State health insurance in Germany (GKV). How payments are formed

Last Updated on November 28, 2023

Actually, at first I wanted to write only basic information about what insurance there are, but I found a lot of information that can be useful to everyone. Therefore, there will be a series of posts, and we will start with state health insurance in Germany – what it is and what it pays for. Let’s make a list similar to the list “All I can return” (from taxes) – alphabetically.

There are two types of health insurance in Germany: state (gesetzliche Krankenversicherung, GKV) and private (private Krankenversicherung, PKV). In any case, you must have one of them.

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State health insurance (GKV)

This insurance is carried out through the particular insurance companies – gesetzliche Krankenkassen. There are 105 of these in Germany, and only about 40 of them operate in all federal states (Bundesland).

Initially (since the 19th century), there were several types of insurance companies: AOK – tied to a specific place (Allgemeine Ortskrankenkasse), BKK – manufacturing insurance companies (Betrieb), IKK – corporate companies (Innung – corporation, workshop), for farmers and for forestry workers. These are the so-called primary insurance companies – Primärkasse.
Later also the so-called Ersatzkasse were created – insurance companies, which voluntarily included those who did not obligatorily belong to other types. There are six insurance companies of this type, including the largest TK and Barmer.

Now for the client there is no difference in the form of the insurance company.

Joining as a member (Mitglied) of such an insurance company does not require any conditions. Conditions may appear if you were in a private insurance and wanted to go to a public one.

Family members who have joined the family insurance are not members of the insurance company. This is important for questionnaires. Question to a non-working wife in family insurance: – Are you a member (Mitglied) of the insurance company? answer: No (you are insured, but not a member). The same for children often needs to indicate who he is insured with.

Who is required to insure with GKV?

There are, however, categories of residents who are required to insure with GKV. It:

• employees earning less than 62.550 euros per year
• retirees who were in state insurance for 9/10 of the second half of their working life. If a pensioner has been in state insurance for the last 12 months / 24 months in the last 5 years before retirement, he can enter into state insurance voluntarily. If he was in a private insurance company, then he should stay there.
• Azubi (industrial trainees), trainees
• recipients of unemployment benefits
• family members without income (children and non-working spouses)
• disabled

Self-employed (Selbstständige), creative professionals (Freiberufler), state employees (Beamten) can choose between PKV and GKV, and employees earning more than 62,550 euros per year for three consecutive years can switch to private insurance at will.

How much does government health insurance cost?

State insurance contributions are paid according to the principle of solidarity – they depend on income, and not on age, health status, etc.

The standard contribution is 14.6%. If you are an employee, you pay 7.3% and your employer pays also 7.3%.

Since the standard contributions do not cover the costs of the Krankenkassen, they have the right to assign Zusatzbeitrag from 0 to 2.7 percent. Most of the insurance companies had an additional 1.1 percent for 2020 and 1.2 percent for 2021.

Thus, the total average contribution is 15.8 percent, half of which is paid by the employer.

This is the standard scheme. Then the options begin.

Self-employed

If you are an self-employed, even with a small income, your membership is voluntary. You can choose whether or not you receive Sickness Benefit (Krankengeld) after 7 weeks of illness. If you will, then your percentage is the same as that of workers, 14.6%. If you don’t, then your base percentage is 14%. Plus an additional percentage from a specific insurance company.

The percentage is calculated from all your income, but not more than a certain amount (about 4.690 euros per month). The minimum limit, below which the calculation of contributions does not fall, is also there – about 1060 euros.

Students

Students pay the so-called Sockelbeitrag, which is calculated regardless of their income from the amount of Bafög and is a little less than 80 euros per month. However, many students stay with their parents in family insurance until the age of 23-25.

Beamte

Beamte (state employees) must pay the full payment to the voluntary state insurance.

Whereas in private insurance they receive favorable rates and compensation (Beihilfe) – as a rule, 50 percent of their expenses. If they have children and a partner, then this compensation goes up to 80 percent. Therefore, 70 percent of Beamte choose private insurance.

Pensioners

Contributions for pensioners are the same as for employees. Half of those who are required to be in state insurance are paid by the pension company. There is a list of additional income of a pensioner, which are / are not taken into account for calculating the insurance payments. Pensioners, who are not required to enter the state pension insurance, pay according to different rules: the list of accounted incomes is larger and there is no additional payment from the pension company.

Unemployed

Arbeitsamt pays contributions for unemployed receiving benefits. Unemployed people who are not receiving benefits must have voluntary insurance. In GKV, the minimum amount of contributions will be about 160 euros per month.

Next – which treatments are (not) paid by GKV A-K, L-Y
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