Working Life > Social Insurance > Health Insurance > Statutory Health Insurance

Statutory Health Insurance

Definition, Explanation

The statutory health insurance, besides the unemployment-, pension-, accident- and nursing-care insurance, is a part of the social security of the Federal Republic of Germany. It is a component of the social insurance. Legal basis is Fünftes Buch des Sozialgesetzbuches (SGB V).

Since Jan 01 2009, every resident of the Federal Republic of Germany are obliged to be insured in a health insurance. That can be in a statutory or a private health insurance. The insured in statutory health insurances are the compulsorily insured, the voluntarily insured and the insured from dependent insurances.

Compulsorily insured:

• Workers, employees, apprentices with incomes up to 4,162.50 € monthly, respectively 49,950.- € per year (since Jan 1st, 2010)
• Recipients of unemployment benefit 1 and 2, and recipients of subsistence money
• farmers
• Artists and publicists, via the artists social insurance
• Students up to completion of the 14th semester, or before the 31th birthday
• Disabled
• Participants of employment-promotive programmes
• Pensioners
• Interns
• Persons without any other entitlement to benefits in case of sickness

Voluntarily insured:

• More-earners, being persons having been earning more than 4,050 Euros a month for 3 consecutive calendar years
• Self-employed who were insured in statutory health insurance immediately before their starting of the independent business, which must have been for either 12 months
• continuously or 24 months in total within the last 5 years
• Dependently insured (via family members) who are earning more than 365 Euros a month (since January 1st, 2010) or have finished their education

Dependently insured, via family members

• Spouses and registered life partners of a statutorily insured
• Children of statutorily insured (up to the age of 18, in unemployment up to 23, in education up to 25)
• Monthly income below 365 Euros (since January 1st, 2010) respectively 400 Euros in a mini-jop
• The mentioned cases result in a new, individual membership

Freed from the insurance are:

• Clerks
• Judges
• Professional military
• Employees of public-law institutions

Financing:

The financing of statutory health insurances, since Jan 01 2009, is done by a health fund. It collects the contributions of the members together with the employers contributions and a government additional payment. From the health fund, the health insurances receive the regular sums for paying the benefits to their insured, while the sums are differentiated according to age, gender and state of health of the insured.

Contribution amounts:

• Regular contribution
  Uniform for all health insurances, regulated by the government in 2009: 15.5 % of the income liable to social-insurance contributions, of which employees pay 8.2 % and employers pay 7.3 %. Thus, for a pre-tax monthly income of 3,000 Euros, the employee pays 246 Euros and he employer pays 219 Euros
• Reduced contribution
  Uniform for all health insurances, regulated by the government. No entitlement to sickness sick benefit. 14.9 % of the income liable to social insurance contributions. Voluntarily insured self-employed, and short-term-contracted employees can choose among the regular and the reduced contribution
• The contribution amounts are limited by the maximum income taken into account being 3,750.- € a month, respectively 45,000.- € a year (contribution assessment ceiling), that is, the maximum regular monthly contribution is 558.75 €
• Self-employed pay all of the contribution they have chosen on their own
• Dependently insured, via family members, do not pay any contributions themselves
• If you are a recipient of starting subvention, your contribution is assessed based on your monthly (minimum-)earnings (2008: 1,242.50 Euros)
• For pensioners, the income counted in assessment is the statutory pension or equivalent benefits like a company pension or working income. Just like employees, they pay 8.2 % while the pension insurance pays 7.3 %
• For mini-jobbers, with an income of maximum 400 Euros, the employer pays additionally 13 %, that is maximum 52 to the health insurance. For the employer being a private household, the amount is 5 %, that is maximum 20 Euros
• An additional contribution is collected by the health insurance if the regular share out of the fund for the insured does not cover the expenses. Generally 8 per month per insured without income assessment, or as an income-dependent contribution of maximum 1 % of the household income. This does not apply to dependently insured, via family members
• Health insurance administration collect the contributions to health insurance as well as the contributions to the other insurances that are part of the social insurance, and pass them on to the health funds and the respective insurances

Benefits:

The basic benefits are legally regulated. Depending on the individual health insurance, there are different regulations regarding support for preventive examination expenses, rehabilitation and health resort stays, alternative medical treatment and extraordinary vaccinations.

• Benefits for prevention of diseases
  • Benefits for primary prevention like dentist's examination, other preventive treatment, immunization and contraception
  • Self-help groups / organizations / networking centres
  • Benefits for health promotion in companies
• Early diagnosis of diseases like cancerous diseases, cardio-vascular and kidney diseases, diabetes
• Sick treatment
  • Medical treatment including dentists and psychotherapy
  • Supply of medication, bandage, curing and aiding articles
  • Dental prostheses
  • Home care and home help
  • Hospital stay and treatment
  • Medical and complementary treatment in rehabilitation
• Sick benefit
• Benefits in pregnancy and maternity as there are medical care, accoucheuse care, hospital births, home care, home help, farming help for farmers, maternity money
• Help in family planning

Carriers of the health insurance:

• General local health insurances
• Company health insurances
• Guilds' health insurances
• Seafarers' health insurances
• Farmers' health insurances
• German pension insurance
• Knappschaft-Bahn-See (railway and seafaring)
• Substitute health insurance societies

Tips, Checklist

For employers:

• A new employee must be registered in statutory health insurance at the start of work. The end of the employment also ends the statutory health insurance membership

For the insured:

• Look through the benefits of your health insurance thoroughly. What benefits do they pay to what extent? Potentially, the contracting of an additional complementary health insurance to be treated by chief physicians, be better-lodged in hospitals, be refunded vision-corrective lenses, dental prostheses or alternative praxis treatment
• If you travel abroad frequently, it might be advisable to contract an additional travel health insurance. The statutory health insurance refunds abroad medical fees only up to the amount that is regular in Germany
• Voluntary continuing insurance:
  • Think whether a continuing insurance after the obligation having ended makes sense, also economically, or you would not rather like to change to a private health insurance. Criteria are your age, gender, family status and your plans for your life
  • If you desire to be continuingly insured, you have to inform your insurance about it, within 3 months after your insurance obligation having ended
  • For your choice of the kind of contribution to pay, check whether it covers sickness benefit being paid to you. The time that is covered, for employees, by the continuing payment of salary can be extended with a sickness-benefit-providing health insurance by choice of the contribution kind
• Change of health insurance:
  To change your health insurance, you must have been insured in your old health insurance for at least 18 months. You can cancel using the simple lines “Hiermit kündige ich die Versicherung zum nächstmöglichen Termin”. Make sure that you receive a confirmation of cancellation notice, 14 days after, at the latest, if you do not, ask them whether your cancellation request has been received. With that comfirmation letter, you turn to your new health insurance who will give you a confirmation of change. This one pass right on to your employer who will take care of everything else

Last update: 05/02/2010