A topic that couldn’t be more scintillating right? Well, for those who plan to uproot to the “Motherland”, it unfortunately is a topic that may have you scratching your head! With any luck, this post will help shed some light on the subject.
If you are planning to work in Germany, Health Insurance is a requirement. So much so, they have a name for it… Krankenversicherungspflicht! Essentially it is your “obligation” to be insured when living/residing in Germany.
For those who may be travelling on a Youth Mobility Visa or have managed to procure an Artist Work Visa, the powers that be may have said “yes” to your traveller’s or Ex-Pat insurance when you applied. Sadly, this kind of insurance does not satisfy the mandatory requirement for Pflegepflichtversicherung – roughly translates to Long-Term Disability Insurance. The Ausländerbehörde likely turned a blind eye when you got your 1 year Visa because most visitors don’t end up staying more than 1 year and I suppose they can’t be bothered to enforce the requirement. But, if you are planning to stay, you will want to make sure you procure insurance with Pflegepflichtversicherung as it is mandated by law in Germany! And as an FYI… there is no equivalent in any other country, so you cannot argue that your “home country / ex-pat / traveller’s” insurance is sufficient. Although there may very well be a loophole in this system, which I discuss at the end of this post.
And into the nitty-gritty we go…
There are two types of organizations that offer Health Insurance in Germany: Die Geseztliche Krankenversicherung (GKV) and Die Private Krankenversicherung (PKV). The common misconception is that GKV is the Public Health System. This is not the case. GKV companies are in fact, not public at all. They are all companies who have chosen to follow government regulations to insure at least a minimum regulated level. PKV companies on the other hand, are companies that provide health insurance according to a contract they make directly with you, the customer.
If you scour the web and forums you will see endless people endorsing the GKV offerings (TK, AOK, Salus). I am however not convinced that this is the right decision for most. For starters, if you choose a GKV company as your provider, you will be locked into a contract with them for a minimum of 18 months. In addition, it maybe more difficult to book appointments with health practitioners because GKV companies require their practitioners to be pre-approved, and the practitioners themselves prefer PKV patients over GKV patients because of the payment system. In addition, GKV does not allow for a “second-opinion” when in comes to diagnoses (or so I have been told).
If you are PKV, you will most likely pay your practitioner directly and then will get an invoice that you will then submit to your provider for reimbursement, or the practitioner will bill the provider directly (no out of pocket expense for you depending on your coverage). PKV insurers are required to reimburse the practioner within 1 month. GKV providers on the other hand get billed directly by the practitioner and they have up to 6 months to pay… you do the math… would you rather have outstanding receivables for 6 months or get paid on the spot? No doubt practitioners like PKV covered patients better!
Some other things to consider… most PKV providers cover between 80 to 100% of treatments – submit your receipts and get reimbursed! GKV providers operate on a “Fach” system — Gebührenordnung für Ärzte (GOÄ) / Gebührenordnung für Zahnärzte (GOZ). What does that mean you ask? There is a “little black book”… of course there is, this is Germany!… that says what a treatment should cost. Most GKV covers up to 2,3 Fach, so that means, a treatment where 1 Fach = 100 Euro, if the practitioner says it is 2,3 Fach, you will be looking at 230 Euro for that procedure or service. Some complicated procedures may be deemed 5 Fach (500 Euro for our calculation purposes), and the GKV system, as a rule, will only reimburse up to 2,3. The excess is the responsibility of the patient to pay. If you are really interested in this system… go have a look at Medizinische Informatik for some more examples. It’s all “auf Deutsch” though!
So what can you expect to pay… well sadly it is not cheap! GKV bases the price on your income while PKV is generally based on your age. For a self-employed person you will probably be looking at 250 – 350 Euro a month. Don’t panic yet… anything you pay, if you are self-employed is a tax deduction. You can claim back 80% of your premiums. The crappy thing is, you need to put out the money up front and you then get it back when you file your taxes.
Also, premiums are dependent upon and when you enter the system. A 30 year old entering the system can expect to pay significantly less than a 45 year old, and the premiums, as I am told, are not supposed to increase if you hit a new age bracket. So, if you enter at 30, expect your premiums to remain relatively the same for the rest of your life, but do allow for inflation!
As it relates to dental coverage… as a rule, most PKV cover dental procedures… GKV do not! Also, most GKV providers do not cover ambulatory expenses (i.e. AOK does not at all and TK will only in some cases).
There are a million more details I could talk about here, but I think that this covers the basics and primarily the differences between GKV and PKV which was always the big mystery for me! There are organizations out there who can help you make an informed decision when it comes to what will suit your personal circumstances the best. A lot of this information I have collected from attending seminars etc. on this subject. If you need a suggestion on someone to talk to, please feel free to drop me an email and I will gladly point you in the right direction.
Lastly… if you are interested in the different PKV and GKV providers, you can get more information and comparisons here (Krankenkassen). Again… “auf Deutsch” but you have some keywords to help you navigate through the murk!
Now for that that “loophole” I mentioned…
Please don’t take this as gospel, but this may be of use. Remember that post where I talked about getting your Artist Visa? The first step was related to registering your residence when you arrive in Germany (Anmeldung). Well, if you are maintaining a residence outside of Germany (i.e. you have an apartment in the USA or Canada where you continue to pay rent or a mortgage), you may want to consider registering your German address as a “Zweitewohnsitz” (Secondary Residence), and your Home Country address remains your “Hauptwohnsitz” (Primary Residence). This is not confirmed, but you could potentially argue with the German Health Insurance Police (don’t know what else to call them), that you have sufficient “Disability” coverage in your Home Country, and as such should not be obligated to have, or pay for Pflegeflichtversicherung. I’d also love to know if this works for anyone… I have yet to try it, but it is is locked and loaded in my arsenal!