来个英文版本的Health Insurance Options

aij

Health Insurance Options. Germany has one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. The health insurance reform 2007 will require everyone living in Germany to be insured for at least hospital and out-patient medical treatment by 2009.The options available to you for health insurance while living in Germany are the government-regulated public health insurance system, private health insurance from a German or international insurance company or a combination of the two.
Government Health System
Most German residents are members of the government health system (Gesetzliche Krankenversicherung or GKV). If your gross annual salary is below 47,700 Euros per year or 3,975 Euros per month, membership in the GKV is mandatory. The total cost of government health insurance is currently approx. 15% of your gross salary up to a maximum monthly income of 3,563 Euros. If you earn more than this amount your insurance premium remains constant. Your employer will normally pay slightly less than half of the monthly premium.
GKV benefits include in-patient (hospital) care as a ward patient with doctor on duty at your nearest hospital, out-patient care with registered doctors (Kassenärzte) and basic dental care. Your non-working dependents resident at your address in Germany are included in your insurance at no additional cost.
Members of the GKV will join one of the 250 "Krankenkassen in Germany (non-profit associations administrating the government health scheme). The health insurance funds adhere to established government regulations on what they offer.
You and your dependents are automatically enrolled in the government long-term nursing care scheme (Pflegeversicherung). This presently costs 1.7% of your gross salary (a maximum of approx. 60 Euros per month) of which your employer pays half.
For those seeking to upgrade their medical coverage, for instance the right to consult a private doctor, to homeopathic remedies, a private room in hospital and higher dental reimbursements, supplemental insurance coverage is available which can top up the government system benefits.
Private Medical Insurance
You may opt for private health insurance (Private Krankenversicherung or PKV) instead of joining the government health plan if you can show that your gross annual salary has been more than 47,700 Euros per year for the past three years. If you cannot or do not, you will automatically be registered as a voluntary member of the government system and will not be able to change to a private insurance plan until you have been a member of the government system for 3 years. It is important to take this decision at the outset when or before arriving in Germany, to avoid being forced into the government system by default.
Generally, private health plans cover a wide choice of medical and dental treatment and provide broad geographical coverage. Private patients generate higher earnings for medical professionals and will usually be treated by senior doctors. A private patient can also request and will often get, doctors who speak their native language.
The cost of full medical insurance is based on the benefits chosen, as well as on the age, gender and any pre-existing conditions of the insured. You can reduce the monthly cost of your private insurance by agreeing to a deductible. Please be aware that private insurance premiums are based on the insured individual and do not automatically include your dependents who will be covered under your policy at their own individual rates. Limited term (often 5 year) policies will often refuse to continue their cover at maturity if you have claimed under your policy; thereby leaving you to find new cover at potentially very disadvantageous rates.
By purchasing a private medical insurance plan from a German health insurance company that provides a certificate recognized by the German government (Arbeitgeberbescheinigung) you take advantage of the same employer subsidies as a government plan member.
Please note that everyone, whether state or privately insured, must pay into the government long-term nursing care scheme.
Sick Pay Insurance
Should you fall ill while in Germany, your employer will usually pay your full salary for the first six weeks. After that, either the government scheme health insurer or your private insurer will provide a measure of income replacement. The government scheme will pay a percentage of your income up to a maximum of approximately 2,160 Euros per month as statutory sick pay for up to 78 weeks. If you are earning more than this per month, it would be worth considering the purchase of supplemental sick pay insurance, which is available at reasonable rates. Privately insured individuals can purchase cover for their entire net salary.
Dental Care
In Germany, dental care can be expensive. For major dental work involving bridges, crowns or orthodontics, you must get a cost estimate and present it to your insurer prior to treatment. The reimbursement amounts in the GKV are calculated based on a fixed price depending on the case and you can expect to pay between 30% and 80% out-of-pocket for dental work under the government system and do not have supplemental dental insurance. Private insurance companies offer a wide variety of dental tariffs to meet individual needs.
Pharmacies
Germany has an extensive network of pharmacies. The statutory national health insurance generally provides reimbursement for prescription generic drugs, though with a co-payment, the scale of which depends on the cost of the medication. Prescription drugs for children have no co-payments. If you are privately insured, brand-name medication will be covered, as long as you have a prescription. You will have to pay the full cost of the prescription medicine at the pharmacy and then submit the bills to your insurer for reimbursement.

aij

Health Insurance Options in Germany - 2007
Germany has a reputation for having one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. Approximately 85% of the population are mandatory or voluntary members of the public health scheme while the others usually have private health insurance. The health insurance reform of 2007 now requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment. There will supposedly be more competition between the various insurance providers but to change between the two systems will be made more difficult than before.
The costs of the German health care system are immense and rising due to demographics as well as long-term unemployment rates. Recent government reforms have attempted to make hospitals more competitive and thereby reduce costs for the state health insurance providers (Gesetzliche Krankenversicherung or GKV). Reduced benefits for dental work, increased out-of-pocket payments for those seeking treatment and an additional 0.9% insurance premium above and beyond the 13 % to 14% of regular income to be borne by the member alone were measures introduced in 2005. Efforts to cut the social security cost for employers and reduce the monthly cost for state health insurance members were controversial and after a very long and drawn out political battle, a further health reform compromise has been reached which goes into effect in 2007.

You have three options for health insurance while living in Germany; the government-regulated public health insurance system, private health insurance from a German or international insurance company or a combination of the two. You can opt for full private plans if your income is above a certain threshold or if you are self-employed. Finding the lowest rates for state health insurance coverage or finding the most suitable coverage from a private provider at a competitive rate is not always easy but it is well worth the effort. As people have different requirements or expectations from health insurance it is important to understand the system in order to filter out the most suitable plan while living in Germany.

Government Health System
Most German residents (approx. 70 Million people) are members of the government health system. If your gross salary is below 47,700 Euros per year or 3,975 Euros per month, then membership in the GKV is mandatory. This income threshold changes from year to year, so you may need to check with your HR department for updated figures.

The cost of government health insurance is currently approx. 15 % (the rates depend on the provider "Krankenkasse" you choose) of your eligible gross salary to a maximum monthly income of 3,563 Euros. If you earn more than this you do not pay a higher insurance premium.

Assuming you pay a monthly premium of 506 Euros as an employee earning at or above the threshold and are therefore a voluntary member, your contribution is approx. 269 Euros and your employer pays approx. 237 Euros. The benefits include in-patient (hospital) care as a ward patient with doctor on duty at your nearest hospital, out-patient care with registered doctors (Kassenärzte) and basic dental care. Please note that there is generally no coverage for private doctors or surgeons, a private room in hospital, alternative/homeopathic medical care, dental implants, vision products for adults or benefits outside of Europe. Your non-working dependents living at your address in Germany are presently insured at no additional cost and are simply to be registered with the "Krankenkasse".

If you choose to join the German government system, you can request your human resources department to register you either with the public national health insurance provider you have chosen yourself or the one they generally use. There are presently about 250 "Krankenkassen" in Germany which are non-profit associations administrating the government health scheme. Some (for instance AOK, BEK, DAK) are very large with millions of members and others (often called BKKs) 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. A Tip: Claims handling, local convenience and perhaps special programs could be different, but if you ask about the possibility of communicating in the English language you are likely to be disappointed, though a limited number offer English speakers.

You and your dependents must also become members of the government long-term nursing care scheme (Pflegeversicherung). This covers some of the cost of meeting personal nursing needs, such as feeding and bathing for those who become substantially disabled. This presently costs 1.7% of your gross salary (maximum of approx. 60 Euros per month) and your employer pays half. The current coalition government has announced that the premiums will have to increase in 2008.

You can switch government health fund providers by giving two months notice if the premiums are increased. The general minimum period of membership is 18 months.

If you would like supplemental insurance coverage to top up the government system benefits, you can purchase a supplemental policy from any private insurance company; for instance if you would like a private doctor and a private room in hospital, homeopathy and other alternative treatment or higher dental reimbursements. Emergency evacuation from places outside Germany and travel insurance should also be considered as these are not paid for by the state health insurance plan and their cost is low.

Public health insurance funds have recently begun to offer supplemental insurance plans from a particular provider, offering a group rebate. Please be aware that you would then be committed to them for three years and could not cancel even if premiums are increased. Such tied plans are largely unnecessary as you have a wider choice of benefits on the private health insurance market.

Private Medical Insurance
You may choose to purchase private health insurance (Private Krankenversicherung or PKV) instead of joining the government health plan if your gross salary is more than 47,700 Euros per year. Self-employed persons, German civil servants and those persons working part-time and earning less than 400 Euros per month are also eligible.

Please note: If you are an employee you must also prove that you earned more than the threshold amount of income in the past 3 calendar years. If not, you will automatically be registered as a voluntary member of the government system and will not be able to change to a private insurance plan until you have been here for 3 years. This is the result of the newest health insurance reform and is supposed to force those people earning higher incomes to remain in the government system for a longer period of time. If on arrival in Germany you wish to be privately insured, you will need to inform your company's human resources department promptly to avoid possible confusion, otherwise, you may find yourself automatically registered in the government system.

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 invoices are also higher than for government patients. The hospitals and doctors depend to a certain extent on private patients to supplement their incomes and tend to welcome them. A private patient can also request and will often get doctors who speak their native language. The private medical insurance market is well served by about 50 German insurance companies, and there are premium/benefit combinations available to suit most budgets. The per person cost of full medical insurance is based on the benefits chosen, as well as on age, gender and any pre-existing conditions that those persons to be covered may have had.

Please note: 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. 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 at retirement.

Be careful to avoid limited-term policies with no requirement for medical underwriting. These policies do not usually offer an 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 contract expires, it could be both difficult and much more expensive to get new health coverage at that point.

If you purchase a private medical insurance plan from a German health insurance company that provides a certificate recognized by the German government (Arbeitgeberbescheinigung) you may take advantage of the same employer subsidies as a government plan member. If such certification is not provided, your employer has the option, but is under no obligation, to compensate you for part of the cost of your medical insurance.

aij

If you are self-employed and already covered by an international insurer, you should check to make sure your coverage is suitable for living in Germany. If you would like to keep the insurance please note that you must in any event still pay into the government long-term nursing care scheme (Pflegeversicherung) and may also wish to purchase supplemental sick pay insurance. This may be difficult to do as the German insurers are not particularly keen on insuring self-employed foreigners. As the cost of your health insurance is normally tax deductible it is not worth skimping on it.

Another measure of the health reform bill of 2007 is that all self-employed persons must be insured by July 1, 2007 and can purchase private health insurance if they were previously privately or even uninsured. The private health insurance companies will be forced to accept all applicants, irrespective of their health situation, in their "Basistarif" which will be available by January 1, 2009. It will offer similar benefits to the government system and the cost is capped. This is to fulfil the requirement that all persons living in Germany must be insured.


Sick Pay Insurance
Should you fall ill while in Germany, your employer will usually pay six weeks' full salary; after which the government scheme health insurer (Krankenkasse) pays a percentage of your income, up to approximately 2,160 Euros per month as statutory sick pay (Krankengeld) for up to 78 weeks.

If you are earning more than this per month, it would be worth considering the purchase of supplemental sick pay insurance, which is available at reasonable rates. This is particularly important if your fixed living costs are higher than 2,160 Euros. If you purchase private medical insurance, you should also consider purchasing adequate sick pay insurance. Please note that neither sick pay insurance nor the government scheme covers permanent disability and assume that you will be returning to full employment. You should consider purchasing a separate policy for permanent disability and critical illness.

Travel Insurance and Evacuation Benefits
The German public health insurance system will provide you with limited cover for travel within the EU. If you need medical care while travelling to another EU country, you will normally need to take the necessary EU forms with you when you travel. You will be required first to pay the medical costs yourself and then to fill out the necessary EU forms in order to apply for a reimbursement on your return. You will be reimbursed for the amount that the German system would have paid for the treatment - sometimes only a fraction of the actual cost you paid.

If you wish to be covered for the full amount of any medical outlay or plan to travel to non-EU countries, you should purchase a travel insurance policy. The German government health system does not cover medical evacuation from foreign countries. Please note that not all travel insurance policies cover evacuations, so always check the fine print before signing up.

Dental Care
In Germany, dental care can be expensive. For major dental work involving bridges, crowns or orthodontics, you must get a cost estimate and present it to your insurer prior to treatment, otherwise you could be faced with a very high bill to be paid out of your own pocket. If you have doubts about a recommended treatment, get a second opinion. And please watch out: German dentists have a reputation for sometimes suggesting complicated and unnecessary dental work. The reimbursement amounts are calculated based on a fixed price depending on the case and you can expect to pay between 30% and 80% out-of-pocket for dental work if you do not have supplemental dental insurance. The fixed price system uses the absolute minimum standards and does not cover gold, porcelain or other materials. Supplemental dental insurance is worth considering if you would like to avoid surprises.

Pharmacies
Germany has an extensive network of pharmacies (Apotheken), with branches on just about every second corner in town, easily recognized by big red "A". The statutory national health insurance generally provides reimbursement for prescription generic drugs, though with a co-payment, the scale of which depends on the cost of the medication. Prescription drugs for children have no co-payments. If you are privately insured, brand-name medication will be covered, as long as you have a prescription. You will have to pay the full cost of the prescription medicine upfront and then submit the bills to your insurer for reimbursement. However, do not expect to be reimbursed by either the government or private health insurance for over-the-counter remedies.

Also see our article "Insurance: It's the Law" for a complete overview of ALL types of insurance in Germany.

wowo

说的都跟唱的似的

AlterWerther

:top: