About 87 percent of people who live in Germany have GKV, which is mandatory health insurance. As of May 2005, the GKV relied on 321 non-profit sickness funds to collect premiums from their members and pay health care providers according to agreements that had been made. Those who aren't covered this way, mostly government workers and self-employed people, get health care through private insurance that makes money.
About 0.3% of the people in Germany, or about 250,000 people, don't have any health insurance at all. Some of them are so rich that they don't need it, but most of them are poor and get health care through social assistance.
Health insurance that is required by law
There are three different kinds of sickness funds: primary funds, replacement funds, and "special" funds. Some workers are required to join the primary funds, such as those who make less than the income ceiling (in 2006, this was EUR 3,937.50 per month or EUR 47,250.00 per year). Those who make more than that limit can choose to be members, or they may be able to choose between funds. Some of them are automatically members of a certain fund because of things like their job (company-based funds) or where they live (local sickness funds). Some jobs, like being a farmer or a sailor, have their own "special" funds.
There are two kinds of substitute funds. Both white-collar and blue-collar workers who make more than the income ceiling can get health insurance through them. There is no obligation to join.
Employers and employees each pay half of a member's premiums, which in 2006 averaged between 13 and 14 percent of a worker's gross earnings up to the contribution assessment ceiling (2006: EUR 3,562.50 per month or EUR 42,750.00 per year). Premiums are based on earnings instead of risk, and they don't change based on a person's marital status, family size, or health. All members of a certain fund with the same earnings pay the same amount for their premiums.
Private insurance for health care
About 11% of the people who live in Germany pay for private health insurance, which is offered by about 40 for-profit insurance companies. Many people who choose private insurance are government workers who want to pay for some of their medical bills that the government doesn't cover. Some people who have a sickness fund buy extra private insurance to pay for things like a private room or a choice of doctors while they are in the hospital. Other than that, both publicly and privately insured people get the same medical care. In both situations, the same hospitals are used. People who work for themselves and make more than a certain amount must have private insurance. Members of a sickness fund who switch to private insurance can't switch back to public insurance.
Unlike the government-mandated health insurance, private insurance depends on the age, gender, occupation, and health of each member, or the individual risk. Even though private insurance companies pay health care providers about twice as much as primary sickness funds, private insurance is often cheaper than statutory health insurance, especially for younger policyholders without dependents. As is the case with members of sickness funds, half of the premiums for employees with private insurance are paid by their employers.
