Bertelsmann BKK - Extraordinary in performance and service

Health insurance in Germany is part of a comprehensive social security system, which consists on sickness and nursing care funds (= statutory health insurance), a pension fund and unemployment benefit. Almost 90 % of the population, or 72 million citizens, are insured under the statutory health insurance scheme.

Instead of being a state-run public health service, our system is characterized by a close cooperation between the health insurance funds, the medical professions, hospitals and other related services. The state provides the necessary legal framework.

The statutory health insurance funds play a very significant role, since their mandate by law is to provide comprehensive coverage to their members should they fall ill.

Your employer automatically registers you and deducts your contributions from your wage to be paid into the state social security system. The choice of statutory health insurance fund is up to you - but you must inform your employer of your choice within two weeks of starting work, so that your contributions can be paid.

The statutory health insurance system has the following tasks:

• Prevention, early diagnosis and treatment of illnesses 
• Medical rehabilitation Payment of sickness benefit 
• Pregnancy and maternity benefits. 
• Payments to people in need of intensive nursing care are part of our long-term care insurance.

All forms, of statutory health insurance fund are self-governing, non-profit organisations by law, and are also legal entities under public law. Each of these forms (see below for an explanation) is responsible for balancing his own budget between income and services to members as expenditure.

The various forms of statutory health insurance fund are as follows:

• The oldest form is the company health insurance fund ("BKK", such as the Bertelsmann BKK), some of which are over 100 years old, see also "What is the meaning of BKK?
• General local health insurance funds (AOK), formally for blue-collar workers, 
• Substitute health insurance funds (Ersatzkassen), formally for white collar employees not covered by a company fund
• Miscellaneous forms cover other sections of the working community, such as guilds, the merchant navy or agricultural sectors.

Since 1996 these restrictions governing the choice of fund no longer apply.

Statutory health insurance is contribution-based (i.e. not levied via risk-premiums or taxes). The contribution rate itself is calculated as a percentage of your income. This percentage is capped at a certain income level wich reflects the average national income in Germany. This income level is currently € 5.157,50 per month in 2024, and will be adjusted yearly. Age, sex and health risk of the insured are irrelevant to the level of contribution to be paid. 50 % of the entire social security contribution (including health insurance) is paid by your employer, and 50 % by you, employee.

The contribution rate is 14,6 % plus an additional rate 2,5 %, so in total 17,1 %. The additional rate differs within the statutory health insurance funds. Half of it is paid by you und the other half is paid by your employer.

In addition to your statutory health insurance you are also obliged to subscribe to a nursing care insurance. The nursing care insurance follows your health insurance like for BKK the BKK-Pflegekasse.

As of July 1, 2023, the contribution rates in long-term care insurance has changed. For members aged 23 and older without children, the legislature is raising the contribution rate from 3.4 to 4.0 percent. For members under 23 or with a child, it has increased from 3.05 to 3.40 percent.

Families, however, will be relieved: For members with two or more children, the legislature introduces deductions that increase with the number of children. These are granted up to the age of 25.

Statutory health insurance also cover any dependent children or spouse (who is not earning more than 505 € per month in 2024) at no extra cost.

The service provided by the statutory health insurance funds are predominantly rendered in kind, such as outpatient services, hospital care, pharmaceuticals and remedies & rehabilitation services. Insured parties are entitled to any services and benefits within the legal parameters set by German law (Social Security Code, Book V).

There are no geographical limits to accessing these benefits within Germany, but there are differences between the service levels offered by individual health insurance funds.

Under statutory health insurance you are basically free to choose your health care provider, unless you decide to join a specific scheme, such as a "quality network of doctors" (general practioneers and specialists) which are currently piloting new ways of organising health care in Germany.

All insured parties have access to all accredited health care providers. The main health providers are as follows:

• Doctors/dentists: General Practitioners and specialists can be consulted, although usually the GP will be responsible for referring the patient to a specialist or hospital. 
• Hospitals: all levels of hospital care (primary to highly specialised care) are covered; hospital care is usually provided on referral by a GP or a specialist, or directly in case of emergency. 
• Pharmaceuticals and prescriptions medicine are available in pharmacies only, with co-payment according to package size.

Almost all health care providers and institutions are accredited by the statutory health insurance funds. Alternative health providers are not covered by statutory health insurance.

Private insurance coverage (i.e. non-statutory health insurance) is by law only available to those whose income is above the national average (see above 4). This can take the form of supplementary or comprehensive insurance, which is provided by profit-based insurance companies, and is based on a cost reimbursement principle.

This does not cover any further family members, and once having signed up for private health insurance you are by law no longer allowed to become a member in a statutory health insurance fund.