COMPULSORY AND PRIVATE HEALTH-INSURANCE
The social insurance systems in Germany
Within the Federal Repubic of Germany each employee is insured by the social insurance systems. These consist of
- the compulsory pension insurance
- the unemployment insurance
- the compulsory health insurance
- the compulsory long-term care insurance
- the compulsory accident insurance
The contributions for the single parts of the social insurance system are calculated depending on the annual gross salary and the place of work (West=old federal states+Berlin / East=new federal states+Berlin). The contribution rates varies for each single insurance and they can be adapted yearly.
The upper earnings limits (2011) for the pension- and unemployment insurance are:
West: 66.000,00 EUR / Ost: 57.600,00 EUR
Contributions | employee | employer |
compulsory pension insurance | 9,95 % | 9,95 % |
unemployment insurance | 1,4 % | 1,4 % |
The upper earnings limit (2011) for the health- and long-term care insurance is:
West/Ost: 44.550,00 EUR
Contributions | employee | employer |
health insurance | ~7,3 + 0,9 % | ~7,3 % |
long-term care insurance | 0,95 % | 0,95 % |
Contributions for the compulsory accident insurance are payed completely by the employer.
Health insurance in the Federal Republic of Germany
In contrast to other countries, Germany has a social insurance system, which is financed by contributions from compulsory (GKV) as well as private health insurance funds (PKV).
- measures for the prevention and early detection of diseases
- for early diagnosis
- for medical treatment
- for pregnancy and maternity
- medically necessary dentures and crowns
Under certain circumstances the coasts for medical rehabilitation are also covered.
A distinction ist made between those who have to join the statutory state health insurance and those who are voluntarily insured.
Can you choose freely how you want to be insured?
Since 2007 there is a duty of insurance which applies to the compulsory as well as the private health insurance.
Thereby it must be pointed out, who is liable to insurance deductions and who is voluntarily insured. According to the rating (beyond ore below the compulsory insurance limit) the assignment is done either to the compulsory or the private health insurance.
Compulsory insurance limit (2009: 48,600 Euro/Jahr):
The compulsory insurance limit defines up to which annual gross salary the employee is subject to the compulsory health insurance (GKV). Relevant is the regular annual salary including special payments (e. g. vacation benefit and Christmas bonus) as well as a lump-sum overtime pay and extra pays. Allowances that are payed with regard to the family status are not taken into account (e. g. child benefit).
In 2009 the limit is defined at the level of 48,600 Euro (2008: 48,150 EUR) or 4,050 Euro (2008: 4,012.50 Euro) per month.
Employees, whose gross salary ecxeeds their relevant level have the choice: They can stay in the GKV as a voluntarily member or they change to a private health insurance fund.
3-Years-period of change
With the 2007 health reform (GKV-Wettbewerbsstärkungsgesetz / GKV-WSG), among others, with the deadline February 2nd 2007 a 3-years-period of change has become effective. According to this, employees will only be exempt from insurance when their regular annual gross salary is beyond the limit and has been beyond within three calender years in succession. This period is also guilty for job entrants and in case of changing the employer.
Employees who do not exceed the compulsory insurance limit, can complete their health insurance with additional private insurances, e. g. for trips abroad, for hospital stay or for dental prosthesis.
Calculation of contributions
Compulsory health insurance
In the compulsory health insurance the premium is calculated on the basis of the gross salary. I. e. the contribution rate of the chosen insurance fund is mulitplied by the salary. The employer pays the half amount. | 511,00 EUR |
Surcharge for increasing costs of the health system 0.9%. This Surcharge is payed by the employee only. | 31,50 EUR |
The contribution for the long-term care insurance is also calculated on basis of the salary. Contribution rate: 1.7%. Half amount of this is payed by the employer. | 68,25 EUR |
___________ | |
Total contribution: | 610,75 EUR |
Employee?s contribution: | 321,13 EUR |
Employer?s contribution: | 289,62 EUR |
The compulsory health insurance offers a non-contributory family insurance in case the marriage partner has no employment or a moderate income only. | |
Childless employees are due to an surcharge for the long-term care insurance of 0.25%. | 8,75 EUR |
___________ | |
Total contribution: | 619,50 EUR |
Childless employee?s contribution: | 329,88 EUR |
Employer?s contribution: | 289,62 EUR |
Private health insurance
In the private health insurance the contribution is calculated depending on the age, sex and health status of the insured person as well as the requested insurance cover. This means that the marriage partner and children are charged additionally. To check-up the state of health, normally only questions have to be answered. According to earlier diseases a risk surcharge might be charged. For the standard rate insurance no health examination is required.
The insurance cover within the private health insurance is defined by the employee. He can choose between different rates that normally vary in the amount of co-payments, insurance cover in hospital and the amount of refund for dental prosthesis.
Example:
35-year-old man with top-insurance cover from 210,00 EUR
35-year-old woman with top-insurance cover from 308,00 EUR
child with top-insurance cover from 100,00 EUR
The employer pays half of the contribution for the private insurance including long-term care insurance up to the maximum contribution of the compulsory insurance. I. e., the maximum employer?s allowance is 304,00 EUR.
Foreign employees have the chance to join a group policy for private health insurance without evidence of insurability, which provides a very exacting insurance cover: no co-payment, single room in hospital and an 80% refund for dental prosthesis.