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How Social Security Has Evolved in Germany

Social security stands as a fundamental pillar in contemporary societies, providing a safety net for citizens in times of need. In Germany, this concept has a rich history that has evolved significantly over the years. From its origins in the late 19th century to the robust system in place today, Germany’s social security system has seen remarkable transformations.

In this article, we’ll take a journey through time to explore how social security in Germany has evolved.

Historical Background

Germany’s social security journey can be traced back to the late 19th century when Chancellor Otto von Bismarck introduced a pioneering social legislation package.

The German Chancellor was driven to implement social insurance in Germany with two main objectives: first, to enhance the welfare of workers, ensuring the optimal performance of the German economy, and second, to mitigate demands for more radical socialist alternatives.

In 1889, he established the world’s first old-age social insurance system, with a primary focus on pension benefits for industrial workers.

The German system included obligatory retirement and disability benefits, with contributions taken from employees, employers, and the government. This, combined with the workers’ compensation initiative introduced in 1884 and the “sickness” insurance program implemented the previous year, established a thorough income security system in Germany rooted in the principles of social insurance.

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World War I

After World War I, there was swift progress in the expansion of social insurance programs across various regions. The concept of social protection found its place on the agendas of newly established international bodies, such as the ILO and the International Conference of National Unions of Mutual Benefit Societies and Sickness Insurance Funds, which originated in Brussels in October 1927 and eventually evolved into the International Social Security Association (ISSA).”

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Weimar Republic and World War II

The Weimar Republic faced economic and political instability during the early 20th century, which had an impact on social security programs.

However, World War II brought about significant changes as the nation rebuilt itself after the devastation. The aftermath of the war saw the consolidation and expansion of social security initiatives to address the needs of a recovering population.

In 1944, the ILO’s historic Declaration of Philadelphia called for the expansion of social security measures. It also advocated for the international or regional promotion of systematic and direct cooperation among social security institutions, the regular exchange of information, and the examination of shared challenges concerning the administration of social security.

Just a year later, the United Nations General Assembly adopted the Universal Declaration of Human Rights, which, in Article 22, acknowledged that “Everyone, as a member of society, has the right to social security”.

Weimar Republic and World War II

The Weimar Republic faced economic and political instability during the early 20th century, which had an impact on social security programs.

However, World War II brought about significant changes as the nation rebuilt itself after the devastation. The aftermath of the war saw the consolidation and expansion of social security initiatives to address the needs of a recovering population.

In 1944, the ILO’s historic Declaration of Philadelphia called for the expansion of social security measures. It also advocated for the international or regional promotion of systematic and direct cooperation among social security institutions, the regular exchange of information, and the examination of shared challenges concerning the administration of social security.

Just a year later, the United Nations General Assembly adopted the Universal Declaration of Human Rights, which, in Article 22, acknowledged that “Everyone, as a member of society, has the right to social security”.

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Post-World War II Reforms

The post-war era witnessed extensive reforms in Germany’s social security system. Comprehensive social insurance systems, including health, pension, and unemployment insurance, were established to ensure the well-being of citizens. This period also saw the emergence of the social market economy, which played a pivotal role in shaping the country’s social security policies.

These reforms were not only designed to provide financial protection but also aimed to foster social cohesion and economic stability.

One remarkable reform during this period was the introduction of the “Sozialer Ausgleich” or “social compensation” policy. This initiative, implemented in the 1950s, aimed to balance income disparities by redistributing wealth through progressive taxation and social benefits. It was a key component of the broader effort to create a fair and just society in post-war Germany.

These post-World War II reforms laid the foundation for the robust social security system that exists in Germany today.

Law Scales Government Regulation

German Reunification and Social Security

The reunification of East and West Germany in 1990 posed unique challenges for social security. Integrating the social security systems of the two regions required careful planning and coordination. East Germany had its own distinct social security framework, developed during the years of the German Democratic Republic (GDR), which differed significantly from that of West Germany.

One of the most significant challenges was the merging of pension systems. East Germany’s pension system was based on a “pay-as-you-go” model, where current workers’ contributions funded the pensions of retirees. In contrast, West Germany had a more advanced and financially robust pension system.

Another area of focus during reunification was healthcare. East and West Germany had different healthcare systems with varying levels of coverage and infrastructure. The goal was to create a unified healthcare system that ensured equal access to medical services for all citizens.

Despite the complexities, the reunification of Germany’s social security systems symbolized the country’s commitment to ensuring that all citizens had access to the same level of social protection.

German Reunification and Social Security

The reunification of East and West Germany in 1990 posed unique challenges for social security. Integrating the social security systems of the two regions required careful planning and coordination. East Germany had its own distinct social security framework, developed during the years of the German Democratic Republic (GDR), which differed significantly from that of West Germany.

One of the most significant challenges was the merging of pension systems. East Germany’s pension system was based on a “pay-as-you-go” model, where current workers’ contributions funded the pensions of retirees. In contrast, West Germany had a more advanced and financially robust pension system.

Another area of focus during reunification was healthcare. East and West Germany had different healthcare systems with varying levels of coverage and infrastructure. The goal was to create a unified healthcare system that ensured equal access to medical services for all citizens.

Despite the complexities, the reunification of Germany’s social security systems symbolized the country’s commitment to ensuring that all citizens had access to the same level of social protection.

Contemporary Social Security in Germany

Today, Germany boasts a comprehensive social security system that encompasses various components, including healthcare, pensions, unemployment benefits, and family support. This system is built on the principles of solidarity and sustainability, ensuring that resources are fairly distributed and that future generations can benefit from the system.

Reforms and Challenges

In recent years, Germany has faced the challenge of an aging population, leading to discussions about the sustainability of its social security system. Policymakers are continually evaluating and reforming various aspects of social security to adapt to changing demographics and economic realities.

  • Pension Reforms. One of the primary areas of reform has been the pension system. As the population ages and the ratio of retirees to active workers increases, there is growing concern about the financial sustainability of the “pay-as-you-go” pension model. To address this, Germany has implemented reforms to gradually increase the retirement age, encouraging individuals to work longer before claiming their pensions. Additionally, adjustments to pension calculations have been made to align benefits more closely with lifetime earnings.
  • Long-Term Care Insurance. With an aging population, the demand for long-term care services has surged. To meet this challenge, Germany has introduced reforms to expand and enhance long-term care insurance. These reforms aim to provide better coverage and support for those in need of care while relieving some of the financial burden on families.
  • Labor Market Integration. Encouraging labor force participation, especially among older individuals and women, has been a focus of recent reforms. Politicians have introduced measures to promote flexible work arrangements, lifelong learning, and retraining to ensure that people can remain economically active for longer periods
  • Healthcare Sustainability. Healthcare costs have been on the rise due to advances in medical technology and the aging population. Reforms have aimed at improving the efficiency and cost-effectiveness of healthcare delivery while maintaining high-quality care. Initiatives such as cost containment measures and the promotion of preventive healthcare have been implemented.

In conclusion, the evolution of social security in Germany reflects the nation’s commitment to the well-being of its citizens. From its inception in the late 19th century to the present day, Germany’s social security system has grown and adapted to meet the needs of its people. As the country faces new challenges and opportunities, it remains dedicated to providing a strong safety system for all its citizens, ensuring that social security continues to play a vital role in its society.

Mandatory and Recommended Vaccinations in Germany

Vaccinations in Germany

Vaccines are some of the most effective preventive measures to protect against infectious diseases. Although they are not compulsory in Germany (with one exception that you will find later in this article), all health authorities strongly recommend it.

The Standing Commission on Vaccination (STIKO) at the state-run Robert Koch Institute decides which vaccinations are recommended in Germany. The Federal Ministry of Health (Bundesministerium für Gesundheit) appoints the members of STIKO, who are primarily doctors from university hospitals. The current and up-to-date recommendations on vaccinations are always available on the website of the Robert Koch Institute, which is also available in English. 

getting vaccinated Vaccination

Is it compulsory to be vaccinated in Germany?

If you recently moved to Germany and are planning to start a family in the country, you should be informed about the vaccines that you and your children may need.

As we mentioned before, unlike other European countries, there is no compulsory vaccination in Germany. However, there is one exception to the rule: the measles vaccination. The Measles Protection Act, which came into force on March 1, 2020, is intended to provide school and kindergarten children with effective protection against measles. However, regardless of this, it is important to educate people about the importance of vaccination and to make vaccination easily accessible to all citizens.

Having said this, the Federal Ministry of Health and the Robert Koch Institute recommend the following vaccinations for all citizens living in the country:

Vaccine recommendations for children and adolescents in Germany

  • Diphtheria
  • Tetanus
  • Poliomyelitis (polio)
  • Haemophilus influenzae type B (Hib)
  • Pertussis (whooping cough)
  • Hepatitis B
  • Measles, mumps, rubella (MMR)
  • Chickenpox
  • Rotavirus, pneumococcal infection
  • Meningococcal C infection
  • HPV (human papillomavirus)

Booster vaccinations for adults in Germany

Booster against diphtheria and tetanus (recommended every ten years)

Booster against measles (people over the age of 18 who were born after 1970 and are unsure of their vaccination status, have not been vaccinated, or have received only one vaccine as a child).

Vaccine recommendations in Germany for people over the age of 60

  • Influenza
  • Pneumococcal infection
  • Herpes zoster (shingles)
  • Further vaccinations for unvaccinated adults after consultation with a doctor
Senior Citizen getting vaccinated
Vaccine Covid 19

The COVID-19 vaccine

The introduction of a mandatory vaccination program for the entire population in Germany was heavily debated, but it was unsuccessful in the German parliament’s Bundestag. When it comes to making COVID-19 vaccinations a requirement, Germans place a high value on self-determination and freedom of choice. According to a survey that was carried out, 63 % of Germans agree that vaccinations are a matter of personal autonomy that the state cannot interfere with, even during a pandemic. However, the majority of the German population is vaccinated against COVID-19: 78 % of people have received at least 1 dose and 76.4 % of Germans are fully vaccinated.

The vaccination record or Impfpass

The vaccination record, also known as the Impfpass, is a yellow booklet that is given to you after you are vaccinated for the first time in Germany. This booklet contains a record of all your vaccinations, making it easier for you to keep track of all your vaccines.

In addition to the vaccination record, you can get a second record book for your children (also known as a Kinder-Untersuchungsheft) for pediatric medical examinations. All of your child’s medical check-ups and assessments will be recorded in this booklet up until the age of six. You receive this booklet shortly after delivery.

Vaccination Card Impfpass Record
Medical Bill Health Insurance

Who covers the cost of vaccines?

The statutory health insurance funds in Germany (GKV) spend about 1.4 billion euros annually on vaccinations (as of 2017, according to the Federal Ministry of Health). Therefore, people who have statutory health insurance are entitled to the vaccinations that are recommended in Germany at no additional cost.

If you’d like to find out more about your health insurance coverage and how you might be able to optimize it, our team of experts will be happy to advise you. Contact us here!

Vaccines are extremely efficient not only because they provide individual protection, but also because they lead to herd immunity, protecting a large part of the population against diseases.

We hope that you found this article useful and it helped you learn more about vaccination in Germany. We must never forget that countless deaths are prevented worldwide thanks to vaccines, so we should stay protected!

German Healthcare Terms Expats Should Know

For expats residing in Germany, it is helpful to learn some of the key German healthcare terms so that you are able to make informed decisions regarding your health and wellbeing both during and after you move.

Moving to a foreign country can be daunting, especially when you don’t know much about the new land’s laws and regulations. On top of that, if you are not well-versed with the language of your new country of residence, you are bound to feel confused and most likely overwhelmed.

Keeping that in mind, we decided to share everything about the German healthcare system for expats living in Germany. Germany has one of the oldest healthcare systems in Europe, dating back to the 1880s, and is now ranked among the best in the entire European region. Anyone living in the country can access the medical facilities offered by the state through health insurance Germany

Sponsored by state-funded programs, healthcare in Germany is accessible to all. But that’s not all; people can (and do) acquire some of the best private health insurance policies in the country to bear expenses not covered by the statutory funds, such as advanced dental procedures. 

German Healthcare Terms Expats Should Know

Here are some German healthcare and related terms you should know as an expat:

  • Arzt (doctor) 
  • Hausarzt (GP, primary care doctor, family doctor)
  • Überweisung (referral from your GP to a specialist)
  • Rezept (prescription)
  • Krankschreibung or Attest (sick note)
  • Zahnarzt (dentist) 
  • Krankenhaus (hospital)
  • Patient (patient)
  • krank (sick)
  • Medizin or Medikament (medicine)
  • Öffentliches Krankenhaus (public hospital)
  • Frei gemeinnütziges Krankenhaus (non-profit hospital)
  • Privatkrankenhaus (private hospital)
  • Apotheke (pharmacy)
  • Heilpraktiker (alternate practitioner/naturopath)
  • Notaufnahme (emergency room)
  • Rettungswagen (fire brigade ambulance service)
  • Krankenwagen (ambulance)
  • Impfung (vaccine)
  • Krankenkasse (health insurance provider)
  • Krankenversichertenkarte (health insurance card)
  • Sozialversicherungsnummer (social security number)
  • Gesetzliche Krankenversicherung (statutory health insurance/public health insurance)
  • Private Krankenversicherung or PKV (private health insurance)

Now that you know about the common German healthcare terms, let’s understand German healthcare.

Understanding Health Insurance in Germany

While the statutory programs take care of all medical health expenses residents incur the country, they need to pay some premium for that. 

The GKV program is managed by 110 Krankenkassen (non-profit organizations that overlook GKV). Once registered with GKV, a person has to pay a premium at the rate of 14.6% of the annual gross salary (7.3% paid by the employee, the other 7.3% taken care of by the employer). All Krankenkassens must charge the same percentage of a beneficiary’s gross yearly salary. If you are asked for more, know that something is not right. 

The amount an employee has to pay for the GKV scheme cannot exceed 4350 euros a month, which is shared equally by the employee and employer. 

Once you have registered with a particular Krankenkassen, you must stay with it for at least 18 months. After the 18 months have passed, only then can you go to a different organization. 

GKV Coverage

As mentioned earlier, GKV or Gesetzliche Krankenversicherung is a federal scheme to facilitate people residing in Germany in getting access to public health. This means, if you want to get state-provided medical benefits, you must sign up with a Krankenkasse. That said, not all medical expenses are covered by said state healthcare program. 

You will receive free services from registered doctors, hospital care (both in- and out-patient) and basic dental treatment. For any advanced medical treatment, you may have to get private medical insurance or pay out of pocket

One other thing about getting registered with a Krankenkasse for GKV is that it will look after the expenses of all the non-working family members residing with you in Germany. You will not have to pay any added amount for getting the medical costs of your dependent kin covered by GKV, provided that they live with you. 

For availing the benefit of having your family’s medical expenses taken care of under GKV, you and they should share the same address that you have given to the Krankenkasse dealing your case. 

Getting German Health Insurance

Expats and permanent residents in Germany can take out public health insurance by following these steps. 

  • Registering at a nearby town hall
  • Once you are registered with the German authorities you will get a social security number, aka Sozialversicherungsnummer as called in the German language. 
  • Next you will begin paying the standard premium and have access to all public medical care amenities. 
  • You should then sign up with a local insurance fund that will provide you with a card. You will have to carry it with you to every doctor’s appointment or visit to the hospital. 

Since public health doesn’t cover all medical expenses, such as cosmetic treatments, some people choose to get private insurance. But not everyone can take it out. There are a bunch of terms and conditions that must be fulfilled if a person wishes to have private medical coverage. 

Choosing Between Private and Public Medical Insurance In Germany

By law, every person residing in Germany needs to take out private or public medical insurance. But which option of the two you pick will depend on your job status and earning. 

Statutory Healthcare in Germany is classified as compulsory (pflichtversichert) health insurance, voluntary (freiwillig versichert) health insurance and getting insured under a family plan. This classification only applies to the public scheme. As the name gives away, the former category is for people who must sign up for public health insurance or GKV while the latter is for those who are free to choose their insurance plan (between private and public). 

Who Has To Apply For Compulsory Insurance?

Compulsory public health insurance is for employees who earn less 64.350 euros per year. If your annual salary doesn’t add up to 64.350 euros or more, you are bound by law to take out a public health fund. 

Who Can Get Voluntary Insurance

Everyone who doesn’t qualify for compulsory insurance automatically becomes eligible for voluntary insurance. Still, here is a quick rundown of people who meet the criterion for freiwillig versichert. 

  • People earning more than 64.350 euros a year
  • Self-employed people or freelancers
  • Students 
  • Stay-at-home family members, primarily spouses. 

What Does Private Insurance Cover

Like in pretty much all other countries, private healthcare insurance covers a larger array of medical expenses, depending on the policy you take out. 

Beneficiaries can get a mix and match of benefits from private insurance based on their needs as you can get coverage for anything and everything. 

Some people like to have a better dental coverage program while others might go for having private rooms or even both. One of the most appealing aspects of private medical insurance is that you can get appointments with specialists much faster than if you are under public health coverage. 

In the public scheme, or GKV, patients will have a general physician or primary care doctor (Hausarzt) assigned to them, which they can choose themselves. This doctor will examine patients and refer them to specialists if need be. 

But since specialists typically have appointments lined up for months in advance, people with public health insurance have to wait for their turn, which can take a while.  

Hospital and Other Medical Services in Germany

If you are registered under GKV, you can access all public healthcare facilities as a German citizen. 

Whether you have public medical insurance or took out private insurance, you should have some basic idea about the hospitals and medical facilities in Germany. To educate you on the topic, here is a quick overview of healthcare organizations in the country.

There are three types of hospitals (Krankenhäuser) in Germany

  • Public, owned and managed by government authorities
  • Non-profit, owned and managed by charitable organizations or churches
  • Private, owned and run by a private association. 

Mother Care and Pregnancy Care Services

Since going through pregnancy and subsequent childbirth is arguably the most common medical need, knowing about the services available for it is important. 

All pregnancy related issues are covered by public health insurance, including sexual, fertility and urological matters. On the contrary, in the case of private insurance, some pregnancy-related expenses may not be covered, depending on the program you choose. So, be sure to go through all your options and pick the best program for yourself. 

Contraceptive items, such as birth control pills, and IUDs must be prescribed by a gynaecologist while emergency contraceptives can be bought over the counter. 

Ending Note

The German healthcare system is among the most advanced in the world. If you want to have access to it, be sure to sign up for medical insurance, private or public, as early as possible. And if you are an expat living here, look up expat health insurance Germany to not miss out on any healthcare amenities and services. 

Public or Private Health Insurance in Germany: Which Is Better for Expats and Why?

As an expat in Germany, getting health insurance is a crucial part of securing the best healthcare for yourself. Not only is it a requirement, but opting for public or private health insurance can make all the difference.

Expats are eligible for State healthcare, but it’s not as comprehensive as some private policies that can help you get various health-related treatments that are within your insurance policy.

Of course, there are additional costs to bear, but it could also help you save money in the long term. So, regarding expat health insurance in Germany, we’ll help you decide whether private service or public is a good option for you based on your needs. Here’s what you should know. 

Private vs Public Health Insurance?

Some people living in Germany do not have the choice of opting for the best private health insurance. So, if they earn less than €64,350 in a year, they cannot opt for private insurance. They will need to continue using public health insurance. This is applicable to both expats and locals. 

However, if you earn more than that figure annually, you can choose between the best private health insurance in Germany or public insurance. There are some reasons why you may want to opt for private insurance. Here’s what they are. We also mention one advantage that’s worth noting if you choose public insurance. 

Private Health Insurance Has More Coverage than Public Insurance

Public insurance covers only limited healthcare treatments. There’s also only basic coverage for dental work. On the other hand, private health insurance can offer a variety of additional forms of healthcare coverage based on your needs.

More coverage could increase the price of your policy, so you can choose coverage for only those treatments that you feel you will need at that moment or in the future. In any case, the coverage for the following is comprehensive with private health insurance as opposed to only basic coverage with public insurance. 

  • Treatment coverage 
  • Dental care
  • Medication 
  • Contacts and Glasses
  • Alternative Treatment 

Private Health Insurance Can Limit Waiting Times for Appointments with Specialists  

With public health insurance, people may have to wait for months until they can get an appointment with a specialist (if they want that to be covered). This is because there are long waiting lines, and you will have to wait on the list. However, private insurance can cut down on those waiting times by allowing only short notice periods. 

Private Health Insurance Allows You to Choose Your Private Specialists and Hospitals

You get to choose both the doctors and the hospitals with a private health insurance policy. With a public insurance policy, you will have to use whatever the state gives to you. 

Private Health Insurance Can Have Coverage Outside of Germany

If you’re an expat who travels a lot, you can certainly benefit from private health insurance. This is because public insurance is geographically limited to Germany and the EU only, while many private health insurance policies offer coverage in different parts of the world. Therefore, you will be protected even if you get sick and receive treatment from a country outside the EU. 

Public Insurance Does Not Have Upfront Costs

One important advantage that public insurance has over its private counterpart is there are no upfront costs of treatments that are covered. However, with a private insurance policy, you will need to pay the charges upfront and then have them reimbursed. That said, you will limit your treatment options and the healthcare facilities when you opt for public insurance. 

When to Choose Private or Public Health Insurance in Germany

Whether you choose private or public insurance will depend on what type of coverage you need for insurance. If you typically don’t have medical bills that are anything more than what’s included in basic coverage, you don’t have to opt for private service.

However, if you want extended dental coverage or coverage for treating chronic conditions, then private insurance is the way to go. 

Opting for private health insurance when public insurance doesn’t cover what you need can help you save a lot of money in the long term. Certain medical procedures can be expensive, and your insurance will ensure that you don’t go broke trying to stay healthy. 

It’s important to note that the coverage can vary from one private health insurance policy to another. So, be sure to review your policy carefully to ensure that it covers the specific treatments that you need. This way, you won’t have to pay for those treatments out of pocket, which, in some cases, can be fairly expensive. 

Last Few Words

The best private health insurance in Germany should be one in which you have all the coverage you need within and outside of Germany. Of course, it should also be affordable so that it makes it worth it. 

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