About 87 percent of the residents of Germany have statutory health insurance, i.e. GKV. As of May 2005, the GKV relied on 321 non-profit sickness funds to collect premiums from their members and pay health care providers according to negotiated agreements. Those who are not insured this way, mainly civil servants and the self-employed, receive health care through private for-profit insurance.
An estimate of 0,3 percent of the German population (around 250,000 people) has no health insurance at all. Some of them are so rich that they do not need it but most of them are poor and receive health care through social assistance.
Statutory health insurance
There are three different categories of sickness funds: primary funds, substitute funds and “special” funds. Some workers are required to be members of the primary funds, e.g. if they earn less than the than the income ceiling (2006: EUR 3,937.50 per month / EUR 47,250.00 per year). Those earning more than that ceiling may be members on a voluntary basis, or they may have a choice of funds. Some of them automatically become members of a particular fund for example because of their occupation (company-based funds) or place of residence (local sickness funds). Some occupations have their own “special” funds, e.g. farmers or sailors.
Substitute funds are divided into two kinds: they provide health insurance to both white collar workers and blue collar workers earning more than the income ceiling. Membership is voluntary.
Both employers and employees pay half of a member’s premiums, which in 2006 averaged between 13 and 14 percent of a worker’s gross earnings up to the contribution assessment ceiling (2006: EUR 3,562.50 monthly / EUR 42,750.00 p.a.). Premiums are fixed according to earnings rather than risk and are unaffected by the respective member’s marital status, family size, or health. Premiums are the same for all members within a particular fund with the same earnings.
Private health insurance
About eleven percent of Germany’s residents pay for private health insurance provided by some 40 for-profit insurance carriers. Many of those choosing private insurance are civil servants who want to secure the percentage of their medical bills not covered by the government. Some sickness-fund members buy additional private insurance to cover such extras as a private room or a choice of physicians while in a hospital. Otherwise, the medical care provided to the publicly and privately insured is identical. In both cases, the same medical facilities are used. Self-employed persons earning above the income ceiling must have private insurance. Members of a sickness fund who leave it for a private insurance carrier are not allowed to return to public insurance.
As opposed to the statutory health insurance, contributions to the private insurance depend on the member’s age, gender, occupation and health status, that is, the individual risk. Although private insurance companies pay health care providers about twice the amount paid by the primary sickness funds, private insurance is often cheaper than statutory health insurance, especially for younger policyholders without dependents. As is the case for members of sickness funds, employees who have private insurance have half their premiums paid by their employers.