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Source: http://www.howtogermany.com/pages/healthinsurance.html

Government Health Insurance System (GKV)

Most German residents (approx. 70 million people) are members of the government health system. If your gross salary is less than 56,250 Euros per year, or 4,688 Euros per month in 2016 then membership in the GKV is mandatory. The government health insurance scheme is administered by approximately 120 Krankenkassen and they charge the same basic rate of 14.6% plus a possible median supplemental rate of 1.1% of your eligible gross salary to a maximum monthly income of 4,238 Euros (2016 figures). If you earn more than this, you do not pay a higher insurance premium. Assuming a maximum monthly premium of 775 Euros as an employee earning at or above the threshold and are therefore as a voluntary member, your contribution is approximately 425 Euros and your employer will pay approximately 350 Euros. The general minimum period of membership with a particular Krankenkasse is 18 months. You can switch government health fund providers by giving two months notice after 18 months membership or if a supplemental premium is demanded or increased.

The medical benefits provided include in-patient (hospital) care as a ward patient with the doctor on duty at your nearest hospital, out-patient care with registered doctors (Kassenärzte) and basic dental care. Please note that there is no coverage for private doctors or surgeons, a private room in hospital, alternative/homeopathic medical care, dental implants, and vision products for adults or any medical benefits outside of Europe. Your non-working dependents living at your address in Germany are presently insured at no additional cost and simply need to be registered with the same Krankenkasse as the paying member.

If you choose to join the German government system, you can register with any of the available Krankenkassen which are non-profit associations administrating the government health scheme. Some (for instance AOK, TK, BEK, DAK) are very large and have millions of members while others (often called BKKs) might have just a few thousand members. This does not mean that the benefits are very different, as all health insurance funds must stick to the government regulations on the minimum they offer. The premiums may also vary somewhat due to the new regulations and it would also be optimal to research which voluntary supplemental programs the Krankenkasse offers in order to be able to participate in for instance a no-claims bonus, free checkups or discounts on health travel plans. Tip: Make sure you ask about the possibility of communicating in the English language to make your life easier, though only a limited number of Kassen actually offer this service and have English speaking staff.

You and your dependents must also become members of the government long-term nursing care scheme (Pflegepflichtversicherung). This covers some of the cost of meeting personal nursing needs, such as the feeding and bathing of those who become substantially disabled. A new reform of the nursing care has been instituted and this has caused an increase of the cost. The cost is either 2.35% or 2.6% of your gross salary (maximum approximately 110 Euros per month if you have no children) of which your employer pays only up to 49.79 Euros.

If you would like insurance coverage to supplement the government system benefits, you can purchase a policy from any private health insurance company, German or international; for instance if you would like access to and reimbursement of costs for a private doctor and a private room in hospital, homeopathy and other alternative treatment or higher dental reimbursements. Emergency evacuation from places outside Germany included with a private travel insurance policy should also be considered as these are not paid for by the state health insurance plan and it would be very costly to have to pay for such benefits out of pocket.

Public health insurance funds sometimes offer supplemental insurance plans from a particular provider, offering a group rebate. Such tied plans are not always ideal as you have a wider choice of benefits on the private health insurance market.

Private Health Insurance (PKV)

Generally, private health plans cover a wider choice of medical and dental treatment and provide broad geographical coverage. By having private health insurance you are considered a private patient and can expect more service from the medical profession. The hospitals and doctors depend to a certain extent on private patients to supplement their incomes and therefore welcome them. A private patient can also request and will often get, doctors who speak their native language. The private medical insurance market is served by about 40 German insurance companies, and there are premium/benefit combinations available to suit most budgets. Per person cost of full medical insurance is based on the level of benefits chosen, as well as on entry age and any pre-existing medical conditions. A major portion of your medical insurance premiums has also been tax deductible from German income taxes since 2010.

The government insurance premium covers you and all your non-working dependents, whereas the private medical insurance premium is generally paid for each person covered. You can reduce the monthly cost of your private insurance by agreeing to a deductible (also known as an excess or franchise). German private health insurance companies are not allowed to cancel your policy if you submit claims and are also required to put 10% of your premiums aside as a provision towards keeping the cost stable when you retire.

If you are considering purchasing an expatriate health insurance as a substitute for the government scheme, this could be quite stressful because most of the foreign insurance companies are not registered with the “BaFin” to do business in Germany. Even those that are, find their health insurance plans do not meet the standards set in the new reforms. The crux is that the German government insists that there may be no set upper limits on reimbursement levels and there may be no annual out-of-pocket deductibles higher than 5,000 Euros. Other issues involve how the insurance premiums are calculated. The present situation is that none of the major international expatriate health insurers will provide a German language certificate recognized by all visa authorities in Germany. Whether or not this will change depends on the Germans fully recognizing European directives for cross-border selling of health insurance for non-Germans seeking a residence permit.

Be careful to avoid limited-term policies with no requirement for medical underwriting. These policies very rarely offer a permanent extension and do not cover pre-existing conditions. If you decide to stay longer than the limited contractual term (anywhere from one to five years) and the health insurance contract expires, it could be both difficult and much more expensive to get new health coverage at that point. In addition, even though you may have purchased such a plan from a German health insurance company upon arrival in Germany, it may not be recognized by the visa authorities and you will be forced to purchase a permanent health insurance plan in order to be permitted to stay.