1. The complex social insurance system in Germany is based on five pillars:
1.1 Statutory health insurance
1.2 Long-term care insurance
1.3 Statutory pension insurance
1.4 Statutory unemployment insurance
1.5 Statuory accident insurance
1.1 German health insurance is characterised by a dual system consisting of statutory health insurance and private health insurance. While statutory health insurance is accessible to the most people, certain conditions apply to private health insurance.
Most people in Germany (73 m) are members of one of the 103 statutory health insurers (Gesetzliche Krankenversicherung-GKV) like the AOK´s (Allgemeine Ortskrankenkassen – AOK Rheinland/Hamburg, AOK Nordwest…), BARMER or Techniker.
The GKV pays the costs for treatment, medical rehabilitation and „sick pay“.
Employees who have a gross income above the income threshold for compulsory insurance (66.600 Euro p.a. in 2023), public servants and also self-employed persons/freelancers are often insured in one of the 42 private health insurers. Public servants partly get compensations from the authorities.
The biggest private health insurers are Debeka, DKV (Ergo), Allianz Private Krankenversicherung and AXA. The services can differ from the statutory ones because there is more flexibility to choose services.
Many germans have supplementary insurances for dental treatment or hospital treatment.
1.2 The long-term care insurance is a branch of the health insurance system (also a statutory and a private system). Services of the long-term care insurers are less relevant in cases of treatment and rehabilitation.
1.3 Statuory pension insurers (Deutsche Rentenversicherung Bund, Deutsche Rentenversicherung Rheinland, KBS…-DRV) are big players in the german rehabilitation system. They offer prevention courses, medical rehabilitation and benefits for participation in working life or return-to-work programmes to prevent payments for invalidity pensions or expensive retrainings. ´
The DRV´s have rehab managers, stationary rehab centers and are paying the costs for ambulant rehabilitation. Ambulant rehabilitation for musculoskletal disorders takes generally three weeks, more weeks are possible in difficult cases.
1.4 Unemployment insurance is not responsible for treatment and medical rehabilitation. If necessary the employment agency (Agentur für Arbeit) also pays the costs for retrainings.
1.5 Social accident insurance is responsible for the rehab, retraining and payments for work-related accidents and occupational diseases. The services are more comprehensive and costly than the services of the health insurance or pension insurance. The institutitions (Berufsgenossenschaften – BG, Unfallkassen – UK) of the social accident insurance have specialized clinics, so called accident clinics (Unfallkliniken), and rehab coordinators.
2. Car insurance and the social security system
There are 93 car insurers in the german market. The biggest car insurers are HUK Coburg, Allianz, VHV, Axa and LVM. Car insurance is the biggest branch in the P&C division with more than 120.000.000 contracts.
In cases of injuries the costs for treatment, rehabilitation and „sick pay“ are paid by the health insurers, pension insurers (except „sick pay“) or the statuory accident insurance of the claimant. The statutory insurers are making a recourse to get the costs back from the car insurers. The car insurers must also pay lost wages, personal injury compensations and for housekeeping expenses. If the claimant is not able to work and gets an invadility pension from the pension insurer or in case of a work-related accident (driving to work and back) from the social accident insurance, the costs for the pension must also be reimbursed.
The level of recourse depends on the liability. In some cases statuory insurers and car insurers make division agreements to keep the complex process easier.
Insurers in Germany have a large network of medical consultants, providers for assistance and rehabilitation services.
This description is a short overview for the complex system. Please get in touch with us for further details, insights and databases. firstname.lastname@example.org