Social security

Social security in Germany

The social network in the Federal Republic of Germany is one of the most powerful social systems in the world. Together with public services and the public welfare system, social insurance plays a major role in this network. Over 90 percent of the German population is covered by social insurance and is thus protected from life risks that can affect any of us.

The five branches of the social insurance

  • Statutory health insurance supports maintenance and restoration of good health
    and eases the consequences of illness.
  • Statutory accident insurance helps an employee regain his earning ability after
    a work-related accident. 
  • Statutory care insurance provides long-term financial support for those dependent
    on permanent care. 
  • Statutory pension insurance insures members in old age by paying them a monthly
    pension as well as in case of reduced capacity for work or incapacity for work.
    Upon an employee’s death, it covers their survivors as well.
  • Statutory unemployment insurance provides financial support in order to insure
    employees' livelihood security in case of unemployment.

Details on the 5 branches of the social insurance

The health insurance

Health insurance coverage is compulsory for all international scientists during their stay in Germany. The health insurance must be valid for Germany. The Foreigner’s Authority requires proof of a sufficient health insurance coverage as a prerequisite for issuing the residence permit.  Please note that the health insurance coverage must be valid from the first day of your stay in Germany.

If you are travelling to Germany for a short term research visit with a Schengen visa (up to 90 days), a travel health insurance for all Schengen countries with a coverage of at least 30,000 EUR is usually required. For long-term stays requiring a residence permit, you need full health insurance coverage that must match the scope of benefits provided by the statutory health insurance. Should you need a residence permit in Germany, a German health insurance coverage is mandatory.

All statutory health insurance companies charge, in principle, a uniform contribution rate.  Statutory health insurance companies differ as regards the medical services they offer and may require an extra premium in addition to the regular contribution rate.

Statutory health insurance companies are, among others, the following:

•    AOK Bayern (website content only in German, but international telephone
      counselling is available)
•    SBK  München (website  content only in German, but international telephone
      counselling is available)
•    DAK München (website content and telephone counselling are available in English) 
•    Techniker Krankenkasse (website content and telephone counselling are available in English)

You have concluded an employment contract with the Helmholtz Zentrum München

In this case, the public health insurance coverage is compulsory for you. You are free to choose your public health insurance provider. If you do not choose a public health insurance, you will automatically be insured with the AOK. In the event that your annual gross income is higher than the compulsory insurance threshold (2018: 59.400 EUR), there is no obligation for you to take up a public health insurance coverage. You can purchase a private health insurance policy or enrol in a voluntary health insurance scheme of your choice.

All private health insurance providers carry out an individual risk assessment.  The assessment comprises detailed enquiries into the state of health of the person concerned and into pre-existing conditions. Applicants must provide information on the treatments carried out over the past three to ten years. If it turns out that the pre-existing conditions cannot be insured at normal conditions, the private health insurance (PHI) will make strides in offering health coverage upon charging an extra premium. Depending on the type and stage of the disease, the extra premium can increase the costs of the insurance by 5 to 50 percent.

Public health insurance provider: https://www.krankenkassen.de/ 
(website content only in German)
Private health insurance provider: https://www.1averbraucherportal.de/versicherung/private-krankenversicherung/liste
Compare private/public: https://www.test.de/Krankenversicherung-Privat-oder-gesetzlich-Der-Vergleich-4201674-0/  (website content only in German)

You have a scholarship or funding from your home country and are insured in your home country

You must prove that your health insurance offers the same coverage as the German statutory health insurance. Normally, it is rather difficult to provide this evidence. We would, therefore, urgently recommend that you acquire a German private health insurance with adequate coverage in any case. Under certain circumstances, you can also apply for a German statutory health insurance.

You have a scholarship or funding from your home country and are not adequately insured in your home country

You must take out an adequate private health insurance in Germany. Normally, a voluntary health insurance with a statutory health insurer is not possible.  We will gladly inform you about existing exceptions.

You are a national of an EU member state

In 2004, the EURpean Health Insurance Card (EHIC) was introduced in the EU member states.  It is issued by the national insurance institutions in your home country. The EURpean Health Insurance Card can be used in other EU member states during a tourist stay in order to consult a panel doctor in the event of sickness or in case you need to be rushed into the accident and emergency department of a hospital. Please note that for a long-term stay in other EU member states, the EHIC is not suitable. Please clarify with your local insurance company the extent to which they pick up the costs of treatment during your stay in Germany. Foreign health insurance companies do not always cover you for treatments carried out in Germany.

Private health insurance

What you need to know

If you apply for a private health insurance or a supplementary insurance policy, you must provide thorough information on the state of your health and answer all the questions about your medical history correctly, otherwise the insurance provider is entitled to withdraw from the contract. This is particularly the case, when an unspecified pre-existing condition is directly related to a disease recurrence. In the case of certain pre-existing conditions, health insurance companies may require medical records, an additional premium or exclusion of benefits.  If you wish to switch to another health insurance provider, you should await the confirmation of your application for health insurance coverage by the new provider before cancelling the existing insurance policy.

Before buying a health insurance policy, you should compare the prices and the benefits of the health insurance companies. Even if one saves 20 EUR per year, the health insurance usually lasts a lifetime. At an insurance duration of 50 years, a difference of 20 EUR per year could result in cost savings of around 1,000 EUR. (Link to the free of charge comparison of insurance companies:  http://www.wissen-private-krankenversicherung.de/anbieter-vergleichen). Make arrangements for a comprehensive health insurance for outpatient treatments. Taking out a plan with an excess payment, could save you a lot of money.   The higher the agreed excess payment, the cheaper the premium will be. (For example: for a man of 33 years of age, the costs of the health insurance coverage can be reduced by about 60-80 per cent at an assumed excess payment of 600 EUR!).  If you have an excess payment on your policy, you must cover all treatment costs incurred within one calendar year yourself until the amount of the excess has been reached.  All costs that exceed the excess payment shall be covered by the health insurance.

When taking out a private health insurance policy, you should be aware of the waiting periods of the policy you purchase. Unlike the statutory health insurance, the private health insurance companies typically impose an initial waiting period of up to 3 months after the start of the new policy. Within this period, there is no insurance cover, even if you have already paid the premiums during this period! However, this does not apply to accident-related treatments. A waiting period of up to 8 months is applied, however, to childbirth, psychotherapy, dental and orthodontic as well as dental prosthetic treatments. On request, the waiting period can be waived if you undergo a medical examination at your expense. In any case, you should clarify this point with your new health insurance provider and ask them to provide precise information relating to the medical examinations required. 

All private health insurance providers carry out specific risk assessment for persons with pre-existing conditions. The assessment comprises detailed enquiries into the state of health of the person concerned including pre-existing conditions. Applicants must provide information on the treatments they underwent over the past three to ten years. If it turns out that the pre-existing conditions cannot be insured at normal conditions, the private health insurance provider (PHI) will make strides in offering health coverage upon charging an extra premium. Depending on the type and stage of the disease, the extra premium can increase the costs of the insurance by 5 to 50 percent.

If the new insurance policy begins on the day immediately following the end of the previous insurance, the waiting period may be waived as regards the base rate or it can be credited. However, the previous insurance policy must have remained continuously in force for at least 3 months.

Before buying a private health insurance policy, you should seek advice and consider the need to know exactly what services and benefits are covered at the prices quoted. Furthermore, we recommend that you obtain quotes from different private health insurance companies in order to compare their benefits and costs.

Link with check lists to a) useful to b) supplementary benefits:

https://www.1averbraucherportal.de/versicherung/private-krankenversicherung/leistungen

What kind of problems might arise?

Basically none.  Persons who are insured in the German statutory health insurance scheme and whose annual income exceeds the threshold for compulsory state health insurance (general annual income threshold in 2016 [planned]: 56,250 EUR) can switch from statutory to private health insurance (PHI) on their own request.

The decision to switch from statutory to private health insurance can have serious consequences 

Admission to a private health insurance depends on the state of health of the person concerned and their pre-existing conditions.  In comparison with the statutory health insurance, private health insurance companies charge individual premiums for each family member. Uniform tariffs, such as in the public health insurance are not available in the private health insurance. Other problem areas:

•    Waiting periods until the start of the insurance coverage
•    The insurance company does not pay child sickness benefits 
•    Premium increases (there is no legal limit relating to premium increases)
•    Exclusion of medical benefits and reduction of the reimbursement on the claims submitted by the policyholder are possible

The switch to private health insurance is often a decision for a lifetime

Self-employed persons are not eligible to out of the private health insurance and join the statutory health insurance scheme. Employees can switch back to the statutory health insurance if their gross annual income does not exceed the gross annual income threshold for compulsory health insurance and if they are not older than 55.
According to § 6(3a) SGB 5, a transfer from the private health insurance into the statutory health insurance is no longer possible for people who
completed the age of 55.

Accident insurance

Within the German healthcare system, the accident insurance covers the consequences of an accident, i.e. both the acute injuries representing a medical emergency and the longer-term injuries in the form of a light or heavy disability, as well as those resulting in death. The accident insurance only covers damages caused to the person insured and those caused to the co-insured persons. 

Accident insurances generally cover the medical costs (first aid, medical treatment and rehabilitation), accident related costs such as emergency ambulance services, as well as longer-term follow-up costs, such as payments for a permanent physical impairment (in terms of compensation for pain and suffering), welfare aids such as transitional allowances in the initial phase after the accident, care and support needs (care allowances) or occupational redeployment in case of occupational-related disability, and even  invalidity pensions and death benefits for surviving dependants. Both within the statutory accident insurance as well as the private insurance systems, the exact scope of the benefits depends on the terms of the insurance policy.

A particular situation may arise when dealing with the consequences of a self-inflicted traffic accident that are not covered by a liability insurance. Depending on the circumstances and the terms of the insurance policy, this can lead to claims for compensation by the accident insurance company. As a rule, the costs of workplace accidents are paid by the competent employers' liability insurance association (funding of the employers' liability insurance association is provided exclusively by the employer).

Retirement pension insurance

During your employment, compulsory contributions are normally withheld at source from salaries under the pay-as-you-earn (PAYE) system and paid by the employer to the competent pension fund. The statutory pension insurance institution in Germany is the German Pension Fund. The statutory pension insurance is a branch of the structured social security system, which is predominantly designed to provide employees financial security in old-age.

Conditions for receipt of a pension

Further information on the payment of pensions can be found at the following links of the German Federal Pension Insurance (for example on the fulfilment of the required waiting period, which implies an entire employment relationship of up to 5 years): http://www.deutsche-rentenversicherung.de/Bund/de/Navigation/0_Home/home_node.html

Federal and State Government Employees Retirement Fund

The Helmholtz Zentrum München offers its employees the opportunity to participate in an occupational pension scheme in addition to the statutory pension insurance. This additional pension scheme is provided by the Federal and State Government Employees Retirement Fund (VBL), and employees can participate by paying their own contributions.

Details on specific features concerning scientists are given in the contract documentation that is handed over to them by their local human resources manager. More information about occupational pensions can be found at:  https://www.vbl.de/

Statutory long-term care insurance

The nursing care insurance belongs to the group of social insurances and covers the risk of nursing care needs. If the need for nursing care arises, the insurance provides money or benefits in kind in order to ensure the necessary care entirely or partially. The benefits are generally designed to cover care of the person concerned both in the home and in special centres.

Unemployment insurance

The unemployment insurance is a compulsory insurance. The insurance covers all persons who are in an employment relationship involving non-minor employment. This applies equally to all employees as well as to trainees. It is financed by employees and employers who co-share the costs.  In the event of unemployment, the Federal Employment Agency pays under certain conditions (completion of the vesting period) an unemployment benefit for a maximum length of 24 months (depending on age and length of employment). The application forms and further information can be found at: https://www.arbeitsagentur.de/

Recommendation

•    Third party liability insurance

In Germany, each person can be held responsible for damages caused to third parties (for example consequences of self-inflicted accidents). It is therefore common practice to take out a private (family) liability insurance in order to protect oneself against the risk of claims for damage or other loss...

•    Private accident insurance

In the event of an accident, a private accident insurance pays the policyholder for the co-insured persons under the terms of the policy a lump sum and/or an accident annuity. This type of insurance must be distinguished from the social compensation  law (for example the SGB IX), the statutory occupational accident insurance (which compensates the insured person for work and commuting accidents as well as occupational diseases) and from the liability insurances which cover damages resulting from an accident to third parties.

These different types of insurances stand independently side by side, which is why their benefits may not be netted out against each other. Unlike the statutory accident insurance, the private accident insurance covers all accidents worldwide and around the clock, unless otherwise agreed.

Employed persons with an employment contract are automatically insured against occupational and commuting accidents through the competent employers' liability insurance association (for travelling to work or coming home from work). For accidents that may occur outside working hours, a private accident insurance policy can be purchased in addition to the statutory accident insurance.

In contrast to the liability insurance which deals with the coverage of damages to third parties that can be concretely calculated and for which the policyholder is responsible, the private accident insurance is an agreed value insurance that previously defines the damage to be compensated by using abstract criteria.  The core benefit of the accident insurance is to provide financial security in the event of a permanent impairment of the physical or mental performance as a consequence of an accident (invalidity). Financial protection is usually provided in the form of a lump sum or of a lifetime annuity. It can be ensured through a progression agreement that the amount of disability allowance increases disproportionately with rising levels of disability.

Source

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