The legal health insurance (GKV) is beside the pension, unemployed person, accident and nursing care insurance a component of the German social security system and part of the health system.

Tasks and arrangement

Task of the legal health insurance is it to receive the health of the insured ones to restore or improve their state of health (SGB V).

All insured ones have the same performance demand, whose extent is fixed in the social legislation V (SGB V). According to the solidarity principle the contributions depend after the financial efficiency of the insured one and not on its personal disease risk (age, sex, health status).

The legal tasks of the SGB V, which contains the regulations for the legal health insurance, are noticed by the health insurance companies.

One differentiates between primary carriers (so-called primary cashes) and private health insurance funds of the GKV:

• Primary carriers are
  • the general local health insurance companies (compulsory health insurance scheme)
  • the staff sickness funds (BKK)
  • the guild's health insurance funds (IKK)
• Private health insurance funds united in the federation of the employee health insurance schemes (Association of Employee's Health Insurance Comp) and/or the workers' health insurance fund federation (AEV). To it belong for example
  • the Barmer private health insurance fund (BEK),
  • the German employees health insurance company (DAK),
  • the technicians health insurance company (TK),
  • the commercial health insurance company - KKH as well as
  • the private health insurance fund (GEK).
• Besides there are still some "special cashes" as for example
  • the agricultural health insurance companies,
  • the seasick cash and
  • the scarce shank (for miners).

This arrangement decreases/goes back to the self-help mechanisms existing in former times, which were included into the GKV system. The distinction in primary health insurance companies and private health insurance funds became insignificant by the health structure law, which stepped 1996 into force and with that all health insurance companies achievement-legally on one level was placed. Since then each citizen, who is not privately ill-insured, can join (opened) a health insurance company of his choice. The compulsory health insurance scheme of the occupation or residence, each private health insurance fund, which is responsible for the occupation or residence, is selectable the BKK or IKK of the enterprise, to which the voter belongs, each opened BKK/IKK, which health insurance company, with which a membership or a family collateral insurance existed last or which health insurance company, with which the spouse is insured.

Basic principles

A konstitutives element of the GKV represents the Solidarprinzip. That means that everyone makes legally income-dependently a contribution to Versicherte to the GKV. It keeps its achievements however contribution independent. The GKV system functions after the allocation procedure, with which the current expenditures must be covered by the current incomes. The particular keeps contributions of equipment direct in the medical case, without it makes direct payments opposite the Leistungserbringern. This is called contribution of equipment principle. The service catalog of the GKV is very extensive compared with states such as Switzerland, the USA or the Netherlands. Cooperating of health insurance companies, hospitals, physicians and their combinations on federation and regional level is coined/shaped by the principle of the autonomy. This is all took part the co-operation in the arrangement of the health safety device to make possible. The strong positioning of intermediate instances, like the federations of the health insurance companies and Leistungserbringer, is thereby a special characteristic of the German health system.

Achievements of the legal health insurance

The achievements of the legal health insurance in Germany are fixed and by the health insurance companies according to the contribution of equipment principle are furnished in the fifth social legislation. They can be divided into:

• Achievements for preventing of diseases and of their aggravation, as well as for with sterilization and with abortion
  • Prevention and self-help
  • Group prophylaxis for preventing of tooth illnesses
  • Individual prophylaxis for preventing of tooth illnesses
  • Medical precaution achievements
  • Medical precaution for mothers and fathers
  • Abortion and sterilization
• Achievements for the early recognition of diseases
  • Health investigations
  • Child investigation
• Achievements for the treatment of an illness
  • Patient treatment
    • medical treatment including Psychotherapie
    • dental treatment
    • Orthodontical treatment
    • Supply of artificial dentures
    • Supply of medicaments, surgical dressings, welfare and aids
    • Domestic nursing for the sick
    • Domestic help (social security benefit)
    • Hospital treatment
    • Achievements for medical rehablitation
    • Medical rehablitation for mothers and fathers
    • Supplementing achievements for rehablitation
    • Artificial fertilization
    • Soziotherapie
    • stationary and ambulatory Hospizleistungen
    • Load testing and work therapy
    • sozialp¤diatrische achievements
    • Sickpay
    • Sickpay on illness of the child
    • Driving costses
• To eliminate or reduce achievements for medical rehablitation, as far as these serve to turn a handicap or an in need of careness away.

To the achievements of the legal health insurance the insured self-portions and additional payments carry out. The additional payment does not amount to in principle 10% of the selling price, at least however 5 "€ and at the most 10 "€, under any circumstances however more, than the costs of the means. In stationary measures becomes due for each calender date 10 "€, for maximally 28 calender dates in the year. With cures and domestic nursing for the sick the additional payment 10% of the costs amounts to plus a fee of 10 "€ for each regulation. With medical or dental treatment a practice fee of 10 "€ for each quarter is to be paid.

Altogether additional payments become maximally up to the personal load limit due. On it going out amounts refund the health insurance companies on request.

Articles in category "Legal health insurance"

We found here 61 articles.