Complete guide to the health care and health insurance for refugees in Germany

Every person who is legally permitted to stay in Germany temporarily or permanently is required by law to have some form of health insurance. Asylum seekers and refugees in Germany are not covered under the statutory health insurance scheme.

However, international laws and certain EU directives obligate the German health care system to provide a set of basic medical services to asylum seekers and refugees when needed. In addition, asylum seekers and refugees can request medical assistance under the Asylum Seekers Benefits Act (AsylbLG).

In recent years Germany has dealt with an enormous flow of illegal migrants which has not been seen for decades. According to some official data, an estimated number of 1.3 million migrants have entered Germany since 2015 and a great proportion of them have submitted asylum requests to German immigration authorities.

This unprecedented number of asylum seekers and refugees has brought a major challenge for the German health care system. Many of these people come in Germany come from environments where exposure to various communicable illnesses is high and the need for medical treatment is of utmost urgency.

Authorities in Germany are trying to find a common approach toward this major issue. There are some differences among federal states concerning the range of medical services asylum seekers and refugees are eligible for and bureaucratic procedures through which medical treatment for them can be delivered as well. It is therefore noticed that asylum seekers and refugees are little or no aware of how and where to seek medical assistance if needed.

Given below is everything refugees and asylum seekers in Germany must know about the German health care system.

Health Care for Refugees and Asylum Seekers in Germany

According to existing insurance laws in Germany, every legal resident in germany is required to have some form of health insurance.

That said, no health coverage under the German statutory health insurance scheme is offered to refugees and asylum seekers. Does this mean they won’t receive medical treatment at all costs unless they pay for it? Not all.

Depending on the personal medical situation of a refugee or an asylum seeker he/she is allowed to seek treatment for a set of basic medical needs free of charge.

After refugees and asylum seekers spend more than 15 months in Germany they enjoy the same benefits as other people entitled to the state-funded social scheme which also includes more extensive health care. By law, if a person lives in Germany for more than 4 years on whatever residence status he/she will be eligible for public health insurance.

Healthcare for Ukrainian Refugees in Germany

Once Ukrainian refugees enter Germany they are eligible for temporary protection status. At the Arrival Centre in Tegel, refugees will be sent to other federal states or be accommodated in Berlin— usually those that have family members in Berlin or have found a job, or permanent accommodation.

After arriving, Ukrainian refugees should apply for a temporary residence permit under the 24 Residence Act to be eligible for social benefits. They must receive their temporary residence permit at the Arrival Center at Tegel Airport. Afterward, they must apply for social benefits at the Job Centre, making them eligible for statutory health insurance. Moreover, Ukrainian refugees are also entitled to social assistance (Sozialhilfe) after contacting their local welfare office (Sozialamt). With social assistance, they don’t receive statutory health insurance but receive a health insurance card from a statutory health insurance fund, allowing them to seek out medical attention while the costs are covered by the Sozialamt.

Ukrainian refugees in Germany who are not yet registered for a temporary permit are not entitled to statutory health insurance. However, they can still get medical services until their permit is issued. Similar to other refugees, they can benefit from the Asylum Seekers Benefits Act (AsylbLG) and receive medical care for a few select medical conditions (see below). Additionally, Ukrainian refugees who have special needs can receive extensive treatment.

Please note that regardless of health insurance status all Ukrainian refugees are eligible for emergency treatments at any healthcare center in Germany.

Health Care Services to Refugees and Asylum Seekers in Germany

The Asylum Seekers Benefits Act (AsylbLG) benefits the following medical services to all asylum seekers and refugees, including Ukrainians:

  • Proper medical treatment of acute illnesses
  • Medical care for pregnant women and those who have recently given birth
  • Basic dental care
  • Preventive vaccination
  • Other essential medical services for a particular illness.

Refugees and asylum seekers in Germany have various medical issues where customized treatment is actually unavoidable. The German health care system is valued as one best in the world and fortunately, it provides some room to treat different cases individually.

The day refugees and asylum seekers are accommodated in specific reception centres they undergo certain necessary medical check-ups. Typically, this medical treatment includes x-ray tests of the lungs, skin and blood tests. If the patient has a complicated medical situation the personnel of doctors can request permission to authorities for further treatment at the hospital.

For instance, a refugee or an asylum seeker who has been exposed to severe physical or psychological torture prior to his/her arrival in Germany or after that, a specialist is called for medical assistance.

How Can Asylum Seekers and Refugees Seek Medical Assistance in Germany?

Another obstacle asylum seekers and refugees face is that they cannot seek proper medical assistance in traditional ways. One cannot simply feel ill and get to the doctor right away.

So how can asylum seekers and refugees request medical treatment in Germany?

To get medical treatment a refugee or an asylum seeker must initially provide evidence which measures how medical assistance is critical for his/her long-term health. This evidence is provided by means of a medical authorization known as “Berechtigungsschein”. Asylum seekers and refugees can get this document either at the refugee reception center or at the local social welfare office.

In addition, one has to provide strong and convincing arguments on what negative long-term effects can he/she suffer if proper medical treatment is not delivered at the right time. For instance, if an asylum seeker is willing to see a dentist he/she must argument what consequences of not getting his/her medical treatment will have for his teeth in the future.

Although these procedures still apply the system has often been subject to critics. Several in-depth investigations have found that this system accounts for significant administrative burden. It is also noted that it often fails to deliver the required medical assistance at the right time due to the incompetence of local authorities to make decisions over individual cases.

To solve this issue several federal states are closely reviewing their policies to facilitate the process of seeking medical treatment for refugees and asylum seekers.

So far Berlin, Brandenburg, Bremen, Hamburg, Schleswig-Holstein and Thuringia are no longer issuing medical certificates to asylum seekers and refugees based in personal cases. Instead, once asylum seekers arrive at a reception centre and undergo regular medical check-ups they’re issued a medical certificate (Gesundheitkarte) which allows them to seek a doctor without having to go through old bureaucratic procedures. Usually, a Gesundheite card is valid for up to three months and can also be used in case of any emergency.

However, health insurance cards cannot be issued to refugees and asylum seekers until they’re not assigned to a particular municipality. Only then local authorities and health insurance companies can agree on a specific contract to equip asylum seekers with health care insurance cards.

Still, in the first 15 months, the range of medical services available to asylum seekers and refugees is limited. Moreover, it is very important for people with the special status of residence in Germany to be aware of the fact that medical services to which they have access to under the Asylum Benefits Act are given in general terms.

Therefore, it is likely that during this period of time asylum seekers and refugees won’t be offered uniform medical assistance in all parts of the country.

After asylum seekers and refugees spend 15 months in Germany they enjoy the same benefits as other recipients of state social. This also means they have to share an amount of their income for health care.

Currently, the amount of money an asylum seeker and a refuge shares for his/her health care coverage is equal to 2% of their yearly income or around 400 euros each month. If the person is undergoing a long-term medical treatment the percentage share of his/her income for health care coverage is decreased to 1%.

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