If you recently became a member of public health insurance fund (Krankenkasse), you might have some questions like how can I use the insurance, what is actually covered, how can I find English speaking doctors?
In this article we are going to answer all of that, so let's start!
How does statutory/public health insurance work?
Statutory or public health insurance is a solidarity-based government fund. It is financed by the contributions of its members and also subsidised by the government. Members pay according to their earnings, but everyone enjoys the same coverage, regardless of how much they pay into the system. If you are employed in a German based company, your employer is in charge of paying your contribution on a monthly basis, so it is automatically deducted from your salary. If you are self-employed you are in charge of paying your contribution directly to the provider. If you want to understand more, read our what is statutory/public health insurance article.
How to use it?
Within a few days of becoming a member of public health insurance, your chosen provider will send you the instructions on how to obtain your health card. The health card is all you need to show when visiting a doctor in Germany. There is no need to pay out of pocket and go through a claim process after visiting a doctor. Everything which is in the scope of the coverage is directly charged by the doctor to your public health provider, so it is pretty easy. 😊
What is covered?
Regarding the coverage itself, the system needs to provide adequate basic coverage for everyone insured. Since this is a government fund, they decide what basic human need is, and cover it accordingly. They are constantly adjusting the terms (minor adjustments), but this is generally what you can expect to be covered:
All pre-existing health conditions (none can be excluded)
General doctor visits (unlimited)
Specialist visits and treatments (your general doctor always needs to do the assessment, and if they send you to the specialist, it will be covered)
90% of all the prescribed medicines (max. you pay out of your pocket is €10)
General vaccinations
Basic dental coverage
Hospital stay and transport
Medical aids
EU wide coverage for travel purposes
As you can see, it provides quite a broad scope of coverage, but it is also quite limited in certain areas. Anything that is considered as non-essential by the government will be excluded. Things like:
Dental services: public health insurance will cover basics, but if you want to receive high quality material such as ceramic crown or composite filling, you will have to pay the major part out of pocket. You can take a look into our dental add-on insurance which will provide 90% coverage for all the high-end procedures that are not covered by your main public policy.
Vision care: public health insurance will pay for glasses or contact lenses only for people with highly deteriorated vision (starting at -/+6).
Natural health treatment: most providers give a certain, very limited yearly allowance.
Worldwide coverage: you are covered for travels within the EU. If you want to travel out of the EU, you can benefit from our travel add-on insurance, starting only at €18 per year.
How to find English-speaking doctors?
Most of the providers have their doctor booking service, available in English as well:
You can also simply search for the doctors near you, or use websites such as Doctolib, which allows a precise filtering.
When choosing a doctor, just make sure it is not a private one. Each doctor/hospital should have that information stated on their website. Public health insurance does not cover private doctors/hospitals, however, you will not be limited since a big majority of doctors/hospitals are public in Germany. If you are not sure, and you are already on your way to the doctor, simply show them your health card when you reach the reception, to avoid possible charges in case it is a private hospital.
It is also worth pointing out that there is no difference between the public providers, they all work with the same doctors/hospitals.
Is there any bonus or cash-back program?
Most public insurers offer bonus programs to encourage participation in preventive examinations or to contribute to the fitness of their insured. The point behind it is simple: if you take care of your health, you will use the insurance less.
Possible bonus criteria are:
Medical prevention measures
Proof of sport activity through earning a sports badge
Membership of a sports or fitness club
Maintaining recommended weight
Dental care
Avoidance of nicotine consumption
Preventive check-ups
Here you can take a further look into the bonus programs of:
Some bonus programs work as a cash-back and can differ between the providers, and some, such as dental incentives, will mean that provider will cover a higher amount of your dental invoice for dentures (crowns, bridges, implants). Basically, if you do a recommended yearly dental check ups, the amount covered by the provider for dentures will increase from 60% for the standard treatment (basic material), to 70% after 5 years, or 75% after 10 years of the recommended yearly check ups. This topic is explained in more detail in our dental coverage article.
Can I add my family to my insurance?
A big benefit of public/statutory health insurance is that you can insure your spouse and kids with you for free, as long as they are not earning over €538 per month (2024). The following article explains more about adding dependents to public health insurance.
If you signed up through Feather, you received an email from us with all the instructions on adding your dependents to your policy.
Exception - If you signup for AOK, they will reach out directly to you once they confirm your policy, and send you all the instructions.
If you signed up directly with one of the public health insurance providers, it's best to reach out directly to them.