Overview of Benefits in the statutory health insurance in Germany

The statutory health insurance funds‘ catalogue of benefits only covers ethical drugs, i. e. those available on prescription only. Part of the cost of these drugs is paid by the health insurance fund. You have to pay a share of between 5 and 10 Euros for the drugs and dressings prescribed by your doctor.

If you need glasses or contact lenses, you must pay the full cost of these yourself. Subsidies are only paid in a small number of cases, e.g. for people with severely impaired vision.

If you are a member in the statutory health insuance scheme you have to pay between 5 and 10 Euro out of your own pocket for simple therapeutic aids and appliances which have been prescribed by your doctor. If you prefer to use ones which meet your personal requirements, the health insurance fund will only pay for the cost of the simple version. You have to make up the difference!

In most cases, the statutory health insurance fund will refuse to pay any costs for such therapies. They must be paid by you in full.

Depending on the dentist‘s findings, the statutory health insurance fund will pay a fixed subsidy of 50 % for the standard treatment in each case. This reimbursement increases to 65 % with documented regular prophylaxis (so-called bonus card).

Dental treatment in the statutory health insurance includes basic medical care for adequate and appropriate early detection and treatment of disorders affecting the teeth, mouth and jaws.

These costs are not reimbursed as a matter of principle.

You are not free to choose a hospital, but will instead be treated in the nearest suitable, contractually affiliated hospital. You are not entitled to accommodation in a private or semi-private room. For every day spent in hospital, you have to pay 10 Euro, up to a maximum of 28 days per year.

Workers and employees: If your illness continues for more than 6 weeks and you are incapable of working, you will lose your statutory entitlement to payment of the full wage or salary. The sickness benefit paid can very soon create painful gaps, as it is lower than the normal income.

Self-employed people: You must apply to the statutory health insurance fund for your entitlement to sickness benefit. If you do not actively take steps to ensure entitlement to cash benefits from private income protection insurance or statutory sickness benefit, you will not be protected against loss of income when ill.

The statutory long-term care insurance scheme is obligatory in Germany and only provides for basic care. Month after month, you or your family must make up the difference between this basic provision and the actual costs incurred.