How does health insurance work

Health insurance in Germany

Most statutory health insurance benefits are stipulated throughout the system and defined accordingly. The so-called service catalog of the health insurers includes treatment by the family doctor, specialist or psychotherapist, in hospital and, under certain conditions, in rehabilitation facilities. These so-called standard benefits also include preventive and early diagnosis examinations, necessary vaccinations (no travel vaccinations) and medical care during pregnancy and around the birth.

Prescription drugs are paid for with a few exceptions. So-called remedies such as or and medical aids such as prostheses or hearing aids are paid for by the health insurance companies if they are medically justified and have been prescribed by a doctor. Aids must also be included in the so-called list of resources. A legally stipulated additional payment must be made for these services. For prescribed medication, it is between five and ten euros, depending on the price. Children and young people up to the age of 18 are exempt from additional payments.

The standard benefits also include dental check-ups and dental, gum and orthodontic treatments. The statutory health insurances pay a fixed allowance for dentures. Before starting a dental prosthesis, the dentist draws up a treatment and cost plan that must be submitted to the health insurance company. On this basis, the health insurance company decides which costs to cover. After that, it is easier to estimate how high the proportion is that you have to bear yourself.

Any additional requests, such as a single room in the hospital, treatment by the head physician or special dental treatments, must be paid for by yourself. Additional private insurance can be taken out for some of these special services.

Since the reimbursement regulations for some services are not the same for all health insurance companies, it is worth asking in advance if in doubt.

Except for additional and partial payments, the following applies: All services contained in the GKV catalog are usually settled by the service providers directly with the health insurer - that is, you do not have to worry about payment.