurance itself, there are deadlines and requirements that must be met. However, a change should be carefully considered, as new private health insurance also results in new contributions. Since you are older at this point than when you first took out the original insurance, it is likely that the premiums will also be higher.
The most common reason to switch is an increasing contribution. Under these circumstances, you can immediately switch to the new premiums, provided that you are insured with another insurance policy without a transition.
Since 2009, old-age provisions that were paid out with the original health insurance company can be transferred to another private insurance company. This means that savings that have already been made can be transferred with virtually no loss of money.
If the change is to take place without a previous premium increase, this is only possible at the end of the calendar year with a period of three months. There are various other options to terminate the private insurance extraordinarily. Another possibility is, for example, a drop in the salary below the mandatory insurance limit. A right to welfare care and entry into statutory family insurance also apply as reasons for a change before the end of the calendar year. In any case, the insured must ensure that they remain insured at all times.
$config[ads_text1] not foundThe model of old-age provisions exists for retirement and the period of retirement. A savings amount is paid in every month over the entire working life in order to build up reserves. This should ensure that the contributions do not increase after retirement, but even decrease.
It is not sufficiently known whether the model actually works. Due to the demographic development of the last few decades, no final result can yet be foreseen. The health insurance companies claim that there are high amounts due to old-age provisions and that this means that the contributions of a 90-year-old tend to decrease compared to a 65-year-old. Critics in politics argue that demographic developments mean that the number of retirees in private health insurance will increase significantly and that they will get older. Sustained and sharply increasing contributions in the coming years will be the result. There is a tendency for contributions in private insurance to rise more than in statutory ones.
After retirement, the employer's contribution is no longer applicable. The employer pays part of the contributions and after the employment relationship this subsidy does not apply. Upon application to the pensioners' fund, they will take over part of it.
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Students are required to take out insurance at the beginning of their first semester. However, you are free to choose which insurance you choose. It is possible for them to be exempt from compulsory insurance at the beginning of their studies and to join private health insurance. Private health insurance is often very cheap for students. They receive many benefits and advantages, for example a reimbursement of contributions if they have not incurred any health care costs within a year.
If students are legally or privately insured through their parents, they can remain insured free of charge during their studies. Those who were previously privately insured can be exempted from the compulsory insurance and remain privately insured through their families.
The health insurance of the child depends on the parents and should be considered before the birth. If both parents are privately insured, the child is automatically included in the private insurance. It is then not possible to take out statutory insurance for the child. If only one parent is privately insured, the child can be included in the insurance free of charge as long as the privately insured person does not exceed the legally stipulated € 56,250 (As of 2016) earned. If so, a separate contribution must be paid for the child. In both cases, the parents can decide whether the child should be covered by statutory or private insurance.
If neither of the parents is privately insured, the child will first be covered by statutory family insurance. The parents can still decide for the child whether they should be privately insured. Private health insurance companies offer insurance cover for such cases. Admission is then carried out in a similar way to an adult through a health examination. As a result, a separate contribution is levied for the child in private insurance.
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Further helpful information can be found at: Three days of fever in the baby - is that dangerous?
