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People in Germany have either statutory or private health insurance. More than 90 percent of the benefits offered are however stipulated uniformly by law for all patients with statutory health insurance. Specific categories of people have the choice under certain conditions as to whether they wish to have private or statutory health insurance. This applies for instance to employees whose income is above the mandatory insurance ceiling, which is re-assessed every year, as well as in the case of civil servants and most self-employed people and freelancers. Private health insurance is however also mandatory in certain cases.
The “benefits-in-kind principle” applies in statutory health insurance, according to which persons with statutory health insurance do not have to make upfront payments to the respective healthcare provider (for instance their doctor) for the cost of treatment. Instead, the healthcare provider provides the desired service and subsequently bills it to the statutory healthcare insurer of the person with health insurance, the “health insurance funds”. The range of benefits is regulated according to statutory requirements. The various health insurance funds can offer additional benefits to supplement these prescribed benefits. More than 90 percent of the benefits offered are however stipulated uniformly by law for all patients with statutory health insurance.
The “benefits-in-kind principle” does not apply in private health insurance. In the case of persons with private health insurance, the respective healthcare provider issues a bill after the treatment. The amount of the costs for the individual benefits is set by fee scales. In a normal case, the patient pays the bill and then submits it to his/her healthcare insurer to have all or part of the costs reimbursed.
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