To maintain, restore or improve the health of the insured persons these are the central tasks of statutory health insurance. As a community based on solidarity, health insurance usually provides benefits covering the necessary medical assistance during illness with the exception of occupational accidents or illnesses and also pays sickness benefit if the employer does not continue to pay a wage or salary while an employee is unable to work.
Statutory health insurance provides a wide spectrum of benefits. Insured persons have free choice of any registered doctor or dentist. But they also share responsibility for maintaining their own health: through a healthy lifestyle, participation in early detection measures and active co-operation in their own treatment and rehabilitation. The health insurance funds actively support their members in these efforts by providing health-care education and advice.
Benefits-in-kind to which insured persons are legally entitled include, for example, medications and hospital treatment. Among the many services provided, the major ones are medical and dental treatment. Cash benefits include sickness benefit for those unable to work, and maternity benefit. We provide for you here a rough overview of the broad spectrum of benefits provided by statutory health insurance. More detailed benefits profiles can be obtained directly from the statutory health insurance funds.
"An ounce of prevention is worth a pound of cure" might be the motto espoused by all statutory health insurance funds. The basic idea behind health promotion is to offer insured persons effective assistance in staying healthy. This assistance includes vaccinations, prenatal care, early detection measures for cancer, and a series of regular check-ups for children. Preventive dentistry designed to protect against dental disease also falls under this benefit category.
The statutory health insurance funds generally cover the costs of, or pay subsidies for, necessary early detection measures. For example, adults over 35 are entitled to a basic check-up every two years, especially for early detection of so-called diseases of civilization, such as cardiovascular disease and diabetes. Early detection of cancer and check-ups for children also belong in this category.
Benefits available in the event of illness include:
A detailed overview of the benefits available can be found in the articles of your statutory health insurance fund.
Workers belonging to a health insurance fund who are unable to work due to illness receive sickness benefit from the 7th week of their illness, which replaces the continued payment of their wages or salary. Instead of sickness benefit, farmers receive an upkeep allowance through an agricultural health insurance fund. Seasonal workers also receive sickness benefit through the agricultural health insurance fund if they are unable to work.
Insured women entitled to sickness benefit are also entitled to maternity benefit, usually for six weeks before and eight weeks after the birth. During pregnancy and while receiving maternity benefit, a woman remains a member in the health insurance fund.
Even when insured members are away on holiday, they are still entitled to medical care and hospital treatment - provided they have obtained a 'European Health Insurance Card' (or certificate) from their German health insurance fund prior to going abroad. In addition to the 27 EU Member States, insured persons are also entitled to medical care in the following countries:
For more information on the range of health insurance benefits available to members while abroad, please contact the German Liaison Office for Health Insurance Abroad (Deutsche Verbindungsstelle Krankenversicherung Ausland; in German).