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Choosing The Right Health Insurance

Choosing The Right Health Insurance

What are the features of the statutory health insurance?

Health insurance reimburses the costs (full or partial) for prevention, early detection and treatment in case of illness and maternity for the insured persons. In the United States, there are two types of health insurance: statutory health insurance and private health insurance. The statutory health insurance is allowed to levy income-dependent additional contributions. If the health insurance company levies an additional contribution for the first time or increases it, its members have a special right of termination and can change their health insurance company.

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The statutory health insurance

  • is organized according to the following principles: the principle of benefits in kind, the principle of costs, the principle of self-administration, the principle of solidarity and the principle of subdivided types of funds
  • is the information center for all social matters of the SGB (German Social Code)
  • handles the reporting of social data and the collection of total social security contributions
  • decides on compulsory insurance and the amount of contributions to be paid into the social security system
  • reimburses employer's expenses for continued payment of wages to smaller companies, if applicable
  • is subject to freedom of choice with regard to the choice of health insurance fund.

Compulsory health insurance

  • exists for all employees
  • recipients of income in lieu of income (ALG I, II; pension, sick pay, students)
  • certain family members of compulsorily insured persons (family insurance).
  • According to § 6 SGB V, the following are exempt from insurance and therefore not compulsorily insured
  • All employees whose annual remuneration exceeds the annual income threshold. These persons have the possibility to insure themselves voluntarily in the statutory health insurance.
  • Civil servants, self-employed and marginally employed persons

a. o.

Health fund:

The members' contributions are passed on to the health fund via the health insurance funds. This distributes the contribution income to the individual health insurance funds in the form of allocations. The amount of the allocation is based mainly on the age and morbidity (state of illness) of those insured by a health insurance fund. The previously existing parity financing between employer and employee was abolished with the introduction of a special contribution.

Additional contributions:

Health insurance funds are allowed to levy additional contributions based on income. If the health insurance fund levies an additional contribution for the first time or increases it, its members have a special right of termination and can change their health insurance fund. In addition to allocations from the health fund, the additional contributions serve to finance the expenditures of the statutory health insurance funds.

Co-payments:

Insured persons have to make co-payments in certain areas for the use of health services: the co-payment in hospital (€10 per day for a maximum of 28 days) and the co-payment for prescription drugs. Since 01.01.2013, the practice fee has been eliminated without replacement.

Citizen Relief Act:

  • Contributions to health insurance paid by the insured can be deducted from the tax base without limit as special expenses.
  • Men and women only have to pay uniform contributions for health insurance (so-called unisex rates for new customers; cf. ECJ).

Tasks:

  • Benefits for disease prevention (education, counseling, early detection).
  • Sickness benefits (medical/dental care, home health care, provision of medicines and medical aids)
  • Maternity benefits (pregnancy, termination of pregnancy, maternity assistance)
  • rehabilitation services following illness
  • Children's examinations for early detection.

Compulsory health insurance applies

For many people in Germany, there is an obligation to take out health insurance so that everyone can receive medical care in the event of an emergency.

These include, for example: trainees, craftsmen, artists, people with disabilities and most employees. Most of these people are insured under the statutory health insurance system. Each of these insured persons has his or her own insurance card, which is scanned, for example, when visiting the doctor.

Some have a choice

Self-employed people, for example - that is, people who have a company of their own - can choose whether they want to be in the statutory health insurance or prefer to opt for private health insurance.

Sometimes the amount that has to be paid for private health insurance is quite high. But if self-employed people can't pay their premiums more often, they lose their health insurance coverage.

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More people without health insurance

This is exactly what has happened to more and more people in recent years. In 2015, about 79,000 people already had no health insurance. Now there are almost twice as many: 143,000 people.
In addition to self-employed people who can no longer pay their premiums, people living on the street often have no health insurance coverage.
Politicians are now considering how they can be helped better in the future than before.

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