THE GERMAN HEALTHCARE SYSTEM….
Germany’s state healthcare system dates back to the 1880s, making it the oldest in Europe; today its doctors, specialists and facilities make it of one the very best in the world. The German healthcare service is funded by a statutory contribution system ensuring free healthcare for all, which means that everyone in Germany has to have health insurance.
The majority of people register with a statutory health insurance fund (Gesetzliche Krankenversicherung or GKV), sometimes called a ‘sickness fund’, which is compulsory for everyone who earns less than EUR 53,550 a year (2014). Insurance payments are based on a percentage of your income and shared between you and your employer and deducted at source or from your bank.
Higher earners and some others can opt out of the state scheme altogether and take out private health insurance (Private Krankenversicherung or PKV) covering all their health needs. You can also take out private health insurance to top up GKV cover.
Do foreign insurance covers apply? If you have a foreign health insurance policy you may be asked to pay in cash at the end of your treatment or visit. If you are from the EU/EEA or Switzerland and staying only temporarily, you may use your EHIC card; once you become a permanent resident you have to take out health insurance.
The Government health insurance scheme (GKV):
If you are an employee and you earn less than EUR 53,550 a year (EUR 4,463 a month) (2014) you have to take part in the government health scheme – Gesetzliche Krankenversicherun or GKV – taking out health insurance as soon as you’ve signed your work contract.
The scheme is administered by around 130 Krankenkassen, non-profit making associations who must all charge the same basic rate of 15.5 percent of your eligible gross salary to a maximum of EUR 4,050 a month (2014). You don’t pay more than this even if your income is higher. This amount is shared roughly equally between you and your employer. You have to stay with a particular Krankenkasse for 18 months, after which time you can switch to another government scheme.
GKV covers you for primary care with registered doctors, hospital care (both in- and out- patient) and basic dental treatment. Non-working dependents living at the same address and registered with the Krankenkasse are covered at no extra cost.
GKV does not cover consultations with private doctors, private rooms in hospitals, alternative or complementary treatments, dental implants or glasses/contact lenses for adults.
You can register with any of 130 Krankenkassen. Some, like AOK, BEK and DAK have millions of members; others have only a few thousand. They must all adhere to government rules on the minimum cover they offer. Employers usually organise this but you can do it yourself. Check out the rates offered by different state insurers here.
You and your dependents must also become members of the government long-term nursing care scheme (Pflegepflichtversicherung), which covers some of the cost of personal care should you become disabled. This presently costs just over 2 percent of your gross salary (2014) (maximum approximately EUR 93 per month if you have no children) of which your employer pays half.
Private health insurance:
You can choose to opt out of the state insurance plan and take out private health insurance cover (Private Krankenversicherung or PKV) if you are: an employee earning more than EUR 53,550 (2014); self-employed; working part-time and earning less than EUR 450 a month (2014); a freelance professional; an artist; a civil servant or certain other public employee.
PKV usually covers a much wider range of medical and dental treatments the GKV. Companies offer different levels of cover, premiums depend on age at entry into the scheme and any pre-existing conditions and cover is usually per person rather than per family as with the government insurance schemes. Part of medical insurance premiums is tax-deductible.
How to register:
If you live in Germany long-term or will be working in Germany, you must register with the German authorities at your local town hall (Einwohnermeldeamt). Once you are registered, have a social insurance number (Sozialversicherungsnummer) and you’re making national insurance contributions, you are entitled to state-run healthcare the same as German nationals. In order to access this, you also have to register with a health insurance fund. See rates offered by different state insurers here. A non-working spouse and children are covered by the same insurance.
Your insurer will give you a health insurance card (Krankenversichertenkarte), which you have to take with you each time you visit any doctor, dentist or specialist. As from January 1, 2014 an electronic eHealth card with a photo of the holder (unless under 15) is proof of entitlement to medical services and benefits. The card, which contains your name, date of birth and address, health insurance data, is scanned when you visit a medical service.
EU/EEA and Swiss citizens: European Health Insurance Card (EHIC)
If you already have an European Health Insurance Card (EHIC) you can get free medical treatment in Germany while you are in the country temporarily. The patient contribution (or co-payment) is not reimbursable. Once you take up permanent residence and/or employment you are no longer covered by the EHIC and must take out a German health insurance scheme and get a Krankenversicherungskarte (health insurance card).
If you don’t have an EHIC and are not paying German national insurance you must take out private health insurance – or pay the fill costs for any medical costs you incur.
Going to the doctor:
Doctors are called Ärzte; a Hausärzt is the equivalent of a GP or primary care doctor. You are free to choose your own doctor. Many speak at least basic English. Some doctors only treat private patients so if you have state insurance make sure check beforehand otherwise you will have to pay for treatment. Doctors who treat patients as part of the statutory health scheme must be registered with the Association of Statutory Health Insurance Physicians or Kassenärztliche Vereinigung. Look for a sign in the surgery saying Kassenarzt or Alle Kassen.
You can find a doctor through a personal recommendation, your embassy, the Gelbe Seiten (yellow pages), on the Weisse Liste (in German) or on this online English language directory.
Practice hours are usually from 8am to 1pm then from 3pm to 6pm from Monday to Friday; many are closed on a Wednesday afternoon. Few practices are open on Saturdays and only emergency services operate on Sundays. Some doctors have an ‘open door’ policy where you can just turn up at the surgery but be prepared for a long wait. Others operate an appointment system, so you’ll need to phone the practice beforehand. If it’s urgent then you will be given an appointment immediately or on the same day; if it’s not you may have to wait for a few days or even weeks.
Don’t forget to take along your health insurance card to your appointment.
If you have state insurance, the practice will send the bill direct to your insurer; if you have private insurance you will pay upfront and be reimbursed by your insurance company later. Everyone has to pay a EUR 10 fee (2014) in cash for your first visit every quarter (private patients can reclaim this).
Hospitals in Germany:
Hospitals are called Krankenhäuser. There are three main types: public hospitals (Öffentliche Krankenhäuser) which are run by the local and regional authorities; voluntary, non-profiting making hospitals (Frei gemeinnützige Krankenhäuser) run by churches or organisations run by the German Red Cross; private hospitals (Privatkrankenhäuser).
You will need to be referred to a specialist in a hospital by your GP. You should take your EHIC or German health insurance card when you visit. You have to pay a fixed charge of EUR 10 per day (2014) up to a maximum of 28 days in a year. If you are under 18 years old you do not have to pay.
If you’re going to be an in-patient, note that hospitals have a certain amount of space allotted to patients with public insurance and for those with private insurance. If you have a ‘private’ room it means private insurance rather than room for your use only; these private rooms are generally used for two patients who are separated by a curtain. Take your own soap and personal items.
Pharmacies in Germany: Pharmacy opening hours
Pharmacies (Apotheke) are open 09.00 to 18.00 Monday to Friday and 09.00 to 12.00 Saturday. They all provide addresses for services outside of opening hours.
Medication does not come with dosage instructions on the package. Make sure you ask your doctor when and how much you should take and write down the information so you have it later. Sometimes your pharmacist will also be able to tell you about dosages but they are less likely to speak English so if your German is not good, make sure you get all the information you need from your doctor.
Check here for information about local on-call pharmacies.
Prescription medication is sold in Germany by company name, not by the active ingredients in them (as they are in the US, for example). Doctors may prescribe the most expensive medication, so ask if there is a cheaper medicine available with the active ingredients you need.
You can take a prescription from your GP to any pharmacy. If the prescription is on a pink slip of paper, you will have to pay a non-refundable fixed charge of EUR 5 per item (2014). You have to pay the full cost for certain medications for minor ailments like cough mixture.
If you have private insurance, you will most often get prescriptions on a blue sheet of paper, which means you have to pay the full price of the drug up front and then send the receipt to your insurance for reimbursement.
Visiting the dentist in Germany:
You can find a dentist (zahnärzte) who operates within the statutory health insurance scheme on the KZBV website (in German). Or when you visit a dentist look for a sign saying Kassenarzt or Alle Kassen which means that the dentist operates under the state health system. Children and young people up to the age of 18 do not pay for dental treatment.
Check with your insurer about what is and isn’t covered as the state insurance has limited cover and even private insurers won’t fully reimburse for all treatments – and dental costs in Germany are extremely high.
Pregnancy and birth in Germany:
The ‘morning-after pill’ or RU487, is widely available in Germany (weekdays you can get a prescription from a gynaecologist and at weekends through a hospital), although some Catholic hospitals won’t administer it. Go to the A&E or ER in the first instance.
Pregnancy tests (Schwangerschaftstest or B Test) are available in pharmacies (Apotheke), but you have to ask for them at the counter.
If you’re pregnant, visit a gynaecologist (Frauenarzt/Frauenaerztin) or doctor to confirm the pregnancy. After the initial consultation you’ll be given a Mutterpass which records all the medical procedures and your state of health throughout your pregnancy. You’ll need to inform your health insurer of the pregnancy: statutory insurers will cover all the costs of the maternity and birth while private insurers may not, so check.
For more information on pregnancy and birth in Germany see our guide to having a baby in Germany.
In an emergency:
For urgent medical treatment, go to the A&E or ER which are called Notaufnahme. Emergency services are covered by both state and private health insurance. If you need an ambulance call the pan-European number 112 free of charge. The fire brigade ambulance service (Rettungswagen) will take you to the nearest hospital. Call 19 242 to find an emergency doctor, 116 117 for a non-emergency doctor on call, or phone your surgery for details of their out of hours service.
I need an ambulance – Ich brauche einen Krankenwagen.
Heart attack – Herzinfarkt.
I need a doctor – Ich brauche einen Arzt.
I need a hospital – Ich brauche ein Krankenhaus.
There’s been an accident – Es gab einen Unfall.
I am allergic to… – Ich bin alergisch gegen…
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