Working Life > Social Insurance > Health Insurance > Private Health Insurance

Private Health Insurance

Definition, Explanation

Since April 01 2007, residents of Germany are obliged to be health-insured. Besides the statutory health insurance, under certain conditions it is also possible to be insured in a private health insurance. Such are private companies, unlike the statutory health insurances which are institutions under public law. In Germany, about 8.5 millions of people are insured in a private health insurance.

Kinds of insurances:

• Full coverage insurance
• Partial coverage insurance, e.g. for clerks entitled to subsidy by the employer
• Complementary insurance to secure risks that are not covered by one’s statutory health insurance. Those include travel health insurances, hospital daily benefits, sick benefit

Insured:

• More-earners, being people earning above the income threshold for compulsory health insurance. This income threshold, for 2009, is set to 4,050 Euros per month (with Christmas- and vacation money taken into account pro-rata)
• Self-employed and liberal professionals who work in their main occupation
• Clerks, judges, delegates in the parliament. The employer takes over 50 – 80 per cent of the contributions, for the duty to subsidy
• University students who have themselves freed from the obligation to be insured in statutory health insurance
• Publicists and artists above the income threshold for compulsory health insurance
• Statutorily compulsorily insured who contract private complementary insurances

Contributions/benefits/tariffs

The monthly contributions, for each insured (there is no dependent insuring via family members) are determined independently from the income. They depend mainly on

• the extent of contracted benefits
• individual risks, being evaluated based on gender, state of health, occupation category and the date of start of the insurance. The higher the risks, the higher are the contributions to pay

Contributions are calculated such that they cover the current risks on the one hand, and on the other provide a finance reserve for increasing risks at older ages of the insured. Therefore, contributions are higher than is necessary at the beginning of the insurance period. Usually, the contributions are adapted annually to the current development of expenses and the total contributions. If the insured does not need any benefits and thus does not charge the insurance any expenses, many insurances grant a refunding of contributions. In such cases, up to 6 months’ contributions of a year can be refunded.

Benefits:

Benefits usually pay:

• Treatment by chief physicians
• Dental prostheses
• One- or two-bed rooms
• Vision-corrective lenses, glasses
• Physiotherapy

Proceedings:

Bills are paid by the patient himself at first, after receipt. Only after the bill has been sent to the private health insurance, the expenses are validated and refunded. By the engaging of a doctor, a contract is made between the patient and the doctor. Subsequently, the doctor makes out an invoice to the patient, after the treatment has been performed.

Hospital stays are billed directly to the private health insurances, by the hospitals, if the patient brings an insurance-card. Chief physicians bill the patients themselves, as ambulant doctors do.

Tips, Checklist

• When making the contract with the private health insurance, look into the catalogue of benefits. Other than the standard tariff, you can optionally choose different modules or partial benefits as you like. There are also pre-designed packages offered by the private health insurances, at different prices
• Have a look at how many different tariffs your private health insurance offers, as well as at the past development of the tariffs. The less often the contributions are adjusted, the more likely is a stable contribution amount in the future
• When the contract is being made, you are usually asked about your state of health. Answer the question truly. Otherwise you risk considerable discount claims and increase of your contributions if you conceal diseases or surgery treatment, even if you may regard them unimportant. In the worst case, the health insurance can even cancel the contract in retrospect. Then you would be without insurance protection
• Take into account that you can pay medical expenses partially on your own, when you choose your contribution amounts. There are cases in which partial self-pay pays off, since your monthly contribution can be considerably lower this way
• Contracting additional benefits is possible at any point in time
• Changing from a private to a statutory health insurance is only possible if the insured person is going back to health-insurance-obligation (e.g. back from self-employed to employee), has not reached the age of 55 yet, and the income is below the income threshold for compulsory health insurance
• Mind that contribution amounts are subject to annual adjustments
• Think well whether it makes sense for you to change to a private health insurance. Here, you have to insure every family member separately, and the contributions increase with increasing age
• Invest the money well that you possibly gain through lower contributions in a private health insurance, compared to a statutory health insurance. You can use it later for possibly higher contributions at an older age
• Use your possibility to check the doctors’ invoices. Report apparent mistakes in charges, to your health insurance. This contributes to disclosing cheating methods and to keeping contribution amounts as low as possible
• Consider that also a change into another private health insurance often does not pay off. Due to your older age of start and correspondingly lesser finance reserves being saved for old age, you do not get the best tariff. If you change in reaction to a disease, you must pay a high risk surcharge. Also, the new private health insurance can refuse to take you on in such cases
• When you choose a private health insurance, also consider that you might be refunded contributions, regularly
• The money you are charged for medical treatment, you must transfer directly to the doctor, as a privately-health-insured
• Check the refunds by your private health insurance for correctness
• If you are not sure whether the treatment to be charged will be refunded by your private health insurance, ask them before you pay the doctor. Also negotiate the rate of increment with your doctor. It is not always that the private health insurances refund rates of 3.5 %, while 2.3 % are normally refunded
• Your employer pays their part to the contributions to health insurance (employer’s share of contributions). For private health insurances, there are the same regulations applying as for statutory health insurances. Except that the employer pays maximum the contribution shares corresponding to statutory health insurance. So, pass on your insurance data to your employer
• To receive sick benefit, you must additionally contract an insurance for sickness daily benefit
• Private health insurance also covers abroad treatment

Last update: 06/17/2010