The largest German health insurance fund Techniker Krankenkasse (TK) is a pioneer in enabling its members to seek treatment abroad. A 2008 survey found that around 1% of its members had care abroad in 2007, of which 7% went for scheduled healthcare, rather than for acute and emergency care while travelling. The insurer multiplied its sample to suggest that 272,000 booked ahead for care. This figure excludes spa visits and dental care not claimed back from insurers. A survey of those who had treatment abroad in 2009 suggests that 40% planned to do so, and of these 90% went for dentistry or spa treatment. For as spas and dentistry, the German customer has to pay a high proportion of the cost out of pocket. For those getting dental treatment abroad, the insurer pays out the same amount, so the balance paid by the customer when the cost is lower, is much less. As the overall cost of treatment is much lower, their own share of the costs will be much lower. Grossing up a small survey is statistically hazardous, so the insurer merely suggests that 1% of the TK’s 7.2m customers, or 72,000, had treatment abroad, but only 30,000 went for planned treatment. Multiplying this to the total population is dangerous, as TK tends to insure technicians who are generally wealthier, but with a population of 82million, a third of a million Germans had planned treatment abroad.
Before hospitals and agencies rush to seek deals with TK and other German health funds, or their customers, it is worth pointing out that no insurer shows any inclination of allowing treatment outside the EU, and the customer can only get treatment within the EU in a facility within TK’s network.
TK and the customer also share the costs of treatment at an accredited health spa, including room and board as well as travel to and from the health spa. TK members can choose a health resort outside Germany, but only one in TK’s network of 26 partners in Italy, Austria, Poland, Czech Republic, Slovakia and Hungary that TK pay on a direct basis. All facilities are inspected on site by TK for their compliance with quality standards.
The health insurance reform of 2007 requires everyone living in Germany to be insured for at least hospital and outpatient medical treatment. 85% of the 70 million population are mandatory or voluntary members of one of the statutory health insurance schemes while the others have private health insurance. And since 2009, everyone in every health fund gets charged the same premium.
TK also pays for certain costs of benefits when received in an EEA country, but only if the treatment would have been paid for in Germany e.g. no cosmetic surgery or cosmetic dentistry. And for planned treatment abroad, to get reimbursement after treatment and after they have paid the hospital/clinic themselves; the customer has to supply detailed bills/medical prescriptions. TK reimburses those costs that would have resulted from that treatment in Germany, limited to the amount of the bill, minus the additional contribution/co-payments stipulated by German law, and with other deductions. TK does not pay for travel or accommodation costs for non-emergency treatment.
TK and fellow insurer AOK also have a small network of 70 private hospitals and clinics in Austria, Belgium, Italy and The Netherlands, and others in the process of joining, where the insurer pays the bills on a direct billing basis. A key requirement to being in the Europa Service network is that the hospital must have German speaking medical and non-medical staff. The network was set up in 2004 just for AOK Rheinland/Hamburg, and in 2009, the AOKs of Berlin, Brandenburg, Sachsen-Anhalt, Schleswig-Holstein and Westphalia-Lippe joined this EuropaService.
AOK has contracts with clinics on the North Sea coast of Belgium and the Netherlands and in Austria to guarantee good medical care, simple procedures and expert service to customers in additional EU member states. It also collaborates with partners in Austria, the Czech Republic and Italy, and is developing partnerships in Poland, Spain and Turkey.
