Health insurance (2007 update) - Germany

See also the earlier document: Health insurance

Introduction

While the German health insurance system was always confusing in the past, it has turned into a regulation nightmare even for professionals through the recent reform with the law named GKV-WSG or "Gesetzliche Krankenkassen – Wettbewerbs-Stärkungs-Gesetz", effective since April 2007. This was probably one of the worst compromise results of a law ever passed in Germany and it is yet to be seen which of the many disputes at the German supreme court for constitutional reasons will end in verdicts burying parts or even the whole law. To top it all, both major parties in the current government want to immediately change major parts of the law if they can build a government after the next election in 2009 without the presence of the other party. Oh what fun we are looking forward to in this area……

But for now this is the law and we have to live with it and use it as best as we can. The following parts describe the situation after the major changes. Since from more than 1½ years experience of advising Expats here via Toytown I have better learnt the many misconceptions and misunderstandings of the health insurance options in Germany, I have chosen to write a new Wiki page, rather than just update the old version, and also to give it a different structure in order to address the typical questions and problems of the different groups of Expats. Please feel free to inform Toytown and myself if you have suggestions as to how this Wiki can be better structured or what information you found missing. This Wiki page is mainly addressing Expats living and working in Germany; students will get ample information from their universities anyway.

SOME BASICS

Some basics so that you know which parts of this document you need to read.

What kind of health insurance you can or should choose, if you can choose at all, is determined by several factors:

• if you are in employment in Germany or working as a freelancer/self-employed
• your age
• your family status or family planning
• how long you do intend to stay in Germany

If you want really good advice and an insurance which you will not regret to have signed up in a couple of years' time, please contact an independent broker or even an insurance agent of your choice right from the beginning. Below you will find some first steps to determine - based on your working-status - what kind of insurance options you face in Germany.

Employees with income below threshold

Newly or long-time employed in Germany with a gross salary of lower than €3,975 per month or €47,700 per year.

If you belong to this group, you have no choice between public and private insurance and will be compulsorily insured in a public insurance. However, read the part about public insurance to see that you DO have a choice among the public insurance carriers and that you can save a lot of costs when choosing those with low costs. Furthermore, read the part about the private add-on insurance if you are unhappy with what you read about the coverage of the public insurance and you want better coverage in certain areas.

New employees with income above threshold

Newly employed in Germany with a gross salary in excess of the threshold €3,975 per month or €47,700 per year.

If you belong to this group, you might have the option of opting out of the public insurance and get yourself insured either in a private German health insurance or, if your employer and HRM personnel cooperate and are flexible enough, even with an international private health insurance.

What determines if you actually have the choice? a) You must be sure that your total gross salary from German and foreign sources for the current year where you start your employment in Germany exceed this threshold for the full year. Lets say for sake of argument that you worked in Australia from January until April of the current year and earned a gross salary of €4,000 (equivalent) per month. Because you need some time to sell you house, pack your things and establish a new household in Germany, you did not work or rather did not receive a gross salary for the months of May and June. In July you start your employment in Germany, again with a gross salary of €4,000. Your total for the year would then only be €40,000 and you would lose your eligibility to opt out from public insurance for this year and for at least the next three years where your gross salary must consecutively remain over the threshold. b)Even if your gross salary for the current year exceeds the threshold, you must also provide proof that your gross salary for the last three years (2004, 2005 and 2006 from the point of view of 2007) has been consecutively in excess of the threshold.

The threshold for those years were:

					
Year  Annual threshold  Monthly equivalent
----  ----------------  ------------------
2004 	  46,350.00€ 	    3,862.00€
2005 	  46,800.00€ 	    3,900.00€
2006 	  47,250.00€ 	    3,937.00€

Only if you have in all three years been over the threshold are you eligible for an immediate opt-out from public health insurance. If you were under the threshold in 2004, for example, you will have to get yourself insured publicly for one more year before you can opt out. If you have been over the threshold in 2004 and 2005 but not in 2006 you have broken the chain of three consecutive years and you will start in 2007 with public insurance and continue to remain compulsorily in the public insurance for the years 2008, 2009 and 2010.

If you do not fulfill the provision under either a) or b), please focus your reading on the public insurance parts of this Wiki page as well as on the private add-on insurances. If you feel that your employer is somewhat flexible when it comes to legal rules and provisions, you might also want to read the part on private insurance where it is explained how the proof under b) has to be demonstrated and to whom and what legal consequences arise out of this process.

Should you fulfill the provisions above, please read the information about private insurances for employees below and also the guideline below on when to opt out of public insurance and when better to remain in the public insurance. It might still be a better solution in the long run for you to remain in the public insurance, sacrificing short term profits for long term gains.

Established employees with income above threshold

Already employed in Germany for some time with a gross salary in excess of the threshold €3,975 per month and €47,700 per year.

I've have seen it happening again and again that Expats who were perfectly eligible to opt out from public insurance from day one have not been informed by their employer or responsible HRM people and discover only later that they missed out on considerable savings.

Until February 2007, it was actually quite simple to get these people out of the public health insurance, but ever since the same rules apply as explained above for Group II and thus make it more complicated.

Scenario 1: You have had a gross salary in excess of the threshold from the very beginning of your employment in Germany. In that case you have to check for how long backwards you can determine and prove that your gross salary inside and/or outside Germany was over the relative thresholds (check table above for reference numbers) for the last three years or more. If your salary was over the threshold consecutively for three years or more, you can opt out immediately. On the other hand, if your gross salary was for instance over the threshold only for two years, then you have to remain publicly insured until three consecutive years with gross salary over the threshold are fulfilled. Scenario 2: Your German gross salary has been raised over the threshold only this year or some time last year. In this case you first have to have one full calendar year of being over the threshold. If your pay rise happens mid-year, chances are that the total for the year will not yet be in excess of the threshold amount. Than you will have to add another three years of being consecutively over the the threshold, i.e. you can opt out after 2010 at the earliest.

Freelancers and the self-employed

Freelancers and self-employed persons in Germany, regardless of income

As a freelancer or self-employed person, you can basically choose from all available forms of health insurance: public health insurance, private German health insurance, or private international health insurance. Which option is best for you depends on those factors enumerated above under Basic Information.

The new law will force everyone in Germany, citizens and residents alike, to have a health insurance in Germany after January 2009. One of the major questions here at Toytown about this regulation was whether that would make the use of international private health insurances as offered by the likes of BUPA, MediCare, Expat HealthCare, ALC and so on impossible after 2009. After a lot of research on this topic I can finally give the following answer to this issue:

According to the information from the "REDAKTIONSBÜRO GESUNDHEIT", a service provided by the Federal Ministry for Health, what happens is this: There will be no "Bußgeld" (fine) if you do not follow this new rule. However, should you fall ill and require treatment and you are not covered by an insurance (i.e. you cannot pay your bills to the hospital/doctor), you will receive only very basic treatment and you will have to pay either the public health insurance or private health insurance dues backwards for the time you should have been paying in such an insurance (page 8, point 17, Fragen und Antworten: Versicherungsschutz, Redaktionsbüro Gesundheit, V02_02042007). We can derive from this somewhat cryptic phrasing that as long as you have an international health insurance you can rely on, you need not fear problems with the German authorities.

There are however two problems with regards to some of the international health insurances offered on the market to be considered when dealing with German authorities:

• While the above description is certainly true for all those Expats who have their residence in Germany without the need for a visa and/or residence permit, it is hard to predict if the German immigration offices (Ausländerbehörden) will not start to require German health insurances after Jan. 2009 in the processing of visa applications or renewal of residence permits. What you will certainly need as a part of your international health insurance if you want to stand a chance of continuing use of it is a long-term care insurance. Here Mike Woodiwiss from Spectrum has rightly pointed out on Toytown already that so far it appears that only ALC health insurance has understood this problem and provides a Germany-compatible solution together with the Allianz insurance group. My prediction is that for all Expats with visa and residence permit issues, their current international health insurance option will be void if they cannot show proof that the insurance also covers long-term care. It will be up to your current insurance providers to see whether they want to face the problems setting up such a kind of insurance addendum or if they rather let those clients in Germany go to another insurance company. Whether freelancing Expats with EU citizenship can get around the long-term care insurance will be seen in the future; here I can offer no prediction at all.

There remains the question, if you have all three options available, what kind of insurance should you take? A large number of individual factors play a role here, therefore my best advice to you can only be: get yourself professional help in this matter because the consequences of making the wrong choice can be dire and very costly. For obvious reasons (see the disclaimer below) I would suggest getting the advice of an independent broker or independent financial adviser because an insurance agent might not have the best solution for your personal needs amongst the portfolio of his insurance company’s insurances and could thus sell you something which is second best.

Below you will find a description of the particulars of the different insurance options and at the very end a table with a basic recommendation which kind of insurance fits best to certain groups of people.

PUBLIC INSURANCE IN GERMANY

As mentioned above, any employee with a gross salary under the threshold will be compulsorily insured in public health insurance. This, by the by, is also the backdoor for freelancers and self-employed persons to get back into the public insurance system if they find that the private insurance, be it German or international, is not the best option for them: just find someone to give you a €400-job for at least one year and you can keep the public insurance afterwards when freelancing again (but only if you are under the age of 57 years, if you are older this won’t work anymore).

Freelancers and the self-employed can choose to be voluntary members of a public insurance.

What are the pros and cons of public insurance?

1. German public insurance computes the monthly premium based on income only. The public system disregards age, gender as well as pre-existing conditions.

- For employees, the lowest costs with public insurance are within a €400 job where the employer pays on top of that around €100 p.m. which includes health insurance - An employee with an average gross salary of €2,500 per month will get an amount deducted from his pay of between €210 and €172. The premium depends on your choice of public health insurance, where the most expensive ones charge more than 15% from your pay while the currently least expensive ones charge only around 12%. Since the basic coverage (see below) is more or less the same with the public insurances, you might as well decide to go for the ones with lower costs to you and invest the saved money in private add-on insurance (see far below) in order to extend the coverage in certain areas according to your needs and wishes. - The highest any employee can be charged with are for all incomes in excess of €3,562.50 (the so-called “Beitragsbemessungsgrenze). This means it does not matter if your gross salary is €4,000 or €6,000 per month, the premium will be always the same top amount. Depending on your choice of insurance carrier you will be charged between €300 and €245 per month maximum. - Freelancer/self-employed: In this case the premium will be computed also on income, the lowest assumed income as base for computation is so far €1,837.50 per month. There is now a new provision since April that allows this amount to be reduced to €1,225 if the insured person can prove that his income is equal or below this amount. If he/she lives together with someone, the income of the partner/spouse may be counted in as well, though. The max. amount for freelancers/self-employed for computation of the public insurance premium is again €3,562.50 (the so-called “Beitragsbemessungsgrenze�? again)

2. Public insurance in Germany is a family insurance. This means all members of the family without their own source of income (and therefore own health insurance) are covered under the umbrella of one public insurance. In all private insurances, each family member has to be insured and paid for individually. If in a family (parents with children) only one of the parents is insured in private insurance and the other parent is in public insurance, the children have to be insured privately as well. This matter is part of a constitutional dispute in our supreme court, but for now it is as it is.

This means that for people with children, whether they are employed or freelancing/self-employed, public insurance is usually the better option. Only if both parents work and are over the threshold can a change to private insurance make sense at all. Here is a typical example for a family of four, where only one parent works in employment:

Comparison Public/Private health insurance for family of four

A comparison of costs in a public, German private, top German private, and international health insurance scheme.

					
Person                  Public  Private  Private TOP  International
------                  ------  -------  -----------  -------------
Husband, 37, employed   245,81	 161,77    308,18        102,50
Wife, 35, w/o income      0      184,75    466,63        99,55
Child, M/F, 1-15y       102,34   102,34    133,02        65,33
                        ------  -------  -----------  -------------
Total per month:        245,81   314,29    1.040,85      332,71

Why are there two different private German insurances on the table? The first is offering coverage only at the level of the public insurance ("analog GKV"). The second offers more comprehensive coverage which you can also get with private add-on insurance on top of your public insurance. Finally there is the last column with an example from an international health insurance. The coverage of the international health insurance includes dental coverage and evacuation/repatriation coverage which would be part of the public insurance (not the evacuation, though) and the private German insurance in order to make rates really comparable. It is of course possible to eliminate those coverage parts from international insurance and receive cheaper results.

As a result of this example you should think carefully about your plans for the future when deciding about health insurance options. Once you are out of the public insurance system it can be rather hard to get back in again. If you get yourself a low cost private insurance now to save costs, you may find that you pay a lot more later when you have established a family to cover. This is why a good financial adviser will talk about your future plans when giving you recommendations for health insurance.

3. As said above, public insurance disregards age and health status. Therefore it is often the better choice for older people and for people with major illnesses (pre-existing conditions) in the past or people who have a chronic illness that needs constant treatment.

4. Coverage: With public insurance you have good coverage for all major treatment and medical emergencies. In comparison with lots of other countries, the German public health system is still quite good. It is therefore impossible to describe all the treatments etc. that are covered with pubic insurance.

It is easier to focus on areas that the public insurance does not cover or requires sometimes major contributions from the insured person. The examples below are just a selection of the most important areas and the list is not exhaustive.

- Choice of doctor: with public insurance you have in any case of illness first to consult your house doctor. Each quarter of a year you have to pay a fee of €10 if you go to the doctor. Only the house doctor can refer you without additional costs to a specialist. The additional costs if you do not follow that rule are €10 and it could be that some of the treatment costs have to be contributed by you. Some of the more specialized doctors only accept private patients. - Alternative practitioner: if you prefer alternative medicine, the choice among public insurances gets very complicated. Most insurances don’t cover alternative practitioner costs at all. Same is true for Chinese medicine and so on. If would like to have these options, either scan the public insurances for some who do offer some service here or rather get a private add-on insurance to cover this. - Prescriptions: if your doctor prescribes any drugs or physics to you and you go get them from the pharmacy, you will have to pay a minimum of €5 and a maximum of €10 each time. A limited number of drugs is free of charge. If you have a chronic illness, the total of your cost share may not exceed a certain percentage of your income. - Remedies like bandages, massage, physiotherapy and the like: you will have to cover 10% of the costs and an additional €10 for each prescription of such remedies. - Glasses, contact lenses: for adults no coverage (except major visual disability) - Choice of hospital: you have to take the hospital your house-doctor sends you to. If you choose another hospital, additional costs from your choice can be fully claimed from you. - Hospital costs: for a max. of 28 days per year you have to bear €10 costs per day. - Hospital lodging: usually in a room with 4 beds/patients - Dental, cavities: in case of caries/cavity treatment, the standard treatment is still amalgam or some composite filling at best. Filling with gold or ceramics is not covered. - Dental, replacements, inlays: 35% to 50% of the standard costs are covered, the rest comes out of your pocket - Transport to and from doctor or hospital: if transport is required, 10% of the costs can be claimed from you - Transport from abroad (evacuation and repatriation): usually not covered at all - Treatment abroad: only covered for countries with which there are treaties, usually EU and near neighbouring countries. Publicly insured persons should have a good travel health insurance and or a comprehensive travel insurance.

If you want to have coverage where the public insurance does not offer it, you have the option of taking private add-on insurance to cover this particular area. Check for more information below at the chapter about private add-on.

5. Excess option/no-claims-bonus: One new development is that since April 2007 public insurances also offer a combination of excess option and no-claims bonus. The IKK DIREKT for instance, which has been named above as the public insurance with the currently lowest premium, offers on top of that a reimbursement of €460 in combination with an excess option of €600/year. If you are already insured publicly, you should first check if you might not be paying too much for public coverage. Just look at your pay-check and see what percentage and amount is deducted from your salary (if you are an employee, that is). After 18 months of membership in a public insurance you can cancel the contract and select another public insurance with two months' notice. If you do not want to change or if your insurance is already quite inexpensive, you might as well check if an excess/no-claims-bonus option is feasible for you and, if so, ask your insurance company about it.

PRIVATE GERMAN HEALTH INSURANCE

Private health insurances have the right to select and refuse members. Theirs is a risk computation for the insured based on age, gender and health status. Therefore you will always face a set of health questions when applying for private German health insurance which you must answer fully and honestly, otherwise you risk your whole insurance coverage at a later time. If anything is reported among the health questions (going back 5-10 years) the insurance may ask for an additional medical report on the condition and might also decide to exclude this from your coverage or charge an extra risk premium on top of the normal premium. Real killer conditions are high blood pressure, all things related to heart and blood circulatory system as well as psychological treatments in the past. This will either get you prompt refusal or unbearably expensive premiums.

For all people from outside of the EU, usually a medical check-up, sometimes combined with a dental check-up, is required with the application. Typically this is not or only partly reimbursed from the insurance after accepting your application. However the costs are moderate, around €40 to €80 for the medical check-up.

I have also experienced problems with private German health insurances lately for people with visa/residence permit if they have not already stayed for a couple of years in Germany. Here the selection of feasible insurances can get a bit more complicated and an international insurance can be a better and far easier choice in the beginning.

For someone who stays in Germany indefinitely, in my opinion a private German health insurance is the better choice compared to an international health insurance. The reason is that the premium price for private German health insurance is initially higher but remains more stable in old age because the German insurances build up a capital stock for the higher costs from more and more expensive medical treatment in old age. Among the German insurances there are some companies who only do a meagre build-up of capital stock and have therefore the inherent danger of becoming much more expensive over time. Here an independent broker can help best with the selection since insurance agents won’t tell you how their insurance is faring there. If you want to check yourself, get information from Morgen&Morgen, one of the top-rated agencies in this area.

On the other hand, if you know that you will only stay for a couple of years in Germany, you might want to take up an international private health insurance. There you do not pay extra for a capital stock for old-age that you will never participate in anyway.

COVERAGE AND SPECIAL FEATURES

With private insurances, you can select the grade of coverage, therefore there can be not description of "average" coverage here since there is obviously no average standard as a yard stick. Coverage can be range from relatively low to 100% of everything, based on how much you are willing to pay. This is why extensive comparative research is required to find the best option for you based on the coverage that is important to you individually. You can get an insurance coverage which mirrors only the public coverage (“analog GKV�?). This is what I recommend to begin with in order to see how much you can save money-wise when switching from public to private with the same coverage. After that you should determine which additional coverage you would like to have and check the best quotes for this combination in the market. Basically you can get coverage for everything not covered by the public insurance as enumerated above.

Choice of doctors and hospital

With most private insurances you will have free choice of doctor and hospital. In addition there are specialized doctors and dentists who will only treat private patients to which you then have access to.

Single bed room in hospital: In my opinion, if a freelancer or self-employed person ends up in hospital this means he is really, really ill and needs all the care and best conditions to get well again. This is exactly the wrong timing to make new friends with other patients who are bedded in the same room with you and who might have very different living and sleeping patterns than you. In addition, if you are in a single room as a private patient it is relatively easy to get phone and internet access so that you can keep up with some work if your profession requires you to. Therefore this is from my point of view an extremely important feature for all freelancers/self-employed.

Excess option/deductible

The monthly premium can depend also very much on your choice of excess option. Excess option means that you set an amount which every year you would pay out of your pocket for treatment and prescriptions and the insurance only kicks in with reimbursement for all amount in excess of this amount. You can get €0 excess cost if you just want to hand on whatever costs you have to the insurance company. Of course then the risk computation of the insurance brings a higher result and the premium will be higher accordingly. Typically excess options run in the area of 150 to 350 EUR a year. But much higher excess options are also possible. If you want to have supreme coverage in case you get really very ill and have to be hospitalized (single bed room, treatment by the head of department in the hospital) and otherwise don’t have much need for doctors and treatments, you might as well choose an excess option of 1,200 or 2,400 EUR if you know you can afford this amount without serious financial troubles should you need a major treatment. By choosing the high excess option your monthly premium will be low in comparison to the comprehensive coverage.

No-claims bonus

Private insurances normally offer a no-claims-bonus. This can be from one monthly premium paid back to your account (in case you are an employee you receive both your share and the employer’s share together) up to six monthly premiums, depending on the insurance and often also on the duration of no-claims. If this is important to you, please state so when you ask for research on a suitable insurance for you.

World-wide coverage

Private health insurance usually covers you world-wide. Some limit this to four consecutive weeks abroad, others to 3-6 months. This is usually an important part for Expats and should be considered carefully in the selection process.

Financial support when ill or in hospital

With private health insurance you can arrange to receive daily payments in case you are seriously ill and/or in hospital. When in hospital, a "Krankenhaustagegeld" can be for instance 50 or 100 EUR a day. This can be important for freelancers and the self-employed with no income when not working in order to cover the fixed costs of life such as rent, insurances etc. "Krankengeld" on the other hand can be arranged for any period when you are too ill to work. Here it is advisable to set a time after which the insurance kicks in. Typically this is six weeks or more. With a waiting period like this the insurance remains affordable and you can set the amount paid to you higher for less money.

Termination of contract

While the insurance cannot cancel the contract because you get chronically ill as long as you pay your dues, they reserve the right to cancel the contract if they found out that you have not been honest and forthright with regards to the health questions in an application. Therefore I strongly urge you to answer those questions honestly and in detail. If an insurance agent or broker tells you to skip over some question or neglect some information you just gave him, be very, very wary because he might do that only to spare himself trouble with the application and he can endanger your coverage at a later time.

You can cancel the contract within the given contract time which can be anything from 1-3 years, usually by giving notice at least three months before the end of the contract, otherwise it will automatically renew itself.

Special cancelling rights occur whenever your insurance increases the premium. In this case you have a short window of opportunity to give notice and change to another insurance company. But be careful only to cancel the existing insurance after you have been accepted by the new insurance just to make sure that you do not get into a time of no insurance coverage if the new insurance is slow to accept your application.

One good thing: regardless of how long the insurance is running according to contract, it automatically ends in two cases and offers therefore a slight advantage here in comparison with international health insurance: a) when you take up an employment where you are compulsorily insured in public health insurance and b) when you give up your residence in Germany and leave the country

How to deal with the new “Three years over the threshold�? condition to have the right for opting out from public insurance as employee? The new rule that your gross salary has to be three consecutive years over the threshold for opting out from public insurance came as quite a shock to many newly arrived Expats and also for most employers and HRM personal who still do not know how to deal with this new regulation. I myself had to do wide and intensive research before I could get a straight answer how this is to be dealt with.

The good news is that your employer has to check and decide if you are eligible for private insurance or not. I feared for some time that there would be a new federal or state administration to take care of that and make it all the more complicated.

As mentioned above, the employer has to check if you fulfill the three year provision. For this you have to demonstrate proof and the proof has to be stored with your personal file. This proof can be made from end-of-year payslips or tax-notes for past years and in a current year with payslips showing cumulative sums for the last month you received salary outside of Germany before starting your employment here. In Germany a lot of income that is not regular (bonuses, overtime payments etc.) are not counted as belonging to the gross salary. Since this is hard to check abroad, it is allowed to base the decision if you are eligible or not on the total payment received in your payslips. If you have had more than one job, the total from all income is the relevant yard stick. This makes it easier for some people to get by this provision.

Now it depends on how flexible your employer is with regards to the letters of the law. The regulation says that if he is doubt he shall consult the appropriate public health insurance company for a verdict. Since it causes not only more costs for you but also for the employer if he has to sign you up with public insurance in most cases, I believe that especially employers in SMEs can be persuaded not to have any doubts and to decide that you are eligible for opting out of public insurance. I cannot see how any authority, be it from the government or from the public insurance companies, is actually going to check the personal files and overrule a decision of the employer. There is neither the personnel for that nor any good reason to do so. Therefore I would assume that even if your salary outside of Germany in the previous three years has not always been fulfilling the requirement, some flexible and enterprising employers might still allow you to sign up for a private health insurance.

My last advice is somewhat tricky because I am not recommending you to do anything illegal. But when you weigh the costs and consequences of being insured publicly or privately, ask yourself: is someone really going to contact your former employer in Ireland or Australia to ask if your gross salary as shown in the copy of the payslip in your personal file was indeed over the threshold or not? If you believe this to be as unlikely as I do, well, do I have to paint the picture for you in detail…? Just make it easy for your employer to decide in your favour when he has to check if you are eligible for private health insurance or not.

Having said that: please also check if going private is the better option for you or not. Don’t over-rate present short term profits against future higher costs if you for instance establish a family and have to pay additional private insurance for spouse and children!

PRIVATE ADD-ON INSURANCE

If you are stuck with public insurance or if public insurance is simply the better option cost-wise, you might still want to be treated like a private patient in certain areas.

Typically there are three areas for add-on-insurance:

1. In-patient: this increases your coverage when you have to be in hospital. You now have the free choice of hospital, no cost participation while in hospital, you can choose between 2- or 1-bed rooms and receive treatment by the head of department, usually a very experienced professor of his special branch. If you have only a minor illness/treatment and forsake your right to the 2- or 1-bed rooms, the insurance will usually pay you a daily allowance of 20-50 EUR instead. A good add-on insurance building up on your public insurance will cost for a 35-year old male around 30 to 40 EUR per month; a child pays up to age 15 only around 4-5 EUR/month 2. Dental: a dental add-on insurance covers especially a bigger part of the costs for replacements, better filling option, professional dental cleaning every now and than and allows you to choose dentists who only take on private patients. A good add-on insurance for a 35-year old female will cost per month between 20 to 35 EUR. A child up to the age of 15 pays only 4-7 EUR per month. 3. Out-patient: as you can see in the description for public insurance coverage, for a number of treatments you have to pay a share in public insurance. Some of the features offered here by private add-on insurance are for instance coverage of all costs for prescriptions and consultations of doctors (those pesky 10 EUR per quarter fees). In addition, you receive coverage for treatment abroad and evacuation/repatriation to whom if medically necessary. A typical good coverage would cost EUR 15-20 for a 35y-old male or female, children would be charged around 4-6 EUR per month.

There is a wide choice with a lot of different coverage, therefore I strongly recommend getting professional advice in this area to get your money’s worth.

INTERNATIONAL HEALTH INSURANCES

As far as I know there is no comprehensive comparison of the major international health insurances. Some seem to have a solid reputation as to how they handle claims. Which coverage you want it usually up to your selection.

While legally also employees would have the right to choose an international health insurance, mostly they will find it complicated or impossible to convince their employers or HRM personnel to accept an international insurance. International companies with branches in Germany are easier there than German employers in my experience. The reason often is that the computer programs for HRM are not fitted to include international health insurances. In addition employers need certain certificates from the insurance company guaranteeing to apply to certain principles in Germany which many of the international insurances either can not or will not hand out. Therefore an international health insurance is possible but not easily set up for employees.

For freelancers/self-employed an international health insurance can be a welcome and solid alternative if

• they are young and single without any family planning in the near future
• and/or will only live for a couple of years in Germany

In a case where an Expat fulfills one or both conditions I would always recommend an international health insurance. As already explained above, however, in the future there will be the requirement of an additional coverage proof for long-term care insurance. So far it appears only ALC has found a solution here together with ALLIANZ. You should check with your current international insurance or your insurance agent/broker if he can offer you some solution for other international health insurances.

Some of the international health insurances work with a “moratorium�? instead with health questions. This can be an interesting alternative for people who suffered some health problems in the past and are healed today. They could encounter problems with German private health insurances due to the pre-existing condition while those international insurances following the moratorium rule will cover such illnesses as a new case after a waiting period of two years. While this means that you run a risk of no coverage for two years, in some cases you would receive no coverage at all for this in a German private health insurance, so it is by far a better option. How the moratorium works and what you have to observe within the first two years can be differ from insurance to insurance, hence you should try to get the information directly or through an independent broker.

There is one other area where I would strongly recommend to go for an international health insurance and that is if you are still uncertain about the length of your stay and if your personal development might not make a public insurance more attractive in the future. This could for instance be the case when you are in a relationship with a partner who is publicly insured in Germany with children and you think a marriage might be possible some time in the future. If you select a private German health insurance and you marry that person, suddenly the children will have to get private insurance as well as a result. If you selected an international health insurance you can rightly claim that you have never been privately insured in Germany and you stand a better chance of getting yourself a public insurance instead, covering the rest of the family. Other examples are certainly possible too.

On the other hand there is one typical scenario where I would not recommend international health insurance, which is usually a one-year contract. That is when you start to work as a freelancer/self-employed in Germany but already plan to pick up a part-time employment or any employment at all. If you do take up employment, you will be compulsorily insured with public insurance starting with the first day of your employment. This would mean you will pay double health insurance for the time until the international health insurance runs out. I have heard claims that employers/companies accepted pre-existing international health insurances even if the gross salary of the employee was below the threshold. I have yet to see convincing evidence of that happening and even then it might be an especially lenient employer, but I can not detect yet a legal claim for this to happen and thus consider it an unnecessary risk for my clients. In this case the better choice is a private German health insurance which simply ends when you pick up employment with compulsory public insurance coverage.

GUIDELINES ON WHICH INSURANCE OPTION TO CHOOSE

For an overview of the best insurance for you based on your age, employment type and length of stay in the country, download the following Health Insurance Overview. This should not be considered a substitute for personalised professional advice!

Health Insurance Options (PDF)

TT ADVERTISED INSURANCE AGENTS

Contact one or more of the following TT-advertised insurance agents. They will be happy to give free quotations and advice on all kinds of insurance for English-speaking expatriates throughout Germany:

• Martin Brown at First Financial Direct
• Mike Woodiwiss at Spectrum International
• Patrick Ott at C R & Cie Insurance and Finance
• Holger Kretzschmar at Kretzschmar Insurance

SEE ALSO

• Changes to health insurance legislation in Germany, Effects on having an expat-insurance from the UK