Whoever lives and works in Germany is usually covered by statutory insurance. Ninety percent of the population are insured through one of the health insurance companies within statutory health insurance. You pay a specific amount towards the insurance each month. The amount is determined by the level of the monthly income. In addition to that amount your employer pays another part. If you become ill or have an accident and have yourself treated by a doctor or in hospital, your health insurance will cover the treatment costs, except for the statutory additional payments. This means that no insured person suffers financial hardship due to illness in Germany. Therefore the health insurance pays not only for medical treatment but also for the medicines the doctor prescribes for you.
If you cannot work due to illness, your employer will also, as a rule, continue to pay your wages for 6 weeks. After this the health insurance will provide sick pay for a certain amount of time. Thus, the statutory health insurance is a dependable safeguard in case of illness. Particular cases can also be: accidents or treatment of diseases of employed persons. If you cannot pursue your profession any longer, due to illness, necessary measures will be covered if need be by other organisations, e.g. by the pension or the accident insurance. The responsibilities of statutory health insurance are subject to change, from time to time. Regulations, e.g. about benefits, contributions, or referrals from one doctor to another can be changed in the near future. The health insurance that you are insured with will update you on the changes. The general principle in statutory health insurance is solidarity. The insurance premiums are commensurate with the income, and do not depend on whether one has a family, is female or male, is old already or perhaps is frequently ill. This means that a person with a higher income will pay more into the insurance than a person with a lower income. In this system, the young support the old, single people support families, and healthy payers support sick ones. Yet, everybody has a right to the same statutory benefits.
There is a difference between being insured by statutory insurance and being privately insured. Usually, employees whose annual income does not exceed a certain amount (the amount changes annually, – the current amount can be found under “compulsory insurance” on the supplementary sheet), as well as trainees, unemployed people, students, pensioners, artists and publicists are members of the statutory insurance scheme. The members of their families can be insured with them free of charge, if they have little or no income. There is an age limit for children, depending also on whether they are still participating in vocational training or higher education. Handicapped children are covered through their parents without any age limit, if their disability prevents them from supporting themselves. Self-employed individuals and employees with a gross income above a certain amount can take out statutory or private health insurance voluntarily. You may choose your health insurance company yourself.
At the doctor’s
Regardless of whether you have private or statutory insurance, in Germany you may choose your doctor yourself. Statutory insurance members may only choose between the doctors who are registered and under contract to the statutory insurance scheme, which almost all doctors are, in practice. One differentiates between family doctors and specialized doctors. Family doctors are general practitioners, paediatricians and some of the practitioners specialized in internal medicine. You should always go to the same family doctor because he/she knows you and your state of health best. If necessary, he will refer you to the correct specialist. Specialists are doctors specialised in certain areas, for example gynaecologists or ear, nose and throat doctors. You can go directly to a specialist when you are sick, but you will have to pay the additional practice fee. If the referral of the family doctor to the specialist is handed in later you will receive a refund of the practice fee. Health insurances pay rewards to their members for always going to their family doctor first. Prior to deciding on a doctor, it is wise to consider what is important to you. Maybe you would rather be treated by a woman doctor than a doctor who is a man. Maybe the location of the doctor’s surgery is important for you because you rely on public transport to get there. It can be worth it to compare the surgery hours of different doctors, too. You can inform yourself as well about whether the surgery is always very crowded, and whether there are always long waiting periods. A good doctor will listen to you properly and explain to you in understandable terms what he is doing and why he recommends which treatment. He links his work to that of other doctors and thus refers you to a specialist or a hospital if needed. If you are not satisfied with your doctor or you do not trust him, you can change to another doctor. You should not do this too often, though, because every doctor has to get to know you all over again, and you him or her. Apart from this, changing doctors frequently may often also lead to unnecessary duplication of diagnostic procedures, for example X-rays, which may be a risk to your health.
The doctor attending you will determine whether you need to be admitted to hospital for treatment of an illness, or for an operation. With statutory health insurance you can only be treated in accredited hospitals. For example, all University hospitals are also accredited. Treatment in a private clinic is impossible for statutory health insurance members. Your doctor will give you a note of referral for hospital treatment. On this note you will find listed the two closest hospitals best suited for your treatment. If you choose a different hospital for treatment, you might have to pay for the extra cost. In this case, speak to your doctor and health insurance, and feel free to explain about special religious aspects. You will be referred by your family doctor or specialist to the hospital. He will write you an admission note which you have to take to the hospital with you. For some operations you do not need to stay in hospital for days or weeks at a time. These operations can be performed in a hospital or specialist clinic as out-patient treatment. This means that you can go home on the same day after the operation is performed. A longer stay in the hospital is referred to as “in-patient treatment”.