Private Krankenversicherung einfach erklärt (explainity® Erklärvideo)

Summary

Simone, a self-employed photographer, and Theo, an employed engineer, are exploring the differences between private (PKV) and statutory (GKV) health insurance in Germany. While PKV offers shorter waiting times, more personalized care, and tax benefits, its premiums depend on factors like age and health, unlike GKV, which is income-based. Simone benefits from PKV, paying her own premiums, while Theo is considering a switch for better coverage. The video highlights how PKV can be advantageous for self-employed individuals, healthy people, and high earners, with options for adjustable premiums and employer contributions for employees.

Takeaways

• 😀 Private health insurance contributions are not based on monthly income, but are determined by age, health status, and personal needs.
• 😀 A significant benefit of private health insurance is shorter waiting times for doctor appointments and better hospital care.
• 😀 Private insurance offers more flexible benefits, including coverage for vision aids, alternative medicine, and dental care, which are not typically provided by public health insurance.
• 😀 Entry-level tariffs in private health insurance are often lower than those of statutory health insurance but increase with age.
• 😀 Early adjustment of contributions can help reduce costs in old age, thanks to the accumulation of age provisions.
• 😀 Higher premiums are linked to more extensive coverage, with different tariff options available, from basic coverage to comprehensive plans.
• 😀 Private insured individuals initially pay medical bills themselves but receive timely reimbursements after submitting claims to their insurer.
• 😀 Many private health insurance plans offer a premium refund if no benefits are claimed during a year.
• 😀 Employees can receive 50% contribution coverage from their employer when switching to private health insurance, or the equivalent of the statutory health insurance contribution.
• 😀 Self-employed individuals must bear the full cost of private health insurance, but can switch plans if premiums rise to keep costs manageable.
• 😀 Choosing a deductible can lower premium costs, where the insured person agrees to pay a portion of their medical expenses annually, leading to potential savings greater than the deductible amount.

Q & A

What is the main difference between private and statutory health insurance in Germany?

The main difference is that private health insurance (PHI) is not based on income like statutory health insurance (SHI). Instead, PHI contributions depend on factors such as age, health condition, and personal needs, while SHI contributions are linked to the insured's monthly income.

Why is private health insurance potentially more beneficial for younger, healthier individuals?

Private health insurance typically offers lower initial premiums for younger and healthier individuals, as contributions are based on age and health rather than income. This makes it a more affordable option for those in good health.

What are some of the advantages of private health insurance that Simone mentions?

Simone highlights several benefits of PHI, including shorter waiting times for medical appointments, better hospital accommodations, and coverage for additional services such as vision aids, alternative medicine, and dental replacements.

How does the cost structure of private health insurance work compared to statutory health insurance?

Private health insurance offers flexible pricing based on age, health, and individual needs, while statutory health insurance premiums are fixed and tied to the insured’s income. The more comprehensive the coverage, the higher the premiums in PHI.

What is 'Altersrückstellung' and how does it help manage future costs in private health insurance?

'Altersrückstellung' refers to age-related reserves built into private health insurance plans. It helps manage future premium increases as the insured gets older, ensuring that premiums do not rise excessively over time.

What should Theo be aware of when switching to private health insurance?

Theo should be aware that initially, he would need to pay medical expenses out-of-pocket and submit invoices for reimbursement. He would also lose the automatic employer contribution to SHI, though his employer would still contribute a portion to his PHI. He should also consider the long-term costs of switching.

Can Theo expect any refunds if he doesn’t use his private health insurance services during the year?

Yes, many private health insurers offer a contribution refund if the insured does not make any claims during the year, which can provide financial relief.

How does private health insurance help with tax benefits?

Contributions to private health insurance can be claimed as special expenses in the income tax declaration, offering tax savings for policyholders.

What options does Simone have if her private health insurance premiums increase?

If her premiums increase, Simone can switch to a different tariff or even change insurers to keep her costs manageable. This flexibility is one of the advantages of private health insurance.

Who are the ideal candidates for private health insurance in Germany?

Ideal candidates for private health insurance include civil servants (due to high employer contributions), healthy individuals, self-employed people like Simone, and high-earning employees like Theo.