In Germany, there are two health insurance systems: statutory health insurance and private health insurance.
Statutory health insurance provides reliable healthcare services for nearly 90 per cent of the population, making it the most common type of health insurance in Germany. Most people automatically fall into the category of mandatory membership in the statutory health insurance system.
Far fewer people have private health insurance, as certain criteria (e.g. regarding a person’s job or amount of income) must be met to qualify for membership. For example, freelancers, people who are self-employed and civil servants may take out private health insurance. All other salaried employees usually have statutory health insurance, unless their income exceeds the threshold for mandatory membership in the statutory health insurance system.
Another difference between statutory and private health insurance concerns the way in which costs are reimbursed. With statutory health insurance, doctors invoice the health insurance providers directly. This means that patients do not need to pay for any costs upfront. With private health insurance, patients are responsible for paying doctors’ invoices directly and are only reimbursed for these costs when they submit the invoice to their health insurance provider.
Please note: regardless of whether you have statutory or private health insurance, both systems guarantee entirely equal and reliable healthcare services. People from Ukraine in need of assistance automatically have access to statutory health insurance in Germany.
Statutory health insurance (gesetzliche Krankenversicherung, GKV) functions in accordance with the solidarity principle. The contributions are based on the financial performance of the members, the health services are the same for everyone.
In case of serious illness, which cannot be excluded at any age, very high costs of treatment exceeding income and property of those affected can accumulate very quickly. This is why health insurance is obligatory for all citizens residing in Germany.
In Germany, people have a free choice of doctor. Those on statutory insurance are allowed to go to any doctor they prefer as long as he or she is approved for or authorized to contractual medical care. This can apply to a physician or a specialist, a medical care center or different forms of out-patient facilities, but also to psychotherapists approved for contractual medical care.
As of 1st June 2022, Ukrainian refugees in need are entitled to benefits in accordance with the second or the twelfth Code of Social Law (Sozialgesetzbuch, SGB II or XII).By this means, they gain access to the statutory health insurance (GKV) and therefore also to social care insurance (Section 20 paragraph 3 SGB XI). This gives them access to the GKV’s full scope of service.
Due to the new regulation introduced as of June 1, 2022, Ukrainian refugees who are not in need as they dispose of financial reserves or have income as they are, for example, continuing their work from Germany for their employer in the Ukraine, receive the right to join the voluntary insurance of statutory health insurance (GKV) and therefore also social care insurance (cited in Section 417 SGB V and Section 20 paragraph 3 SGB XI).
A prerequisite for the right to enter is that the conditions regarding the right of residence are fulfilled and that there is no need for help in accordance with SGB II (citizen’s income) or SGB XII (social benefits). The application for GKV membership has to be made within 6 months after having taken up residence in Germany. The voluntary insurance also includes the possibility of free family insurance in GKV.
Attention: Applications for statutory health insurance must be made within six months after arrival in Germany! If you fail to apply within this period, your entry into statutory insurance in accordance with paragraph 417 of the fifth Code of Social Law (SGB V) will not be possible, and you will have to cover any medical care expenses yourself and take out private health insurance.
All employees whose gross income lies under the annual earning limit (EUR 66,600 in 2022) and above the low income threshold (EUR 520 per month) are compulsory members of the GKV.
Children, spouses and registered partners of members are insured as family members without them having to pay contributions when their residence or habitual abode is in Germany and when their total income does not exceed a certain income threshold.
Numerous medical services are paid for by health insurance. These encompass:
- Medical and dental treatment
- Protective vaccination and medication
- Medical check-ups for pregnant women and children
- Medical aids (e. g. crutches)
As a member of statutory health insurance, beneficiaries receive their services from their particular health insurance company. The health insurance company in question issues an electronic health card (eGK) as credential with which you are able to claim services of statutory health insurance.
It is obligatory that administrative data regarding you as a person, for example your name, date of birth, address and health insurance number, so-called master data, is stored on the eGK chip. The data is checked during the reading out of the eGK at the surgery. In case of treatment, present your health card at the doctor appointment or dentist appointment.
Ukrainian refugees have access to health insurance for the duration of their recognized residence and are therefore entitled to the whole scope of services of statutory health insurance.