[分享]健康保險介紹(英文版, 在職員工適用)

rAbBiFiNiTy

以下是我過來德國上班之前,公司的搬家顧問整理給我們的介紹. 希望能給將來計畫過來工作的朋友們提供些幫助. 一方面因為在職工作的人有比較穩定的收入, 另一方面在年齡/健康條件/家庭狀況..又和學生族群不盡相同, 對於保險的選擇我想也會有不一樣的著眼點(比方說公保多半包含你的眷屬,私保因為只保個人所以就要考慮家中只有你本人或是夫妻都有工作...之類的差異)

因為我工作的地方在B-W州,有些內容或許在其他地區不見得適用.總之,有不確定的地方請先向你未來的雇主問清楚. 另外這些資料整理的時間是在2008年年初...所以如果有已經修正的部分,也請不吝指正

另外如果是以下幾種的就不用繼續讀下去了:
1.德文程度比英文好的(原文的資料相信必定完整許多,只可惜我來的時候會的德文一隻手就能數完了...我猜這些資料也是從德文資料節錄彙整的,因為有些地方用英文讀起來怪怪)
2.個人條件符合學生健康保險的(因為肯定比底下介紹的來得便宜)

Health Insurance
Every employer has to check that his employee is insured. For this purpose the employee has to show proof of a health insurance coverage. Therefore a health insurance, either public or private, is compulsory. The public health insurance institutions are in this regards often referred to as “Krankenkassen”.

1.1 Public Health Insurance
The premium rate of the public health insurance fluctuates between roughly 12-16 % of the gross income and up to an income limit of 3600,00 €. This amount is the assessment threshold for the calculation of the health insurance premium. If, for example, the insured earns 3800,00€, the difference of 200€ will not be considered in the premium calculation.

The percentage premium rate is charged up to a maximum gross income limit of 3600,00€. An income of 3600,00 or more attracts by 14,9 % premium rate 536,4 € as insurance premium. The employer pays 50% of the premium. Except for a 0,9 % surcharge on the premium which, since 01.07.2005, has to be paid by the employee alone.
He is however not allowed to influence the employees choice of insurance institution.

The public health insurance is designed as a family insurance. The unemployed spouse and minors are included in the coverage.

Normally the insured has little to do with the accounting modalities. The insured gets a card which has to be presented on visiting the Doctor. The Doctor bills then the insurance institution for the services rendered. One has also very little to do with the insurance institution. Only on rare occasions where one is applying for services not included in the catalogue but which lies within the discretion of the institution (e.g. treatment at a health resort, dental prostheses, etc), must a prior contact be made.

In the case of long term and incurable illnesses quick response and competent as well as reachable contact person is desirable. So any person knowing in advance that they would be needing to contact the insurance, perhaps as a result of chronic illness, should give priority to reach ability of their chosen insurance institution.

Comment
There exists numerous public insurance institutions. They arose out of historical differentiations which have as time went on been eroded. So today one hardly has pure insurance institution for guilds (e.g. Technikerkrankenkasse) or exclusively for employees (e.g. Siemens Betriebskrankenkasse). However, there still exists insurance institutions which are region specific. Besides there are large public insurance companies like the AOK (Allgemeine Ortskrankenkasse) which in its internal workings has a regional structure. The AOK is bound to the various federal states.

Every insurance has to offer the legally stipulated services. All public insurance have almost the same service catalogue in which is stipulated all
services rendered, the medication paid for, aids (adjuvant) and therapy. Since 2004 public insurances are allowed to render through bonus programme additional
services or make premium refunds to a limited extent.

In spite of the similarity in services offered there is a price difference of circa 20 % which points to a gap in the market. Actually, before a few years ago there was no competition among the public insurance institutions. This could be traceable to various, partly ideological, reasons which have also partly been eroded with time. Previously changing from one public insurance to another was an exceptional case. Today one can change so long one has stayed up to 18 months with the old insurance and gave adequate notice. All the same the willingness to switch insurance is not highly developed.

Conclusion
The premium rate is no indication of service quality rather an indication of gap in the market. One can choose without qualms from any of the regionally available public insurance companies with reasonable premium. There is differences in service though. The larger public insurance companies with more employees tend to have more experienced staff and round the clock accessibility. Whoever may be dependent on such should in making a choice check on competence and accessibility.

The AOK (Allgemeine Ortskrankenkasse) with 300 branches in Baden-Württenberg alone and 14;5 % premium rate is a reference Public insurance institution.
The Technikerkrankenkasse (TKK) which although only has 200 branches nation wide, is present in Ulm. And the premium rate is only 13,8 % + 0,9%.
There are some other cheaper health insurances. The IKK-Direkt or BIG-Die Direktkrankenkasse which have a premium rate of 12,4 % and 12,5 % respectively are the cheapest in Baden-Württenberg.

下圖是一些試算的範例用來說明每個月應繳納的保費是如何計算出來的...加上了一些曾經聯繫或是使用過的評價


[ 本文最後由 rAbBiFiNiTy 於 2008-12-19 15:34 編輯 ]

rAbBiFiNiTy

1.2 Private Health Insurance

Current Health Systems Reforms 2007

A three year deadline for employees
As from 01 April 2007 changeover from public health insurance to private health insurance will be more difficult. Exempted are those who in three consecutive years exceeded a stipulated upper income limit (4.012,50€ monthly). Employees who are voluntarily in the public health insurance scheme since three or more
years, but whose income exceeds the yearly remuneration limit can terminate their voluntary membership at any time and changeover to private health insurance.
(Termination notice is two calendar months).

What is new?
Basic Principle: Almost all employees are statutorily bound to take up a public health insurance coverage, no matter what they did before, where they were insured and how much they earned. The statutory status ends upon expiration of the third consecutive calendar year in which the employee’s income exceeds the stipulated yearly limit and if in the fourth year this remains so. It does not matter if the employee changes jobs in between.

What if an Employee misses the D-Day?
An insured who is yet to complete the three years required, but misses the d-day (01.02.2007) for termination of voluntary public health insurance does not have to wait another three years. The voluntary insurance will official be converted into a statutory public health insurance, however the years in which the statutory income limit was exceeded will still be taken into consideration.

New Calculation Modality
The government has used the opportunity of the 3 year rule to redefine the yearly income limit on which the statutory insurance is based. Until now this calculation was just a forecast. In case of a new income level or new job, the previous income was uninteresting. The new income was projected into the future using a notional calendar year. Until now, for example, if an employee receives between January and August 2006 a monthly income of 3,400€ this employee falls under a statutory health insurance scheme.

But then as from September, due to salary increase, the monthly pay improves to 4,100€. This new income if projected over a 12 calendar month period exceeds the statutory limits. Therefore by the end of the year 2006, the employee is no longer bound to be under the public health insurance scheme. But under the new dispensation only the actual income within a calendar year is taken into consideration. If this exceeds the stated limits within a given year, then the employee has two more years to be free from the statutory public health insurance scheme. Therefore exemption from public health insurance is possible only if for three consecutive calendar year the employees income exceeds the statutory limits.

Note
The three year rule does not affect employees who as at 02.02.2007 are privately insured or who before this date have terminated their voluntary membership in a public health insurance scheme. You are voluntarily insured if your income exceeds the statutory limit but you are still insured by a public health insurance company.

New Gross income threshold in 2008: 4.012,00 EUR Monthly

Any person with income up to or above 4.012,00 EUR Monthly in three consecutive years can decide freely to remain with the public insurance or change over to a private health insurance (they are not referred to as “Krankenkasse”). As opposed to the public health insurance, the private health insurance covers just the
individual taking up the policy. Spouse and minors have to be insured separately. This means that in most cases families with children and unemployed spouse could come off cheaper with a public health insurance and perhaps extra health insurance.

On the other hand, singles and small households where both partners are employed are often better served by private health insurance. In practice there is a lot of flexibility in the features included in the private health insurance, however, the insurer tries using medical history to eliminate or gauge risks.
The insured has much more work to do because he is responsible the accounting. The insured must in most cases pay the doctor directly and later tender refund claims with the insurance company. The process is not so strenuous and most private health insurance companies make refunds so fast that often the money is there before the doctors bill is debited.

Conclusion
Whoever earns above the income ceiling, is single or has a small household should consider the private health insurance.

If the stay in Germany is temporary, and the prolonged discussion on premium refunds is actually not interesting, then the public health insurance could be a cheaper and better coverage.

Due to the very individual nature of policies in this area, we cannot make across the board recommendations. Practice has shown that it is better to make comparison and afterwards request for detail calculation.

Almost all private health insurances are done through a broker who also is your contact person for information on coverage. Many private health insurance companies have service numbers for medical enquiries. It must be emphasised that persons with private health insurance receive better treatment
at the doctor’s (shorter waiting time) because the doctors usually can charge more for their services.

最後在這裡可以查到一些公家健保的費率資料