Many of you ask about the differences in Germany. One of the biggest ones is probably the healthcare here. Contrary to popular American belief, Germany does not have that ubiquitous universal, national insurance that we're always hearing about in the US (but the UK does).
As a US expat I had my US paycheck and insurance. I only went once to the doctor in Germany because it involved submitting expense forms for reimbursement and having gone once to the dentist in the UK, the insurance company would not convert the pounds to dollars. As pounds are worth more than dollars, by paying me only in dollars instead of the charged pounds converted to dollars, they saved some money. Since it was only 10 dollars in the end I could not be bothered to spend that amount in postage writing them letters to fight it, but let it be known that a certain dental insurance company that uses Snoopy in its advertisements does not treat expat dental reimbursements properly.
Fast forward to Germany. Upon becoming a German J employee, I had to take a German insurance. In Gemany there are two types of insurance: public or private. Around 90% of Germans have public insurance and the remaining 10% have private.
Public insurance is an option for all Germans. There are a variety of companies that offer it, many were formed to offer insurance to a certain company or employee union, so they exist with that background but now they are open to everyone. It depends on the company or the plan year, but they charge around 11-14% of your pay to insure you, depending on how last year went. These percentages are adjusted each year, and employees can switch each year as they wish.
Private insurance is only offered to employees who make a certain amount of money. Private insurance offers a higher level of coverage and more enhanced options to choose from. Private also gives you some leeway to create your own plan. You may choose a deductible from 200 to 1200 euro; the higher the deductible, the lower your monthly cost.
Each German must choose an insurance carrier, and then they tell the payroll department. If you choose not to pick a carrier, a standard public one will be chosen for you. Then, whether you are public or private, the company pays 50% of your health insurance premium, the only difference being that the company pays the public insurance directly, vs. for private insurance the company requires proof/cost of coverage and then pays you the 50% so that you pay 100% of the premium each month.
Why would someone choose one or the other?
If you have public insurance and you have a non-working spouse or dependent children, they are automatically covered for free under your premiums. If you have private insurance they are an additional cost.
It is easy to go from public to private--public plans must take everyone regardless of health status or pre-existing conditions. Private plans require a questionnaire before taking you and can require a physical exam if there are any doubts.
It is sometimes difficult to get in to see a doctor. However, doctors get more money from private insurance and often faster payments. Therefore, you will get an appointment faster with private insurance.
Public insurance works similarly to the US health networks that a doctor's office submits an expense to the insurance company and then bill you later for the part not covered. Private insurance requires you to submit the doctor's bill to insurance and receive payment and then to pay the doctor.
With private insurance you can request an appointment with any doctor that you like, whenever you want; public insurance requires following some procedures of who you see exactly.
Private insurance caters to the young and healthy who do not use it much. If you go an entire year without submitting any expenses, you have the ability to claim back some of the premium costs, including that which the company paid for you.
So, particularly in light of that last point, I chose the private option. Then a month ago I was playing volleyball and did something to my finger similar to what I had done previously to a different one. My colleagues did not like the black and blue color so insisted that I go to a doctor.
They were able to find me an Orthopedic/Sports Medicine specialist in this tiny town who could see me in one week. I get the feeling that they are not used to non-Germans, but they were nice enough. The office was actually an old converted house that used every square inch. There were two chairs next to a stairway that was the 'waiting area' for the x-ray room upstairs.
So for being there an hour and seeing the assistant and then the doctor, having my finger x-rayed in two positions, the doctor to look at it once more with the digital x-rays online, and then the assistant to bandage it--do you want to guess how much that cost? Having had something similar in the US the last time this happened to a different finger, I can tell you it ran a few hundred dollars, of which insurance would have covered a good chunk, if not for the deductible.
Oops, left out the final part. I was expecting to have to pay upon leaving, like in the US. They looked at me like I was crazy when I asked in bad German about the bill. You'll get the bill by mail when we write the bills. Are you kidding me? I was seen by a doctor with x-rays and all, and because I told you I have private insurance and I gave you a name, street address and birthdate, you trust that I will receive and pay the bill. Quite a change from the US doctor offices that have a big sign saying something like 'payment expected on day of office visit'.
So when I finally got the bill this week, I had slight trepidation. However, that was all for naught, as this is Germany and seeing the doctor is relatively cheap. The whole thing came up to 60 euros. A mere pittance to what I would have been chared for the same exact thing in the US. So now I need to pay and hold it to see if I go any more to the doctor. I have the ability to save bills for up to one year before submitting. Then I can see if I go again, or if it is better to pay out of pocket if I only go once and go for the 'non-use' refund instead.