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If your gross monthly salary is higher than 4,575 euro, you can choose to enroll in a private health insurance program. Self-employed, civil servants and other professionals can also choose to enroll in a private health insurance program. Your employer is required to contribute the same amount they would have paid under the public system, which usually amounts to about half of the monthly premium.

There are currently about 40 private health insurance companies serving the German market and there are a wide range of options available. Generally speaking, private health care premiums for individuals under 35 years of age tend to be lower than in the public system. Premiums in the private system take into account an individual's income, state of health, age and other coverage options. Monthly premiums can be lowered by increasing co-payments and/ or deductibles. Some private insurance companies also offer a 1-2 month premium bonus if you don't use your insurance for more than 12 months.

Because the scope of services from private insurance companies is not regulated by the state, the PKVs offer more extensive coverage which can be adapted to an individual's needs. Private health insurance programs also offer better dental coverage, vision products and other medical treatments. Additionally, there is a larger pool of physicians to choose from, since many medical professionals prefer to treat privately-insured patients.

When deciding between the private and the public health care systems, it is important to weigh the costs and benefits. The major disadvantage of the private system is that non-working spouses and family members must be separately insured. Also, PKV members must initially pay for treatment costs and then submit paperwork to the insurance company for reimbursement. And finally, the decision to enroll in a PKV cannot be easily reversed. You will be not permitted to switch back to the public system unless your salary falls below the monthly threshold.

Nursing Care Insurance
Regardless of whether you are a member of the public or private health care insurance plan, you will also be required to pay into the German government's mandatory long-term nursing care plan (Pflegepflichtversicherung). This nursing care insurance covers a certain portion of the costs of personal nursing needs, such as feeding and bathing, for those people who become substantially disabled. The cost is an additional 2.35 percent of your gross salary (up to a maximum of 94 euro per month) in the GKV, and your employer will pay half of the cost.

Private Health Insurance from an International Provider
In the past, it was quite popular for expatriates to use international health insurance policies offered by insurers within the EU but outside of Germany - mostly based in the UK -because they catered to the specific needs of expats and they were less expensive. However, the German health insurance reform of 2009 required international insurance companies to comply with the German insurance code. Most of these policies failed to clear this legal hurdle and were withdrawn from the German market. This issue has become even more complicated, because some of the German regulations may be in violation of EU law. The issue revolves around whether Germany will recognize European directives for cross-border selling of health insurance for non-Germans seeking a residence permit. New developments may finally clarify the regulations and could allow non-German health insurers to compete again in the future, but right now it is a gray area.

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