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Using German Government Health Insurance (GKV)

A short guide of some things you should expect when making use of the statutory health insurance in Germany

The German health care system enjoys a very good reputation around the world. This is deservedly so because the medical care delivery system excels at all levels. There are highly trained doctors and other medical professionals; large, modern university clinics and private hospitals as well as easy access for all residents of Germany to medical and dental practices, pharmacies, emergency care, rehabilitation facilities and other support services. The high standards and quality of German healthcare can be attributed in a large part to its system of health insurance.

Health insurance coverage is mandatory for all residents of Germany. Insurance is provided by a government health insurance company (GKV) or a private health insurance company (PKV.) The government health insurance is sometimes referred to as "statutory", "public" or "national|" health insurance and is used by about 90% of German residents. The GKV also normally covers the children and spouse of the policyholder.

Students have a choice

At the beginning of their course of study, students can choose between the private and the public health insurance options. There are special rates for students in the public insurance programs. Up until the age of 25 students may be insured under their parents’ public insurance policies free of charge under certain conditions. After that there is the favorable Student Health Insurance (KVdS) program that extends benefits to age 30 or the 14th semester of study. Older students may also voluntarily be insured under the public health insurance programs. However these can be expensive. As an alternative, the private providers also offer health insurance with better rates.

The type of health insurance is often dependent on one’s work situation and the income level of the insured. Most employees have GKV from one of the more than 100 insurers and the cost is a percentage of their salary with about half of the premium paid by their employer. High-income individuals, civil servants, self-employed persons, freelancers, artists and others are often covered by private health insurance. However, they can voluntarily also be covered under certain conditions within the GKV.

The Electronic Health Insurance Card

Everyone covered under the GKV (and often PKV) is issued an electronic health insurance card with a photo ID and an electronic chip.

Medical services for doctors visits, outpatient treatment, hospitalizations, prescribed medications and medical products are processed and invoiced using the card. The microchip embedded in the card records the necessary information obtained during a doctor’s visit, when processing prescriptions and when using other required medical services. Always be sure to have the card with you whenever you have need for any sort of medical service.

Benefits provided by Public/Gesetzliche Health Insurers

Of the 110 providers of public health insurance registered in Germany in 2018, the benefits provided its policyholders are almost identical. The choice between government health insurance providers is mostly based on the voluntary, add-on benefits provided and the quality of the paid supplemental services augmenting the basic policy. There may be differences, for instance, in reimbursement for professional teeth cleaning; alternative medicine or healing procedures; or preventative medical care.

What to do when you have to see a doctor and are covered by GKV

Those insured with GKV are allowed to choose their own doctors. Before you make an appointment with any doctor, find out whether they are registered either as a public and/or private insurance plan physician. Doctors that accept the GKV will have in their online listing or the shield outside their office the words "alle Kassen" Should you go to a doctor who is not registered as a public sector practitioner, you will have to pay for treatment out of your own pocket.

As a rule is the first person whom you contact if you are having problems with pain or illness should be a General Practitioner (Facharzt für Allgemeinmedizin). A GP can also be referred to as a Hausarzt (house doctor) in German and Primary Care Provider in English.

A GP also conducts regular examinations and in case of illness will first examine you. You will be given a form to fill out at your first appointment and your personal data that can be read and downloaded from your Health Insurance Card will be obtained. Your house doctor can conduct treatment as well as various diagnostic studies and basic tests. If you should need medication that requires prescriptions, these will be issued. Should your primary care giver determine a need to consult a specialist, he or she can provide the transfer form (Überweisung). You can visit specialist of your choice or accept a referral from the GP.

In some instances you will get the results of your doctor’s appointment either when leaving the practice or per post. The document contains, as a rule, information regarding your diagnosis, the procedures taken, and eventual, necessary follow up measures for treatment. Should you require documentation for sick leave purposes at work, the doctor will provide that also.

At the Pharmacy

Filling out prescriptions is relatively simple and uncomplicated. You present the prescription at a pharmacy (Apotheke). Depending on the type of medication, a fee of at least 5 Euros to at most 10 Euros can be charged for each prescription by the pharmacy. This is sometimes called a "Zuzahlungß" or supplementary fee. Prescriptions for children up to age 12 are generally exempt from supplementary fees. Should a medication not be on hand at the pharmacy, it can be ordered and picked up later.

Going to the dentist

The GKV benefits include a yearly dental hygiene visit for adults and a twice-a-year visit for children. Dental treatments costs may not be entirely covered. It depends on the type of treatment, the materials used and insurance provisions. Before undertaking a treatment, most insurers request an estimate from the dentist for labor and materials prior to beginning treatment.

The insurance company will then inform you how much it will pay for the treatment and how high your portion of the cost will be. For those with GKV, a good supplemental dental insurance can be a sensible move in order to reduce possible costs that can tend to be very high.

Additional Treatment

Additional treatments might include a hospital stay, physiotherapy, rehabilitation, or other procedures and healing means.

Hospitalization in normally usually occurs on the recommendation of a specialist. The specialist helps with the preparations for and the actual admissions procedure - including the choice of hospital. As a rule, you will be charged 10 Euros for every day you are in hospital. Privately insured patients must inquire as to how much their costs will be covered which depends on their premium level. If your doctor is not on staff of the hospital to which you are brought, the staff doctors of that hospital administer treatment. You could be placed in a multi-bed ward unless you have supplemental coverage for a private or semi-private single or two-bed room.

The number and duration of physiotherapy treatments is often determined by your illness and its severity. Note that you should be in touch with your insurance advisor in order to learn which type and duration of physiotherapy are covered and how high the charges for the therapy will be. Generally, additional costs to be borne by the patient who is insured under GKV run 10 Euros per type of treatment plus 10% of the treatment cost. Therapy appointments may be conducted in the therapists practice or in a hospital.

Should you require medical assistance or appliances (medical transport escort, railings, crutches, splints, walkers, wheelchairs, etc.) these will be authorized by prescription. Devices can be obtained in stores specializing in medical equipment or ordered. As is the case with pharmacies, this may entail additional costs. In the case of transportation for treatment, the patient should check with the insurance company to see what payments are made in full or those that may have to be shared.

Major illnesses can result in long-term treatment and possibly lengthier stays in rehabilitation centers. It is recommended to discuss the choice of facility, the anticipated length of stay and benefits of your policy with your insurance advisor.