Gesundheitsversicherung

Gesundheitsversicherung is a system intended to cover the costs of medical care and protect individuals from high health-related expenses. It aims to provide access to necessary treatments, medicines, and preventive services and to ensure financial stability in case of illness. In Germany, health insurance is mandatory for most residents and can be provided through statutory funds or private providers. The basic aim is universal coverage with a standard level of benefits, while allowing some differences in scope and cost.

The Gesetzliche Krankenversicherung (GKV) refers to the statutory health insurance system. It is funded by contributions shared between employees and employers, based on income up to a cap. The system operates on solidarity: higher earners do not pay proportionally more than others, and dependents such as children and non-working spouses are typically insured at no additional cost within the GKV. Benefits are defined by law and cover doctor visits, hospital treatment, medications, preventive care, and rehabilitation, with co-payments for certain services. Long‑term care insurance for daily care needs is usually a separate component.

The Private Krankenversicherung (PKV) offers private health insurance. It is available to certain groups, such as high earners or self-employed individuals, and to those who choose to switch from the GKV under specific conditions. Premiums in PKV are risk-based and depend on factors like age, health, and selected benefits. Coverage can be broader or more tailored but may involve higher costs later in life and different rules for dependents. Co-payments and ancillary services vary by contract.

Both systems operate within a broader framework of cost control, patient rights, and regulation to maintain access to care while managing expenditures.