Krankenversicherung

Krankenversicherung, or health insurance, is a system that covers the costs of medical treatment and related services. It aims to reduce the financial risk of illness and to ensure access to necessary care, including doctor visits, hospital care, medications, preventive services, and rehabilitation. In many systems, long-term care may be included or supported separately.

Two dominant models are common in German-speaking contexts. The gesetzliche Krankenversicherung (GKV) is a compulsory, solidarity-based system for most employees and other insured persons. It is funded by contributions that are typically shared between the employee and employer and based on income. Coverage is provided through sickness funds (Krankenkassen), which pool risk and negotiate benefits with providers. The private Krankenversicherung (PKV) is a private, individual contracts-based option available to those who meet certain criteria, such as higher income or self-employment. Premiums in PKV depend on age, health status, and the level of coverage chosen; private plans may offer broader services or shorter waiting times but can become more expensive over time and may not cover dependents as automatically.

Benefits and cost-sharing are defined by the system. Statutory benefits generally include medical and hospital care, prescribed medicines, preventive services, and maternity care, with potential co-payments or annual caps. Private plans may customize benefits and impose deductibles or exclusions.

Administration and access vary by country. In some states, health insurance is mandatory for all residents, with a mix of public and private providers. The concept has historical roots in social insurance programs established in the 19th and 20th centuries and remains a central element of modern health care systems.