Status: 18.09.2023, 19:50 p.m.
By: Carolin Gehrmann
There are many questions about health insurance. Insured persons often do not know what they are allowed to do in the event of illness. And which could lead to problems.
Bremen – In Germany, it is mandatory to have health insurance. However, there is often a lot of ignorance about one's own health insurance coverage, especially with the statutory health insurance companies. Some myths about sick leave and health insurance persist. In order to get the most out of your own insurance, you should know it.
In Germany, there are two systems side by side, private and statutory health insurance. But is the care really that much better if you are privately insured? Each of the two systems has advantages and disadvantages. And one thing is clear: You can only switch to private health insurance from a certain income limit, the so-called annual earnings limit (JAEG). According to the Federal Ministry of Health, it is currently 66,600 euros – which is comparatively high. This means that private health insurance is often considered the better option with many advantages. Is that really the case?
Myth about health insurance: Is statutory insurance worse than private insurance?
The contribution to private health insurance is based on age, state of health and desired insurance coverage. Due to risk allowances in the event of a pre-existing condition or at an older age, it can become very high. As a rule, you stay in private health insurance for life. A return to statutory insurance is difficult and only possible under certain conditions. You have to live with the contributions – even if there is a decline in income for the self-employed.
Not every privately insured person automatically receives the highest standard of benefits. Cheap tariffs often lure young people in particular into private health insurance, warns the consumer advice center. In some cases, you can even get away with worse conditions than in statutory health insurance. So you should take a close look before entering into a contract and compare many providers.
Myth: All statutory health insurance plans are the same - is that true?
This also applies to the statutory health insurance companies, because the same services are not available everywhere. Basic care is regulated by law for all of them. However, the health insurance companies have various additional offers such as sports programs or certain preventive examinations. It is therefore also worthwhile to compare whether the benefits of your own health insurance fit your individual needs or whether a change would make sense.
There are a number of myths surrounding the topic of health insurance. © Zoonar/Imago
There are other disadvantages in private health insurance, which you may not immediately think of: Children's sickness benefit and maternity benefit, as in statutory insurance, mothers do not receive from private health insurance. Also, children cannot be insured free of charge. In the case of the statutory health insurance, the contribution is calculated according to income. Everyone is admitted, regardless of age or state of health.
Myths about sick leave and medical certificates: Is an AU always necessary from the third day?
Anyone who is unable to work must prove this to their employer with a medical certificate. However, when this proof must be available is regulated very differently. The rule of thumb that the certificate of incapacity for work must be presented on the third day of illness is therefore not always correct. You should inform yourself beforehand exactly. Some employers want a medical certificate on the first day. However, this must then be expressly stated in the employment contract. If not, it is important to adhere to the period of three days.
By the way, you do not have to tell your employer the nature of the illness. Nor is he allowed to ask for it. However, you should tell him how long you are likely to be absent.
Going on holiday or to the cinema despite being on sick leave – is that a reason for dismissal?
By the way, if you are on sick leave, you don't just have to stay in bed. It always depends on the specific disease, which is conducive to recovery. Ultimately, it is always the doctor who decides. If bed rest has been prescribed, you should stick to it and not leave your home or hospital. However, this is rarely the case. Otherwise, short walks are allowed. Often they are even recommended. Doing necessary shopping is always allowed.
When going to the cinema or at a rock concert, it depends on the type of illness whether they are allowed or not. Such activities are not beneficial to health in the case of flu or a severe cold. However, for other ailments, especially psychological ones, it can also be beneficial to your health to do something with others or to do sports.
This also applies to holiday travel. In exceptional cases, it may be possible despite sick leave. The attending physician must then certify that the trip does not jeopardize recovery. Important: When traveling abroad, you need the approval of the health insurance company. In this case, you will continue to receive sick pay.
Going to work despite being on sick leave? Is that allowed?
By the way, in case of illness, it is not forbidden to work. If you get well sooner than expected, then you even have to go to work. However, this should always be discussed with the attending physician and employers are not allowed to build up any pressure in this direction.
If you have to look after sick children and are legally insured, you do not have to use up your vacation days. Parents can take advantage of 30 children's sick days per child per year. In the case of single parents, the figure is twice as high. 90 percent of the net salary is then covered by the health insurance companies.