Illness

The health insurance

Basics

The contributions of the statutory health insurance funds are getting higher and higher, and co-payments place an additional burden on the insured. This means that additional costs can quickly arise for medication, medical aids or dentures that you had not even expected. In addition, the statutory health insurance can only provide basic care for you and your family.

Who is comprehensive health insurance for?

In principle, anyone who is self-employed or freelance (e.g. practising doctors, notaries, architects) and also students and civil servants can take out private health insurance without an income limit. Employees can switch to private health insurance after exceeding the statutory income limit for the first time.

What does private health insurance offer me?

• Individual premium structure depending on the tariff
• Free choice of tariff, individual composition of insurance cover
• Premium calculation advantageous for singles with high incomes
• Free choice of doctors, including private doctors
• Better treatment, as doctors receive more money
• In-patient treatment in a single room/chief physician, depending on tariff
• Cost coverage for non-medical practitioners, depending on the tariff
• Relatively high reimbursement of dental prostheses, depending on tariff
  
• Reimbursement of premiums if benefits are not claimed
• Worldwide health cover, depending on the tariff

With an additional daily sickness allowance, you can cover a loss of earnings from professional activities in the event of prolonged 100% incapacity to work. In addition, the following can be optionally insured:

• Daily hospital and nursing allowances
• tariffs that do not include a limit on the scale of fees or a waiver of premiums in the event of prolonged hospitalisation
• special tariffs for children, pupils and students

What should be considered in private comprehensive health insurance?

• Risk surcharges or exclusion of benefits for pre-existing conditions possible
• Each family member pays a separate monthly premium
• Obligation to pay premiums, even in case of prolonged illness of more than 6 weeks
• Change of health insurance only possible to a limited extent, e.g. pre-existing conditions
• No premium exemption during maternity and parental leave
• Sum limit for dental prosthesis possible in the first few years
• No assumption of accommodation costs for stays at a health resort
• Three- or eight-month waiting period, e.g. if there is no previous insurance and no medical examination has been carried out
• no coverage of return transport costs abroad, depending on the tariff - bills must be prepaid within a certain limit
• Legal disputes will be conducted n front of the civil court with costs.

What are the premiums for private comprehensive health insurance based on?

1. Private health insurance calculates premiums according to risk. These depend on the scope of benefits chosen
2. In contrast to the statutory health insurance companies, which charge a solidarity contribution based on income, the premiums of private health insurance are based on the insured benefits - depending on the age of entry and the state of health at the beginning of the insurance.
3. This equivalence principle is intended to ensure that groups with the same risks pay the same contributions, which are then also sufficient to provide the insurance benefits accruing in this group.

Is it possible to return to statutory health insurance?

Persons who become subject to compulsory health insurance after the age of 55 remain exempt from compulsory health insurance if they have not been subject to compulsory health insurance in the last 5 years before becoming subject to compulsory health insurance. However, anyone who does not have health insurance and can be assigned to the statutory health insurance scheme or was last insured in the GKV must be readmitted. But he or she must expect that the health insurance fund will demand contributions from him or her retroactively to April 2007, as the obligation to be insured in the GKV began from that time. Employees can only return to statutory health insurance if their gross earnings fall below the annual income threshold. If this is the case, the employee is again compulsorily insured, but there are exceptions, e.g. if the employee was already insured in private health insurance from 31 December 2002. In this case, the employee has to earn less than the maximum earnings threshold in order to be compulsorily insured again.

Further information

Illness is not a biometric risk in the classical sense. Rather, the illness is the trigger or cause that can lead to a biometric risk. Therefore, the illness itself, the degree of the illness and the speed of recovery have an enormous influence on the biometric risks. As a rule, the faster an illness is cured or the less frequently someone is ill, the lower the probability of a biometric risk occurring.

Therefore, the quality of health insurance indirectly plays a major role in biometric risks. The better the health insurance cover, the better the available treatment methods, remedies, aids, inpatient facilities and so on.

In Germany we have two systems. Statutory health insurance and private health insurance. While in statutory health and long-term care insurance the catalogue of benefits is determined and decided by the government, in private health insurance the customer can choose from thousands of tariffs. It is a veritable jungle. Here it is particularly important to buy private health and long-term care insurance with very good insurance conditions, otherwise there is a risk of considerable gaps in coverage in very essential areas such as fee schedules, remedies and aids, follow-up curative treatment and insurance coverage in mixed institutions. Here it may be that only little or no medical expenses are reimbursed. 

As a rule, self-employed persons, civil servants, students and employees who earn more than the so-called annual income threshold can take out private health insurance. Employees below this limit can improve their insurance cover with so-called supplementary health insurance.

In the following, we would like to present health insurance in a little more detail:

• private comprehensive health insurance
• Supplementary insurance for those with statutory health insurance
• supplementary inpatient insurance
• supplementary outpatient insurance
• Supplementary dental insurance