As of: April 6, 2024, 9:26 p.m
By: Andreas Schmid
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Around 74 million people in Germany are insured by statutory health insurance (GKV). That corresponds to around 90 percent of the population. © Daniel Karmann/picture alliance
Health insurance companies must pay their insured persons a basic level of healthcare treatment. But there are also other services that are covered.
A law is currently being planned that deals with the reimbursement of costs by health insurance companies: the Health Care Strengthening Act. Contrary to what was previously planned, homeopathy will not be canceled. Health insurance companies will probably continue to pay for globules, Schuessler salts and other parts of alternative medicine. But what else does statutory health insurance (GKV) cover? An overview of the service catalog from AOK, DAK, Barmer, Techniker Krankenkasse & Co.
What rules and laws apply to health insurance?
The Social Security Code basically regulates which costs the health insurance companies must cover. However, there are no specific requirements for specific services. Rather, it means that the insured person is entitled to adequate and needs-based medical treatment. This treatment must also be economically reasonable. Not all health insurance companies cover the same services. Who pays what is stated in the health insurance company's service catalogue.
Which services are completely covered by the health insurance company?
The classic trip to the doctor is covered by health insurance. This includes, among other things, normal check-ups, the treatment of illnesses and after accidents, standard vaccinations or the treatment of serious, long-term illnesses. This general definition is very flexible and some health insurance companies are now accommodating their customers due to competition, which is why many other services are taken on. There is also a legal right to sick pay.
How long does the health insurance company pay sickness benefit?
Anyone who becomes unable to work will generally continue to receive a salary from their employer for six weeks. The health insurance company then pays 70 percent of the regularly earned gross wages up to the contribution assessment limit (4,837.50 euros per month; as of 2021), but not more than 90 percent of the last net wages. Sickness benefit is limited to 78 weeks within three years.
Does the health insurance company cover medication?
As a rule, health insurance companies pay the majority of the costs of medication. However, you have to pay your own contribution. It is 10 percent per pack, but corresponds to a minimum of five and a maximum of ten euros.
Do I have to pay if I am treated in hospital?
Yes, if you are treated as an inpatient in hospital, you must pay a personal contribution of 10 euros per day (max. 28 days). You are entitled to accommodation in a shared room as well as general care services including food. Those under 18 do not have to pay anything.
Does the health insurance company pay for treatment or rehabilitation?
Every four years you are entitled to outpatient rehabilitation (approximately three weeks), provided it is medically necessary. Medical and treatment costs are fully covered. Inpatient rehabilitation – i.e. overnight stay at the rehabilitation site – is also conceivable. However, as in the hospital, you then have to pay a personal contribution of 10 euros per day.
Does health insurance pay for psychotherapy?
If depression or other mental illnesses are diagnosed, the health insurance company will cover a certain number of therapy hours. How much depends from health insurance company to health insurance company. In addition, it is de facto only a theoretical offer. Due to the high demand and the low number of psychotherapists, many patients have great problems getting an appropriate therapy place.
Does health insurance pay for homeopathy?
Homeopathy is generally approved in Germany. It is referred to by the legislature as a “special treatment method”. So far it is like this: There is no subsidy per se for the majority of homeopathic methods. However, most health insurance companies cover the costs, such as Barmer, hkk or Techniker Krankenkasse.
Is acupuncture covered by health insurance?
Acupuncture treatment has been covered by health insurance companies for almost 20 years. However, proof is required that the insured person suffers from chronic back or knee pain.
Does the health insurance company pay for preventive examinations?
Certain preventive examinations are taken over from a certain age. Cancer screenings are paid for from the age of 20 for women and from 35 for men. This also includes colonoscopy, mammography and skin cancer screening.
Does health insurance cover an abortion?
Most health insurance companies only pay for abortions under two main conditions. The AOK states, for example: “The AOK only pays for the procedure itself if a medical report recommends the abortion for medical or criminological reasons.” The Techniker Krankenkasse covers the costs “if the abortion is for medical reasons or due to rape “.
Does health insurance pay for glasses or contact lenses?
Around half of the people in Germany wear glasses. Most of them probably paid for it themselves, as health insurance rarely covers the costs. The health insurance company actually only pays if your vision is severely impaired: from 6.25 diopters for nearsightedness or farsightedness and from 4.25 diopters for astigmatism. However, glasses for those under 18 are usually covered. Things are different with contact lenses; the health insurance companies almost never pay here.
Does health insurance pay for a hearing aid?
Basically yes, as long as it was prescribed by a responsible doctor (e.g. ENT). However, the statutory health insurance company only covers the costs for the medically necessary cash register device: If you want a “better” and more expensive model, you have to pay the additional price yourself.
Does the health insurance company also pay for treatment at the dentist?
A visit to the dentist is like any other visit to the doctor: the health insurance company covers basic care. Cosmetic procedures such as bleaching are not included in most health insurance plans. For dentures, the health insurance company pays certain fixed amounts. The cost of implants can be increased if you go for regular checkups. Orthodontics is usually only paid for young people under the age of 18.
What does the health insurance company not pay for?
The Federal Joint Committee regulates what is covered by the health insurance funds and what is not. In constantly updated guidelines, the committee also deals with “methods that may not be provided as statutory medical services at the expense of the health insurance companies”. These include electro-acupuncture, magnetic field therapy and other forms of alternative medicine.
Other so-called individual health services (IGeL) are also not covered by statutory health insurance companies and must be paid for by patients themselves.
What will be adopted in the future and what will not?
The Federal Government's patient representative, Stefan Schwartze (SPD), has spoken out in favor of a ban on certain self-pay services for doctor's visits. “Services that are described as harmful by medical societies have no place in doctors’ offices,” Schwartze told the newspapers of the
Germany
editorial network
. They were forbidden. Specifically, he mentioned the ultrasound examination for the early detection of cancer in the ovaries and uterus.
There are currently discussions about homeopathy, as can be seen from a draft law available to
IPPEN.MEDIA
. Will it be canceled as a health insurance benefit?
(as)