The Health and Social System in Germany – An Overview for Study and Practice

Course content

Self-study without supervision, assignments or evaluation of learning progress by instructors; the voluntary self-reflection is for your own self-check only. This self-study course provides professional knowledge for practice. It does not replace legal advice in individual cases or any mandatory induction or instruction, and it does not fulfil any statutory or contractual training obligation; whether it can be credited is decided by your employer. The laws in their currently applicable version and the concepts and procedures of your organisation are authoritative.

PART 1 – Why a welfare state? Life risks, basic concepts and overview

Cushioning life risks collectively

Illness, need for long-term care, accidents, unemployment, old age: these are life risks that can overwhelm individuals and their families both financially and organisationally – even if they have made honest efforts to provide for themselves. A welfare state responds by not leaving such risks to individuals alone but cushioning them collectively: through insurance schemes, through help in situations of need and through special benefits for particular groups.

For you as a professional in social work, nursing and care, or counselling – and all the more so as a manager or future leader – this system is not background noise but the framework for action in your work. Whether a measure is funded, which body is responsible, which documents an application requires and how you explain this clearly to people seeking advice: all of this follows rules that can be traced back to a few basic logics. If you know these logics, you do not need to have every individual provision in your head to find your way. If you do not know them, you quickly get lost in a thicket of legal sections – and so do the people who rely on your guidance. This knowledge is also indispensable for decisions at management level: anyone who plans services, clarifies funding questions or leads teams is constantly operating within this framework.

Important basic concepts

You should keep four concepts clearly apart from the outset.Social protection (soziale Sicherung) refers in this course to the totality of legally regulated benefits and institutions intended to protect people against life risks and in situations of need and to enable them to participate in society (working definition of this course). The Social Code (Sozialgesetzbuch, SGB) already formulates the corresponding entitlement in its General Part, Social Code Book I (SGB I): within the framework of the Social Code, everyone has a right of access to social insurance (section 4(1) SGB I), and anyone who cannot help themselves and does not receive sufficient help from other sources has a right to personal and financial assistance (section 9 SGB I).

Thewelfare state (Sozialstaat) is the state that has committed itself under constitutional law to social responsibility; its foundation is the welfare state principle in Art. 20(1) GG, which Part 2 deals with. Thesolidarity principle describes the basic idea that many people bear risks together and that benefits are geared to the needs of those affected rather than to their own contributions; Part 3 illustrates it using the example of statutory health insurance (GKV). Finally, thestructural principles of insurance, social assistance and provision form a classification grid with which the wide variety of social benefits can be sorted – a teaching classification that you will need again and again in practice.

The overview as a mind map

Figure 1 shows as a mind map how the building blocks of this module fit together: the welfare state principle forms the constitutional basis, the solidarity principle the basic logic of contribution-based financing, the three structural principles classify the benefits, the subsidiarity of social assistance (Nachrang der Sozialhilfe) governs the relationship between self-help and state assistance, and the typology of welfare states places Germany in international comparison. Feel free to return to this figure if you lose track during the course.

PART 2 – Legal framework: the welfare state principle and its statutory anchors

Art. 20(1) GG – the welfare state principle

Article 20(1) of the Basic Law states: ‘The Federal Republic of Germany is a democratic and social federal state.’ The welfare state principle is derived from the word ‘social’ (Art. 20(1) GG). It is remarkable how brief this text is: it names neither benefits nor amounts nor responsibilities. It stipulates that the order of the state is to be social and leaves it to the legislature to translate this mandate into specific rules – for example, into the books of the Social Code.

This leads to an important distinction for practice: the welfare state principle is the constitutional guideline; the individual entitlements that your clients, patients or residents assert arise from the social legislation. So when you explain why someone does or does not receive a benefit, you refer to the relevant statutory provision – the welfare state principle stands behind it like a foundation, without itself determining the level of any benefit.

Outlook: the minimum subsistence level as a fundamental right

A landmark decision shows how seriously the welfare state principle is taken in law: in 2010 the Federal Constitutional Court (Bundesverfassungsgericht, BVerfG) derived from Art. 1(1) GG in conjunction with the welfare state principle of Art. 20(1) GG a fundamental right to the guarantee of a minimum subsistence level consistent with human dignity, which secures not only physical existence but also a minimum level of participation in social life (BVerfG, 2010).

You do not need to go into this in more depth at this point. The topic is deliberately framed as an outlook: Module 7 returns to the decision when it deals with Grundsicherungsgeld (basic income support benefit) and social assistance. For this module it is enough to recognise that, at the lower end of protection, the welfare state principle is linked to a fundamental right. Help in extreme need is therefore not charity but a legally anchored task of the state.

Sections 4 and 9 SGB I – two statutory anchors

The Social Code anchors the two most important logics of social protection in its General Part. Under section 4(1) SGB I, everyone has a right of access to social insurance within the framework of the Social Code. Under section 4(2) SGB I, insured persons in health, long-term care, accident and pension insurance have a right to the necessary measures to protect, maintain, improve and restore their health and capacity to work, and to financial security in the event of illness, maternity, reduced earning capacity and old age; surviving dependants also have a right to financial security. Here you can recognise theinsurance principle: anyone who is insured is entitled to protection when the insured risk occurs.

Section 9 SGB I, by contrast, describes welfare in the form of social assistance (Sozialhilfe). Anyone who cannot meet their living costs from their own resources or cannot help themselves in particular circumstances, and does not receive sufficient help from other sources, has a right to personal and financial assistance. This assistance is to meet the particular need, enable self-help, make participation in community life possible and secure a life consistent with human dignity; those entitled to benefits must cooperate to the best of their ability (section 9 SGB I). Note the two building blocks ‘no sufficient help from other sources’ and ‘cooperation to the best of one’s ability’: they lead on to subsidiarity, the next topic.

The subsidiarity of social assistance (section 2 SGB XII)

Under section 2(1) SGB XII, social assistance is subsidiary: it is not granted to anyone who can help themselves, above all by using their capacity to work, their income and their assets, or who receives the necessary support from others – for example from relatives or from providers of other social benefits. Subsidiarity explains why counselling sessions so often begin by asking which priority benefits exist: before welfare steps in, insurance benefits, a person’s own means and other forms of help have to be clarified. Subsidiarity does not imply that the help is of lesser value; it describes an order of precedence.

For managers this has a practical consequence: counselling and social services should design their processes so that priority entitlements are systematically clarified before welfare benefits are applied for – and so that people are not lost between the different bodies in the process. Module 3 and Module 8 deal with how this can be achieved.

PART 3 – The solidarity principle and the three structural principles

The solidarity principle: contributions according to income, benefits according to need

At the heart of social insurance is the solidarity principle: many people pay in, and anyone affected by a risk receives benefits – regardless of how much they themselves have contributed. You can see this most clearly in the GKV. Contributions depend on income: according to the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG, 2026a), the general contribution rate in 2026 is 14.6 per cent; in addition there is a supplementary contribution (Zusatzbeitrag), which averages 2.9 per cent and may vary from one health insurance fund to another. For employees, employers and employees each pay half of the contribution.

Benefits, on the other hand, are based on need. Insured persons receive them as benefits in kind and services (benefits-in-kind principle, Sachleistungsprinzip, section 2(2) sentence 1 of Social Code Book V, SGB V), and the health insurance funds (Krankenkassen) provide them in accordance with the principle of economic efficiency (Wirtschaftlichkeitsgebot), insofar as they are not attributed to personal responsibility (section 2(1) sentence 1 SGB V). Whether someone sitting in the emergency department pays a higher or lower contribution therefore makes no difference to the fact that the necessary care is based on need – not on the level of contributions. Solidarity is particularly visible in family insurance (Familienversicherung): co-insured family members – children as well as spouses and registered civil partners – do not pay their own contributions (BMG, 2026a).

Figure 2 shows this balancing effect in figures: in March 2026, 74,495,244 people were insured in the GKV, of whom 58,714,600 were members and 15,780,644 were co-insured family members (BMG, 2026b). This is a finding about the structure of the insured population. The interpretation that it reflects a balancing of solidarity follows from the rules on family insurance, not from the statistics themselves; moreover, the figures say nothing about how the burden of contributions is distributed in detail.

Three structural principles: insurance, social assistance, provision

To classify the large number of social benefits, a threefold division has proved useful in teaching. Theinsurance principle (Versicherungsprinzip) refers to contribution-financed social insurance; its statutory anchor is section 4 SGB I. Thesocial assistance principle (Fürsorgeprinzip) refers to means-tested, subsidiary, tax-financed assistance; its statutory anchors are section 9 SGB I and section 2 SGB XII. Theprovision or compensation principle (Versorgungs- oder Entschädigungsprinzip) stands for benefits for particular groups, for example after an event causing harm; this course deals with it only in general terms. Module 2 systematically classifies the five branches of social insurance – health, long-term care, pension, accident and unemployment insurance.

Figure 3 arranges the three principles in a four-field table according to two guiding questions: who finances the benefit – the community of insured persons through contributions or the general public through public funds? And is need clarified? Insurance is at the top left, social assistance at the bottom right, provision at the top right; the fourth field – contribution-financed and at the same time dependent on need – is not a typical case in this classification scheme.

Table 1 adds further features to the four-field table that are important for your counselling and management practice: the legal basis of entitlement, the example and the statutory anchor.

Assigning with three guiding questions

In practice, three guiding questions are enough to provisionally classify a benefit or an enquiry; Figure 4 summarises them as a decision tree. The first question is whether the benefit is financed from contributions by insured persons. If not, ask secondly whether need is clarified, i.e. whether income and assets play a role. If that does not apply either, ask thirdly whether the benefit is linked to a special reason, such as harm suffered. If the assignment remains open, this is not a mistake but an indication that the legal basis and the responsible body need to be clarified more precisely. The tree deliberately simplifies and is not a legally binding classification.

PART 4 – Application: assigning, explaining, classifying

Worked example: one family, three principles

Before you practise on your own, here is a fully worked example. The Arnold family is fictitious; the sole purpose is to demonstrate the logic of assignment, not to evaluate or calculate individual entitlements. Figure 5 shows the five steps that we will now go through one after the other.

Initial situation. Moritz Arnold has been ill for several weeks and is receiving medical treatment. His partner Ella Arnold loses her job and registers as unemployed. Their daughter Mila is co-insured in the GKV through her parents. Ella’s mother Nele Voigt, Mila’s grandmother, receives an old-age pension that is barely enough to live on. One of Moritz’s brothers, Henry Arnold, receives benefits under social compensation (Soziale Entschädigung) because of the consequences of an event that caused him harm.

Two case examples from the field

Exercise: assigning five situations

PART 5 – Critical evaluation: Germany in comparison, limits and open questions

Types of welfare state: Germany in international comparison

A look beyond national borders helps you to understand the German solution as one of several possible ones. The typology put forward by Esping-Andersen in 1990 distinguishes three ‘worlds of welfare capitalism’, as Schmid (2020) sets out in his encyclopaedia article on the welfare state in Europe. Figure 6 summarises the three types with their example countries and characteristics.

Germany is assigned to the conservative continental European type and is regarded as an example of a social policy oriented towards classic social insurance schemes (Schmid, 2020). The typology is a classification grid: it helps with comparison but does not capture every particular feature of a country, and real systems contain elements of several types. Please also note that only the three types presented by Schmid (2020) are used here; other classifications are not the subject of this module.

Criticism, limits and open questions

The characteristics that Schmid (2020) names for the conservative continental European type are at the same time the starting points for criticism. This is an interpretation, and you should label it as such when you use it in your studies or in practice:

• Status-related rights: If social rights are linked to status and to an insurance relationship, protection depends on whether and how someone is positioned within the system. Anyone who is not, or only patchily, integrated into insured employment is more dependent on subsidiary social assistance.
• Focus on wage labour: A system that is strongly geared to social insurance and wage labour reflects life courses outside the classic employment biography less well – care work, for example.
• Inequality: The typology attributes relatively high inequality to this type (Schmid, 2020). Whether and to what extent it occurs in a specific field is an empirical question that this module does not answer.

The solidarity principle itself also has limits. The GKV levies contributions only up to the contribution ceiling (Beitragsbemessungsgrenze), which in 2026 is 5,812.50 euros per month, and the compulsory insurance threshold (Versicherungspflichtgrenze) of 77,400 euros per year limits the group of compulsorily insured persons (BMG, 2026a). What this means for the distribution of the burden is judged differently in political terms: one position emphasises that solidarity-based protection should rest on the broadest possible contribution base. Another position highlights personal responsibility, which the law also mentions when benefits are only provided insofar as they are not attributed to personal responsibility (section 2(1) sentence 1 SGB V). Both views can be justified; as a professional you need to know them and be able to present them objectively without taking sides yourself.

Finally, there remains a question of access: rights are only of use if people know about them and can enforce them. A structured system with many responsibilities can itself become a barrier. Module 3 and Module 8 take this up and ask what professionals and managers can do about it.

Implications for management and practice

What does all this mean for your day-to-day work? First: a shared language within the team saves time and avoids misunderstandings. If everyone knows what is meant by insurance or social assistance logic, handovers and case discussions become more precise. Second: attitude matters. Social benefits are rights granted by the welfare state on the basis of laws, not acts of grace; this applies also, and especially, in the area of social assistance. Respectful language towards benefit recipients is therefore a professional requirement, not merely a matter of courtesy. Third: be honest about the limits of your role. You classify and refer on, but you do not decide on entitlements. And fourth: keep in mind the order that subsidiarity prescribes – priority entitlements first, social assistance as a supplement.

In the next modules you will build on this foundation: Module 2 covers the five branches of social insurance with their risks and contributions, Module 3 the responsibilities within the structured system. The guiding questions from this module will continue to accompany you.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – Introduction and key terms: what defines social insurance in Germany

From principles to branches

Module 1 introduced the insurance principle as one of three organising lines of the social system: contribution-financed protection in which entitlement follows from the insurance relationship and not from a check of need. This module now opens up how this principle works in practice. The question is no longer why social insurance exists, but: which branches exist, which life risk does each one cover, who pays, and what do insured persons receive when the risk materialises?

For managers, this map is directly useful for three reasons. First, you need it to refer employees to the right body after an accident at work or during a long illness. Second, it helps you clarify responsibilities in conversations with clients and relatives without providing legal advice. Third, every academic paper on the social system requires a clean allocation of risk, law and financing. Figure 1 shows the five branches as a mind map; it forms the common thread for the whole module.

Social insurance: working definition and legal anchor

In everyday language, the term social insurance is used in broader and narrower senses. The working definition of this course (not statutory wording) is: social insurance (Sozialversicherung) refers to the legally regulated, essentially contribution-financed protection against typical life risks, under which insured persons have a legal entitlement to benefits once the insured event occurs. The legal anchor is provided by section 4 of Book I of the Social Code (SGB I): within the framework of the Social Code, everyone has a right of access to social insurance (subsection 1). You know from Module 1 which rights insured persons have in health, long-term care, accident and pension insurance under subsection 2; for this module it is also important that surviving dependants have a right to economic security as well.

Three technical terms underpin the entire module. The life risk is a typical event that endangers health or income, such as illness or unemployment. The insured event (Versicherungsfall) is the legally defined occurrence of such a risk; only this triggers entitlements. The contribution (Beitrag) is the ongoing payment with which the community of insured persons – or, in one branch, the companies – finance the benefits. The public body or authority that provides the benefit is called the benefit provider (Leistungsträger, section 12 SGB I); more on this in Module 3.

The five social insurance schemes and their branches

Under section 1(1) sentence 1 SGB IV, the common provisions for social insurance apply to statutory health, accident and pension insurance, including old-age security for farmers (Alterssicherung der Landwirte), and to social long-term care insurance. Unemployment insurance is regulated as employment promotion in SGB III. Together, this gives the five branches which, in practice and teaching, are referred to for short as ‘the five social insurance schemes’: health insurance (SGB V), long-term care insurance (SGB XI), pension insurance (SGB VI), accident insurance (SGB VII) and unemployment insurance (SGB III).

Rule of thumb: Each branch covers one life risk. If, when an event occurs, you first ask about the risk and only then about the name of the benefit, you will allocate it correctly in most cases. Figure 2 adds the laws and the financing of the individual branches to the mind map.

PART 2 – Legal framework: common provisions, contribution logic and financing

SGB IV as an umbrella and the special position of employment promotion

Book IV of the Social Code acts as an umbrella: it bundles rules that apply jointly to several branches instead of repeating them in each specialised book. For this overview, it is enough to note that for questions affecting all branches you should look first in SGB IV and only then in the relevant specialised book. Unemployment insurance stands somewhat apart here: it is regulated as employment promotion in SGB III and is not mentioned in the list in section 1(1) sentence 1 SGB IV; its contribution rate is governed by section 341 SGB III. This can be read as a special position.

For your studies, this leads to a rule of wording: ‘the five social insurance schemes’ is an established formula in practice and teaching. The law itself distributes the branches across different books, and in an academic paper you gain precision by stating this explicitly once.

Health insurance: contribution rate, supplementary contribution and equal sharing

Statutory health insurance (gesetzliche Krankenversicherung, GKV) is the branch with the best-documented contribution logic. For 2026, the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG), as of 3 September 2026, states a general contribution rate of 14.6 per cent for members entitled to sickness benefit (Krankengeld) and a reduced contribution rate of 14.0 per cent. In addition, there is a supplementary contribution (Zusatzbeitrag), whose average rate in 2026 is 2.9 per cent; the individual health insurance fund may deviate from this (Bundesministerium für Gesundheit [BMG], 2026a). For employees, the contribution, including the supplementary contribution, is borne half each by employers and employees; co-insured family members pay no contribution (BMG, 2026a). The three tiles summarise the contribution figures.

Two terms deserve an explanation. The contribution rate (Beitragssatz) is the percentage applied to income subject to contributions; it therefore makes the contribution burden income-dependent, which corresponds to the solidarity principle from Module 1. The income ceiling for contributions (Beitragsbemessungsgrenze) determines up to what level of income contributions are calculated; in 2026 it is EUR 5,812.50 per month (BMG, 2026a). The fact that this upper limit exists is important for the critical discussion in Part 5.

Unemployment insurance: employment promotion under SGB III

Unemployment insurance covers the risk of losing paid employment. Its contribution rate is 2.6 per cent (section 341(2) SGB III). This course does not go into detail on how the burden is divided between employers and employees; the benefit providers can give information on this. It is typical of this branch that it does not only replace income but also provides help with job placement and qualification – hence the statutory name ‘Arbeitsförderung’ (employment promotion). Part 3 shows how this insurance benefit is to be distinguished from the tax-financed basic income support for jobseekers (Grundsicherung für Arbeitsuchende).

Statutory accident insurance: prevention, rehabilitation, compensation

Accident insurance differs from the other branches in its financing: liable to pay contributions are the entrepreneurs for whose enterprises insured persons work (section 150(1) sentence 1 of Book VII of the Social Code, SGB VII). Insured persons do not pay a contribution of their own. Its tasks are also broader than the name suggests: under section 1 SGB VII, they concern the prevention of accidents at work, occupational diseases and work-related health hazards, the restoration of health and compensation through cash benefits.

For managers, prevention is a point of connection: the legislator names it as an objective of this branch. What this means in detail for the obligations of your organisation is clarified by specialist advisory services, the legal department or the staff representation body (Mitarbeitervertretung).

Pension insurance and long-term care insurance at a glance

Statutory pension insurance (SGB VI) covers the risks of old age and reduced earning capacity (Erwerbsminderung) and contributes to the economic security of surviving dependants (cf. section 4(2) SGB I). This course deliberately does not state contribution rates, pension values or the pension level; such figures change and belong in up-to-date information from the pension insurance providers.

Social long-term care insurance (SGB XI) covers the risk of need for long-term care (Pflegebedürftigkeit) within the meaning of section 14(1) SGB XI, i.e. health-related, lasting impairments of independence or abilities. How exactly the term is defined and how care grades (Pflegegrade) and benefits are derived from it is dealt with in Module 5.

The following table brings together the findings of this part and adds the typical benefit of each branch.

PART 3 – From contribution to benefit: the benefit logic step by step

Five stages from contribution to benefit

Despite all the differences in detail, all branches follow a common basic pattern, shown in Figure 3. First, there is compulsory insurance, and contributions are paid on an ongoing basis – this is the contribution phase. When the insured event occurs, the benefit phase begins: the person concerned or the organisation reports the event or submits an application, the benefit provider clarifies whether the statutory requirements are met, and provides the benefit. Which body is responsible in each case and how applications are forwarded is the subject of Module 3.

At the same time, the graphic makes visible what the solidarity principle from Module 1 means in practice: there is no personal savings account between the contribution phase and the benefit phase. The legal entitlement arises from the insurance, not from the sum of one’s own payments. The misconception discussed in Module 1 – that higher contributions bring better treatment – is thus dispelled here too.

Benefits in kind, services and cash benefits: the example of health insurance

The types of benefit are best explained using SGB V. Under the benefits-in-kind principle (Sachleistungsprinzip, section 2(2) sentence 1 SGB V), which you know from Module 1, insured persons generally receive benefits as benefits in kind and services. In addition, there are cash benefits such as sickness benefit, the amount of which, under section 47(1) SGB V, is based on previous regular earnings (Regelentgelt) and is capped.

A useful observation can be derived from this: benefits in kind are geared to medical need, while income replacement benefits such as sickness benefit are geared to previous income. In the health insurance branch, two logics thus meet – needs-based care and the idea that the level of a replacement follows previous earnings. Module 4 takes up both and works through a sickness benefit calculation.

Contribution or need? Distinguishing employment promotion from basic income support

A common confusion concerns unemployment insurance and basic income support for jobseekers. Both have to do with unemployment, but follow different principles. Employment promotion under SGB III is an insurance benefit and is linked to the insurance relationship. Basic income support under Book II of the Social Code (SGB II) is social welfare (Fürsorge) in the sense of Module 1: among other things, it requires the ability to work and need of assistance (section 7(1) sentence 1 SGB II; details in Module 7). Since the New Basic Income Support (Neue Grundsicherung), which has applied in stages since 1 July 2026, the benefit has been called ‘Grundsicherungsgeld’ (basic income support benefit, section 19(1) SGB II), as reported by the Federal Government (Bundesregierung, 2026a); ‘Bürgergeld’ (citizen’s income) is now only the former name.

A simple question helps with the allocation: is the benefit claimed on the basis of an insurance relationship, or does it depend on someone being unable to meet their needs in any other way? In the first case it is social insurance, in the second social welfare. Module 7 covers subsistence support in depth.

Worked example: a working life in four events

Before you allocate events yourself, you will see a worked example. The fictitious nursing assistant (Pflegehelferin) Maja Nowak experiences four events over the course of her working life. For each, we ask the same four questions: Which life risk has occurred? Which branch and which legal provision apply? Who finances it? What does the branch provide in broad terms? Figure 4 guides you through the answers step by step; it is an orientation, not a review of entitlement in an individual case.

Pay attention to the line of reasoning: it is not the name of the benefit (sickness benefit, pension) that determines the allocation, but the risk that has occurred. In the case of the commuting accident, the question ‘Is the event connected with the insured activity?’ leads to accident insurance and not to health insurance, even though treatment also takes place there. At the same time, the example shows that the same person can receive benefits from almost all branches over the course of their life; this is a system that accompanies a working life, not separate pots for separate groups of people.

PART 4 – Putting it into practice: clarifying responsibility, advising, managing

The question grid for advice and management

From the worked example, a question grid can be derived that you can use in team meetings, advisory conversations and academic papers:

1. Risk: Which life risk has occurred – illness, need for long-term care, old age or reduced earning capacity, accident at work, unemployment?
2. Branch and legal provision: Which branch covers this risk, and in which law is it regulated?
3. Financing: Who pays, and is there a connection with employment or a company?
4. Benefit and binding decision: What does the branch provide in broad terms, and who clarifies the individual case with binding effect? That is the benefit provider, not the organisation.

Case examples from care and studies

The second case example is set in higher education. It shows how the allocation of financing and legal basis for entitlement is reflected in an academic paper. Figure 5 contrasts the two logics.

Holding conversations: explaining responsibility in simple words

Clients and employees rarely ask about ‘branches’; they ask: ‘Who pays for this?’ A good answer names the risk, the branch and the next point of contact, without making judgements about entitlement. Examples: ‘Because the fall happened on the way to work, accident insurance comes into consideration first – the provider will clarify this with binding effect.’ Or: ‘On the question of which benefits you are entitled to, your health insurance fund can help you with information.’ The latter is legally covered: the providers of statutory health insurance and social long-term care insurance give information on all social matters under the Social Code, including naming the competent benefit providers (section 15(1) to (3) SGB I). There is also a right to advice on one’s own rights and obligations (section 14 SGB I).

Now it is your turn: apply the question grid to six events. You have already seen a complete example in Figure 4.

PART 5 – Critical discussion: limits, areas of tension and open questions

Contribution financing: arguments and questions

Contribution financing is evaluated differently in the professional debate; this course does not take a party-political position on it. In favour of the model, it is often argued that the entitlements are legally binding, follow from an insurance and are therefore less bound up with the determination of personal neediness. This is an argument for predictability and against stigmatisation, as described in Module 1. Questions about the model focus on its link to paid employment: Schmid (2020) classifies Germany as a conservative continental European type in which social rights are strongly tied to status and wage labour and relatively high inequality exists. People without a continuous employment history may benefit less from this pattern.

A second question concerns the income ceiling for contributions. Because contributions are only calculated up to an upper limit (in health insurance in 2026: EUR 5,812.50 per month; BMG, 2026a), it is asked whether this sets limits to solidarity-based balancing. Others regard the ceiling as a precondition for contributions and benefits remaining in a recognisable relationship. The dispute therefore revolves around the question of how strongly contributions should redistribute; empirical statements on this are not part of this course and should only be made in academic papers with a source of your own.

Partial cover, gaps and transitions

Social insurance is not synonymous with full cover. Long-term care insurance, for example, does not automatically cover all costs; where income and assets are insufficient, social assistance steps in on a subordinate basis (Modules 5 and 7). In addition, the right of access to social insurance (section 4(1) SGB I) only becomes effective in practice through knowledge and submitting an application. The structured system, with its many laws and providers, can itself become a barrier to access; Modules 3 and 8 show how practitioners deal with this.

The classification also has its limits: ‘five social insurance schemes’ is a simplification. Special arrangements such as old-age security for farmers are expressly mentioned in section 1(1) sentence 1 SGB IV, but are usually not included in the teaching formula. You should be aware of such peripheral areas, but not go into them in depth unless your research question requires it.

Current development: draft for the reorganisation of long-term care insurance

Consequences for management and studies

For managers, all this results in an attitude of precise orientation without judging entitlement: you know the branches, allocate events cleanly, state figures only with year and source and leave the decision in individual cases to the benefit providers. For students, it results in a writing rule: support allocations with the legal provision, separate findings from interpretation and mark drafts as drafts. Working in this way, you remain able to act even when contribution figures or responsibilities change.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – The structured system: terms and basic idea

Why knowing who is responsible is part of professional guidance

Benefits for health, long-term care, participation and subsistence do not come from a single source. They are provided by numerous bodies, each with its own laws, its own procedures and its own contact persons. In social policy, this coexistence is called a structured system (gegliedertes System): depending on the cause and the aim of a need, a different provider organisation (Träger) is responsible. For people in difficult life situations this is often confusing, and this is exactly where professional support comes in. Anyone who knows who is responsible can shorten pathways, avoid duplicate applications and prevent concerns from being left lying between the bodies.

In Module 1 you were introduced to the insurance principle, the welfare principle and the provision principle as organising concepts, and in Module 2 to the five branches of insurance and their risks. This module adds a further layer: it asks neither about the principle nor about the risk, but about the body that acts. This is the question that clients, patients and family members ask most often, and for managers it is at the same time an organisational question: how do we make sure that this knowledge is available in the team and can be reliably accessed?

The term benefit provider (§ 12 SGB I)

The General Part of the Social Code defines who is responsible for social benefits: these are the corporations, institutions and authorities named in §§ 18 to 29 SGB I, which are referred to as benefit providers (Leistungsträger). According to § 12 SGB I, how their responsibilities are to be distinguished from one another follows from the specific parts of the Social Code. This leads to a sober but important insight: there is no single provision that governs ‘the’ responsibility. Anyone who wants to know whether a health insurance fund (Krankenkasse), a pension insurance provider or a social assistance provider is responsible has to look at the relevant book of the Social Code that governs the need.

The benefit provider must be distinguished from the service provider (Leistungserbringer). The benefit provider decides on the entitlement and approves the benefit; the service provider, such as a hospital, a care service or a counselling centre, actually delivers the benefit. For you as a manager of a social organisation, this means: your organisation is, as a rule, a service provider. The decision on responsibility and entitlement is made by the benefit provider, not by your team. Your team can, however, provide good orientation, accompany the path there and prepare applications so that they are clear and complete.

Figure 1 shows the five building blocks of this module as a mind map: the term benefit provider, the rehabilitation providers, submitting an application, clarifying responsibility and the rule of thumb for distinguishing between SGB II and SGB XII, which we look at explicitly together with its limits.

Three guiding questions for every clarification of responsibility

So that you do not have to start from scratch every time in practice, a simple structure helps. First: what is the need – treatment, long-term care, participation, protection in the event of unemployment, or subsistence? Second: what is the cause – an illness, an accident at work, a disability, a lack of income? Third: what is the personal situation – for example the question of the ability to work, age or existing insurance relationships? These three guiding questions run through the following parts and reappear in the decision tree in Figure 4.

PART 2 – Who covers what? Benefit providers and rehabilitation providers at a glance

Need and benefit provider: the responsibility map

Figure 2 assigns typical needs to the bodies that may be considered for them under the Social Code. The needs are on the left, the benefit providers with their code book on the right. The map is deliberately a selection at the level of legal provisions: it does not name any local authorities, because their names and remits differ depending on the federal state (Land) and municipality.

Two reading notes help with the map. The ‘R’ marks bodies that can be rehabilitation providers under § 6(1) SGB IX; they are described in more detail in the following section. And the dashed line is a reminder that, depending on the situation, a need can involve more than one possible provider. In addition, many people are not faced with just a single need: after a serious illness, medical treatment, long-term care, participation and securing subsistence can all play a role at the same time, and enquiries may then have to be made with different bodies at the same time.

The table serves two purposes. It is a memory aid for matching body and code book. It also shows that some bodies appear in two roles: as providers of their ‘own’ benefits and additionally as rehabilitation providers. The health insurance fund, for example, approves sickness benefit and can at the same time decide on benefits for medical rehabilitation.

Rehabilitation providers under § 6 SGB IX and the five benefit groups

Participation law (Teilhaberecht) organises its benefits into five groups. Under § 5 SGB IX these are, first, benefits for medical rehabilitation; second, benefits for participation in working life; third, subsistence-securing and other supplementary benefits; fourth, benefits for participation in education; and fifth, benefits for social participation. Who may provide these benefits is governed by § 6(1) SGB IX: rehabilitation providers can be the statutory health insurance funds, the Federal Employment Agency, the providers of statutory accident insurance, the providers of statutory pension insurance and of old-age security for farmers (Alterssicherung der Landwirte), the providers of social compensation (Soziale Entschädigung) and of soldiers’ compensation (Soldatenentschädigung), the providers of public child and youth welfare services and the providers of integration assistance (Eingliederungshilfe).

What matters is how the providers are assigned to the benefit groups, because not every provider delivers every group. Under § 6(1) SGB IX, the health insurance funds come into consideration for benefit groups 1 and 3, the Federal Employment Agency for groups 2 and 3. The providers of statutory accident insurance are named for groups 1 to 3 and 5, the providers of statutory pension insurance for groups 1 to 3. Child and youth welfare and integration assistance are named for groups 1, 2, 4 and 5; the providers of social compensation and of soldiers’ compensation for all five. Benefits for participation in education (group 4) are therefore provided neither by health insurance funds nor by pension insurance, but among others by the providers of integration assistance and of child and youth welfare; an application under § 16 SGB I can nevertheless be submitted to any benefit provider (Part 3). We look at the complete matrix and its practical significance in more depth in Module 6.

PART 3 – The application on its way: § 16 SGB I and § 14 SGB IX

Submitting an application under § 16 SGB I: every door leads further

The most common worry of people seeking advice is: ‘What if I hand in the application at the wrong office?’ The General Part of the Social Code answers this. Applications for social benefits are to be submitted to the responsible benefit provider, but are also accepted by all other benefit providers and by all municipalities (Gemeinden) (§ 16(1) SGB I). If the body is not responsible, it forwards the application without delay. The legal consequence is central for counselling: the application is deemed to have been submitted at the time it was received by the first body (§ 16(2) SGB I). According to the wording of the law, choosing the wrong addressee therefore does not cost the applicant their application date.

The third subsection is addressed to the benefit providers themselves: they work towards ensuring that clear and appropriate applications are made and that incomplete information is supplemented (§ 16(3) SGB I). This is the legal background to you going through applications together with clients without providing legal advice. At the same time, a practical tip remains: record when and where an application was handed in, ideally with an acknowledgement of receipt or a note, because the date of receipt at the first body is the decisive factor.

Clarifying responsibility under § 14 SGB IX: two and three weeks

For participation benefits, SGB IX provides for a special clarification procedure, because several rehabilitation providers may come into consideration. Within two weeks of receiving the application, the rehabilitation provider determines whether it is responsible for the benefit. If it does not consider itself responsible, it forwards the application without delay to the provider it considers responsible and informs the applicant (§ 14(1) SGB IX). If the application is not forwarded, it determines the rehabilitation need without delay and comprehensively and provides the benefits. If no expert opinion (Gutachten) is required, it decides within three weeks of receiving the application (§ 14(2) SGB IX).

The question of responsibility is thus shifted from the sphere of the people concerned to that of the administration: people do not have to find out for themselves which provider is the right one; instead, the provider that receives the application must clarify within a short period whether it is responsible. What applies further after an application has been forwarded, for example regarding reimbursement of costs between providers, is not the subject of this module and is deliberately not covered here.

Worked example: an application for retraining step by step

Before you practise yourself, we take a fictitious application through both provisions in six steps. Ayşe Rossi, an employee with a chronic back condition, will probably no longer be able to work in her previous occupation and would like to apply for retraining. This is a benefit for participation in working life, i.e. benefit group 2 under § 5 SGB IX. She hands in the application at her health insurance fund because she already knows contact persons there. Figure 3 shows the process.

This is how you think it through step by step: in the first step you ask whether the application has been received and whether the date can be proven. In the second step you know from § 16(1) SGB I that handing it in at this body was not in vain. In the third step you recognise that the special procedure under § 14 SGB IX applies, because participation benefits are involved. The assignment of benefit group 2 to the providers in § 6(1) SGB IX shows that the health insurance fund in the example may consider itself not responsible. In the fourth step this results in Route A with forwarding and informing the applicant; in the fifth step Route B, for the case where the application is not forwarded. In the sixth step you see your own contribution: you do not decide anything, but you make sure that the path remains traceable. How the two provisions relate to each other in detail when calculating deadlines is clarified in the individual case by the benefit provider or through legal advice; this is not a task for the practitioner.

PART 4 – Responsibility in practice: decision tree, rule of thumb and cases

The decision tree ‘Who is responsible?’

Figure 4 translates the guiding questions from Part 1 into a decision tree. You start at the top by clarifying the need and then ask six questions in turn. The first question concerns the cause: if there is an accident at work or an occupational disease, the path leads to accident insurance, whose tasks include prevention, restoration of health and compensation (§ 1 SGB VII). The further questions concern long-term care, rehabilitation and participation, medical treatment and finally subsistence. A ‘yes’ leads to the right to the benefit provider, a ‘no’ leads down to the next question. The tree is an orientation aid for the conversation and no substitute for the benefit provider’s decision.

Note the footnote in the graphic: several needs can exist side by side. Someone who comes to need long-term care after an accident at work may need both accident insurance and the long-term care fund. The tree is then worked through several times, and the practitioner brings the results together in an overview instead of stopping at the first answer.

The rule of thumb ‘able to work → SGB II, not able to work → SGB XII’ and its limits

In counselling, the rule of thumb that people who are able to work (erwerbsfähig) and in need of support belong with the Jobcenter, and those who are not able to work belong with the social assistance provider, has proved useful. As a first signpost this is helpful; legally it is a simplification. SGB II (Social Code Book II) is linked to several requirements at the same time: in addition to the ability to work, among others, neediness, a minimum age of 15 years, not having reached the age limit, and habitual residence in Germany (§ 7(1) sentence 1 SGB II). In addition, members of a joint household for benefit purposes (Bedarfsgemeinschaft) with persons able to work who are themselves not able to work also receive basic income support benefit, provided there is no entitlement to basic income support in old age and in the event of reduced earning capacity (§ 19(1) SGB II).

Basic income support in old age and in the event of reduced earning capacity under SGB XII, by contrast, is linked to reaching the age limit or to permanent full reduction in earning capacity from the age of 18 (§ 41(1) and (3) SGB XII); Module 7 covers the exact requirements. Social assistance is also subsidiary: it is not received by anyone who can help themselves or who receives the benefit from others (§ 2(1) SGB XII; see Module 1). The rule of thumb therefore captures the core correctly, but overlooks the age limit, the joint household and the principle of subsidiarity. What ‘able to work’ means in detail and how it is determined is decided by the responsible bodies; practitioners do not make this classification but prepare the conversation.

Practice cases from hospital and counselling

PART 5 – Critical appraisal: limits, tensions, consequences

The structured system: strength and barrier to access

The structured system can be viewed from at least two perspectives. From a legal and organisational point of view, it enables specialised bodies that map needs precisely within their code book and have expertise in risk, financing and procedures. The division by cause and aim follows a comprehensible logic which you got to know in Modules 1 and 2 as the logic of insurance and of welfare. From the point of view of the people concerned, the same structure can be an obstacle. Anyone who is ill, has little energy or only partly masters the language has to know the map of responsibilities before making a first application. This view is a professional interpretation, not a finding empirically substantiated here; it is regarded as a widespread criticism of the complexity of the system.

The provisions you have learned about in this module are a legal response to this tension. § 16 SGB I and § 14 SGB IX relieve those affected of the risk of choosing the wrong addressee. § 14 SGB I gives people seeking advice a right to advice from the benefit providers, and the participation counselling under § 32 SGB IX offers supplementary counselling independent of benefit providers and service providers, including before specific benefits are applied for. Both remain a topic in Module 8, which deals with duties to advise and the navigator role. It remains open how well these instruments actually work in practice; this course provides no evidence-based statements on this, and you should not claim any in conversations either.

Tensions for practitioners and management

A first tension concerns the practitioner’s role. Knowledge of responsibilities is meant to provide orientation without turning into binding information or legal advice. Phrases such as ‘As a rule, … is responsible for this; the provider determines this itself’ keep the balance. A second tension lies between speed and care. In everyday work, time is often pressing, for example with discharges from hospital; at the same time, applications are only helpful if they are clear and complete. A third tension concerns interfaces: when several providers are involved, coordination work arises that nobody ‘owns’. This is where the management level comes into play.

From this, design tasks can be derived for managers. These include maintaining an overview of responsibilities for the team, supplemented by the local contact points that apply in your area. It has also proved useful to agree on a uniform procedure for documenting the submission of applications, to discuss questions of responsibility openly in case reviews and to introduce new staff specifically to the logic of responsibilities. Because laws change, the overview needs a date and a responsible person who records changes; the example of the New Basic Income Support since 1 July 2026 shows how quickly names and rules can shift. Questions of employment, data protection or procurement law should be clarified with your legal department or staff representation.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

In Module 2 you got to know the five branches of social insurance as a common foundation, and in Module 3 the question of which body is responsible for which need. This module focuses on the branch that health and social care professions deal with most often: statutory health insurance (gesetzliche Krankenversicherung). Anyone who works on care-related questions in a hospital, a home care service, a counselling centre or in their studies encounters it every day – as a patient’s question about sickness benefit, as a funding question in organisational planning or as the subject of the hospital reform, which is reorganising inpatient care.

The module therefore links three levels: the law (what Book Five of the Social Code provides for), the logic of contributions and financing (who pays how much and why) and current developments (the hospital reform). Each level is explored with a view to your tasks in counselling, management and study, and where academic research and professional practice reach different judgements, you will find several perspectives side by side.

PART 1 – Statutory health insurance: terms and context

What statutory health insurance provides

Statutory health insurance (gesetzliche Krankenversicherung, GKV) is the branch of social insurance governed by Book Five of the Social Code (Social Code Book V, SGB V) that provides cover against the life risk of illness. It therefore belongs to the insurance principle, which you distinguished from social assistance and state provision in Module 1: benefits are financed from contributions, and entitlement arises from the insurance, not from proof of need.

The general statutory anchor is section 4(2) of Social Code Book I (SGB I), which you know from Module 1: insured persons have a right to the necessary measures for their health and to economic security, among other things in the event of illness. Two families of benefits can be derived from this for the GKV (a didactic classification, not a statutory term): treatment and care services that protect or restore health, and cash benefits that secure income in the event of illness – in practice above all sickness benefit (Krankengeld). This module covers both families.

For managers, the GKV has a twofold significance. First, for many organisations in the health sector it forms the framework within which services are provided, remunerated and organised. Second, it affects your own employees: as an employer you pay a share of the contributions (more on this in Part 3), and as a line manager you encounter staff who, after a longer illness, have questions about sickness benefit, phased return to work and responsibilities. Figure 1 summarises the building blocks that this module unpacks one after another: the principles, the range of benefits, the contributions, the structure of the insured population and the hospital reform.

Distinguishing terms clearly

In counselling conversations in particular, GKV terms are often mixed up. Someone who says ‘insured person’ does not automatically mean a person who pays contributions themselves; someone who talks about ‘the fund’ (die Kasse) means the body that provides the benefits, not the practice where treatment takes place. Table 1 defines the seven terms used throughout this module.

The distinction between member and co-insured person has practical consequences. Sickness benefit is linked to the earnings from employment and self-employment actually received (section 47(1) SGB V), and contributions are based on members’ income. Whether someone is covered through their own membership or through family insurance therefore helps determine which questions arise in the first place. In a counselling conversation it is therefore worth asking in what capacity the person seeking advice is insured before you give any further information.

How big is the GKV? A look at the structure of the insured population

The GKV statistics of the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG, 2026b) show a total of 74,495,244 insured persons on the reference date of 1 March 2026. Of these, 58,714,600 are members and 15,780,644 are co-insured family members. Figure 2 compares these two groups as bars; the axis starts at zero, and both bars are labelled with their exact value.

Summarised as text: in March 2026 there were 58,714,600 members and 15,780,644 co-insured family members; together these make up the 74,495,244 insured persons mentioned. In absolute numbers, family members are therefore a very large group whose cover exists without their own contribution.

At this point, carefully separate finding and interpretation. The finding is: there is a reference-date population of members and of persons co-insured free of contributions of exactly this order of magnitude. The interpretation that the juxtaposition of the two figures reflects the solidarity-based redistribution from Module 1 – the cover of co-insured people through members’ contributions – is a professional interpretation and not a result of the statistics themselves. The figures also say nothing about how often services are used or how the structure changes over time; they are a snapshot for one month and one area (Germany).

PART 2 – Legal framework: the benefits-in-kind principle, economic efficiency and the range of benefits

The benefits-in-kind principle: treatment instead of money

The benefits-in-kind principle (Sachleistungsprinzip) is one of the defining structural features of the GKV. Under section 2(2), first sentence, SGB V, insured persons receive benefits as benefits in kind and services, unless SGB V or Social Code Book IX (SGB IX) provides otherwise. What this means is that, as a rule, insured persons receive the treatment itself – the examination, the operation, the medicine, the therapy – not a sum of money with which they would have to obtain the service themselves. The financial settlement takes place in the background between the health insurance fund and the service providers. Figure 3 makes this triangular relationship visible: members pay contributions to the health insurance fund, the fund remunerates the services, and the service providers treat the insured persons.

In practice this is more than a formality. The principle explains why questions of remuneration tend to concern organisations and funds rather than individual patients, and it explains why counselling conversations so often end up with the question: ‘Will my fund pay for this?’ The answer depends on whether the requested service lies within the statutory scope of benefits, not on how high the individual contribution was. This links back to the idea from Module 1: the contribution depends on income, the entitlement to benefits on need. Co-payments and the cases in which the law departs from the standard case of benefits in kind are regulated in detail by the law; they are not explored further here.

The principle of economic efficiency and personal responsibility

The first subsection of section 2 SGB V contains two terms that come up again and again in professional discussions and in everyday counselling. The principle of economic efficiency requires the health insurance funds to handle the jointly raised funds carefully. This module deliberately does not answer which specific service is economically efficient in an individual case; that is a matter for the application of benefits law by health insurance funds and service providers. The addition ‘insofar as not attributed to personal responsibility’ indicates that the community of solidarity does not pay for every expense. Where this boundary lies is also a socially contested question, to which Part 5 returns.

For your counselling practice it is important that the principle of economic efficiency is not a carte blanche for refusals and makes no statement about a person’s worth. It describes a standard for the actions of the funds. When people seeking advice receive a refusal, that is not the final word for them: professionals help them to understand the decision, organise their documents and find the appropriate advice channels – without making a legal evaluation of the individual case.

The range of benefits at a glance

The GKV covers a wide range. From professional practice, six areas of benefits can be highlighted that are particularly relevant to health and social care professions. Table 2 organises them and shows where they touch on your work. Amounts, co-payments and detailed rules are deliberately not included, because they change and must be clarified with the health insurance fund in the individual case.

Information and advice from the health insurance fund

Health insurance funds are not only paying agencies but also advice and information centres with a statutory obligation to provide them. In addition to the general right to advice from the responsible benefit provider (section 14 SGB I), section 15 SGB I obliges the bodies responsible for statutory health insurance and social long-term care insurance to provide information on all social matters under the Social Code and, in doing so, also to name the responsible benefit providers. Module 8 presents the complete advisory framework of sections 13 to 16 SGB I.

From a management perspective this is an asset: if your team refers a question that goes beyond your remit to the health insurance fund of the person seeking advice, this is not passing the buck but making use of an information structure provided for by law. Good practice consists of clarifying referral routes within the team in a binding way – who calls, who accompanies, what is documented – and designing referrals so that the person does not have to start all over again. Module 8 takes this up again as the navigator role (Lotsenfunktion).

PART 3 – Contributions, solidarity-based redistribution and the distinction from private health insurance

The contribution parameters for 2026 at a glance

The financing of the GKV is best understood through the reference values that the Federal Ministry of Health (BMG, 2026a) publishes for 2026 (page last updated: 3 September 2026). In Module 2 you already encountered the average supplementary contribution rate as a key figure; here it is placed in the context of the other parameters. Table 3 summarises the values.

Employees and employers each pay half of the contribution, including the supplementary contribution (BMG, 2026a). The contribution ceiling limits the level of income up to which contributions are calculated; it does not protect higher earners from contributions, but it caps the absolute burden. The compulsory insurance threshold, by contrast, is a threshold for the question of whether employees remain subject to compulsory insurance. The two limits must not be confused, because they answer quite different questions: one determines the reach of the contribution calculation, the other access to the option of choosing.

How solidarity-based redistribution works in practice

The contribution structure makes the solidarity principle from Module 1 tangible. In the GKV it works in two directions. First, between incomes: contributions depend on income up to the contribution ceiling, benefits on medical need. Second, between life situations: co-insured children as well as spouses and civil partners are covered free of contributions through family insurance (BMG, 2026a). The conditions for family insurance are regulated in detail by law, and the health insurance fund clarifies them in the individual case.

The professional debate assesses this arrangement in different ways. Supporters emphasise that people with lower incomes or with family responsibilities do not receive poorer care for that reason alone. Critical voices point out that the contribution ceiling limits income-dependence at the upper end and that the possibility of private insurance above the compulsory insurance threshold can shrink the risk pool. Both are lines of argument in the socio-political debate, not findings of this module; for an academic paper you should therefore label them as positions and support them with your own sources.

Statutory and private health insurance compared

Alongside the GKV there is private health insurance (private Krankenversicherung, PKV). Both systems provide cover against the risk of illness, but follow different logics. The GKV applies the solidarity principle: the contribution depends on income, and co-insured family members are covered free of contributions. The PKV applies the equivalence principle: the premium depends on the insured risk and the chosen tariff, not on income. Who is allowed to leave the GKV is regulated by law; the compulsory insurance threshold of 77,400 euros per year (BMG, 2026a) marks the income threshold above which the option may arise for employees. Figure 4 places the two systems side by side as comparison cards.

For your counselling, the following applies: a sweeping statement about which system is ‘better’ can neither be substantiated nor is it the task of a professional. Premiums and tariff details are not covered in this module. Decisions about switching have long-term consequences and belong in individual specialist advice. What professionals can provide is structure: they help to clarify what information a decision requires and refer people to the appropriate information services.

PART 4 – Fields of practice: sickness benefit and hospital reform

Sickness benefit under section 47 SGB V

Sickness benefit secures income when employees are unable to work for a longer period because of illness. It is thus the second family of GKV benefits alongside benefits in kind. Section 47(1) SGB V governs the amount: sickness benefit amounts to 70 per cent of the regular earnings from employment and self-employment actually received, referred to as regular pay (Regelentgelt). In addition, an upper limit applies: sickness benefit calculated from earnings from employment may not exceed 90 per cent of net earnings. The start, duration and further conditions of entitlement are regulated by law; they are not part of this module and are clarified in the individual case by the health insurance fund.

The calculation logic therefore has two stages: first 70 per cent of regular pay, then a comparison with 90 per cent of net pay. If the lower limit applies, it is decisive. The following worked example takes you through this logic step by step – deliberately with entirely fictitious figures and without contribution deductions, because the aim is to understand the percentage logic, not to calculate an entitlement.

Worked example: sickness benefit of a fictitious employee. Nils Hoffmann works full-time in an organisation and has been ill for a longer period. Let us assume (fictitious values, simplified monthly calculation): his regular pay is 3,000 euros per month, his net earnings 2,200 euros per month. Figure 5 shows the calculation in four steps.

As a check, here is a second calculation with different values: if regular pay is 2,000 euros and net earnings are 1,600 euros, 70 per cent of regular pay gives 1,400 euros, and 90 per cent of net pay gives 1,440 euros. Here the first value is below the limit, so the upper limit does not apply and 1,400 euros is decisive. It remains important to note: this is a simplified illustration. The actual calculation is carried out by the health insurance fund in accordance with the statutory requirements and may take further components into account; none of the figures replaces information given in the individual case.

Hospital reform: what the KHVVG changes and the KHAG adjusts

The hospital reform is the second major field of practice in this module, because it affects the structure of inpatient care with which home care services, social services and counselling centres constantly work. The Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz, KHVVG), signed into law on 5 December 2024 (BGBl. 2024 I Nr. 400, Federal Law Gazette), introduces several instruments according to the Federal Ministry of Health (BMG, 2026d):

• Service groups (Leistungsgruppen) with minimum quality requirements: hospitals should only provide services in a service group if they meet defined quality requirements. The number of service groups is deliberately not stated here.
• Provision-based remuneration (Vorhaltevergütung): around 60 per cent of the hospital budget is to be paid independently of the number of treatment cases. The arrangement thus decouples part of the financing from case numbers.
• Transformation fund (Transformationsfonds): it supports the restructuring of the hospital landscape; according to the BMG, 29 billion euros of federal funds are available for this over ten years.
• Cross-sectoral care facilities (sektorenübergreifende Versorgungseinrichtungen): they are intended to combine inpatient services with outpatient and nursing care services.
• Planning authority of the Länder: hospital planning remains a matter for the federal states (Länder); the Federation sets the framework.

The Hospital Reform Adjustment Act (Krankenhausreformanpassungsgesetz, KHAG; BGBl. 2026 I Nr. 98, published on 14 April 2026, in force since 15 April 2026 according to the BMG) adjusts the reform, among other things regarding deadlines for provision-based remuneration, the financing of the transformation fund and exceptions and service groups (BMG, 2026d). Figure 6 places the events in chronological order: the KHVVG was signed and published in December 2024, the KHAG followed in April 2026 and is now in force. All five events shown have been completed; this is not a draft.

The case illustrates how managers can shape the reform without overestimating it: clarify which questions specifically concern your team (admission, discharge, responsibility) and answer them as far as you have reliable knowledge. Everything else remains an open question and is monitored. It is particularly helpful to clarify information channels to hospitals and state authorities within the team, so that changes do not only become visible through individual cases.

Application: relating situations to the GKV logic

With the worked example you have learnt a calculation logic, and with the tables the terms and contribution parameters. Now you apply this knowledge to short everyday situations. The exercise is intended as a self-check; there is nothing to submit and no evaluation. Only open the hints once you have found an approach yourself.

PART 5 – Critical analysis: areas of tension, limits and consequences for practice

Taking an objective view of the GKV is part of professional competence: anyone who explains a system should also be able to name its areas of tension. The following three questions are not closed debates but invitations to form your own judgement. They are deliberately worded in a politically neutral way and without figures that are not substantiated by sources.

Area of tension 1: economic efficiency and individual need

Section 2(1) SGB V combines the mandate to provide benefits with the standard of economic efficiency and the proviso of personal responsibility. From the perspective of insured persons and professionals, the specific need is often the main focus: a therapy, an aid or a rehabilitation measure should be available at the time it is needed. From the perspective of the health insurance funds and system management, the main focus is the responsible use of limited resources. Both perspectives are legitimate; they come into conflict when needs and resources do not match. It helps to justify and document needs in a professionally comprehensible way, without deriving forecasts about the funds’ decisions from this.

Area of tension 2: solidarity-based redistribution, contribution limits and the coexistence of GKV and PKV

The solidarity of the GKV is capped at the upper end by the contribution ceiling, and above the compulsory insurance threshold employees have the option of private insurance. Supporters of this coexistence point to freedom of choice and the variety of options. Critics counter that it splits risk pools and weakens solidarity-based redistribution. Which view is more convincing depends on value judgements that cannot be settled definitively by research. For study and practice, this means: assign arguments to a position, cite evidence and make your own evaluation recognisable as such.

Area of tension 3: quality and accessibility in hospital care

Service groups with minimum quality requirements aim to ensure that complex services are provided where the necessary structures are in place. At the same time, accessibility – especially in rural areas – is a legitimate concern of patients and relatives. Cross-sectoral care facilities are designed as a response to this area of tension, because they are intended to combine inpatient services with outpatient and nursing care services. How the Länder plan and how routes for patients actually change is an open question that can only be answered during implementation. Forecasts are inappropriate here; what is appropriate is an observing and documenting attitude and early coordination with partners in the region.

Consequences for your role as a professional or manager

Three consequences follow from these areas of tension. First: provide orientation rather than decide. You convey the logic of the system, terms and referral routes; binding information on entitlements is provided by the health insurance funds, counselling centres or legal services (sections 13 to 15 SGB I). Second: separate what is established from what is open. Federal laws such as the KHVVG and KHAG are established; their local effects are not yet. Third: state the date and the source. Contribution parameters are values for the year 2026 and change; anyone who quotes them should state the year and the source.

The following modules build on this foundation: Module 5 covers long-term care insurance and its care grades (Pflegegrade), Module 6 rehabilitation and participation, in which the health insurance funds are involved as rehabilitation providers. If you feel unsure about terms, return to the flashcards in this module.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – Introduction: long-term care insurance, the need for long-term care and the principle of partial cover

A phone call from practice: a daughter reports that her father now has ‘Pflegegrad 2’ (care grade 2) and asks what this means for the family. Behind this single question lie several layers, which this module unpacks one after another: a legal concept of the need for long-term care, a standardised assessment procedure, a range of benefits linked to the care grade, and a boundary at which long-term care insurance ends and other forms of support begin. For managers, there is a further layer: they must ensure that the team reliably explains, refers and documents – without straying into individual legal advice.

Long-term care insurance within the social insurance system

In Module 2 you got to know long-term care insurance as one of the five branches of social insurance, and in Module 1 the insurance principle and the solidarity principle. Both are assumed here. What is new is the special feature of this branch: benefits from long-term care insurance under SGB XI are not linked to a diagnosis but to the care grade that has been determined (sections 14 and 15 SGB XI). Unlike statutory health insurance (Module 4), in which benefits are generally provided as benefits in kind and services (section 2(2) sentence 1 of Social Code Book V, SGB V), long-term care insurance also includes a cash benefit, the care allowance (Pflegegeld), with which people in need of care can organise their care at home themselves.

The second difference concerns the scope: long-term care insurance is designed as a partial-benefit system. It provides benefits within a legally defined framework and does not automatically cover the actual need for care in full (cf. section 61 of Social Code Book XII, SGB XII). The image of ‘Teilkasko’ (partial cover, as in car insurance) is often used as a memory aid. Importantly, this is a teaching image, not a legal term. It is only meant to illustrate that a remainder may be left over after the long-term care insurance has paid. How this remainder is dealt with is the subject of Part 5.

What does ‘in need of long-term care’ mean? The concept under section 14 SGB XI

The key concept is set out in section 14(1) SGB XI. According to this, people in need of long-term care are persons who have health-related impairments of their independence or abilities and therefore require help from others. The need for help must be long-term, expected to last at least six months, and must reach at least the severity laid down in section 15 SGB XI.

From a professional perspective, four building blocks can be identified. First, the health-related cause: not every need for support is a need for long-term care in the legal sense. Second, the yardstick of independence and abilities: the question is what a person can do themselves and where they depend on others – not which diagnosis they have. Two people with the same illness may therefore be classified differently. Third, help from others as a consequence of these impairments. Fourth, a time and substantive threshold: expected to last at least six months and reaching at least the severity under section 15. This structure is a professional interpretation; only the wording of the law is binding.

The six areas of the need for long-term care

What counts as an impairment is defined in section 14(2) SGB XI through six areas. They form the compass for the entire procedure:

• mobility – for example moving around the home or changing body position;
• cognitive and communicative abilities – for example orientation, understanding and making oneself understood;
• behaviour and psychological problems – for example distressing restlessness or anxiety that requires help;
• self-care – for example personal hygiene, eating and drinking, and dressing;
• coping with and independently managing demands and stresses caused by illness or therapy – for example medication, doctor’s appointments, aids;
• organising everyday life and social contacts – for example daily structure and participation in social life.

The examples after the dashes are explanations for practice, not the wording of the law. Figure 1 shows as a mind map how the concept, care grades, benefits, limits and current developments fit together into an overall picture. It serves as a map for the following parts.

PART 2 – Legal fundamentals: assessment, care grades and the application process

The assessment instrument under section 15 SGB XI

Under section 15 SGB XI, the care grade is determined using an assessment instrument grounded in nursing science (Begutachtungsinstrument). This instrument is made up of six weighted modules. ‘Weighted’ means that the areas do not contribute equally to the overall result; for self-care, the provision gives a weighting of 40 per cent as an example. For counselling practice it is sufficient to know the principle: the ratings in the modules produce a total score, and this determines the care grade. If you need the other weightings, you can look them up in the law – in conversations with relatives this is rarely the decisive question.

What matters is a change of perspective compared with the everyday understanding: the care grade does not measure how ‘ill’ someone is, nor how much time a carer spends. It reflects the extent to which independence and abilities are impaired in the six areas. The fact that this results in a single number is a deliberate simplification – with advantages and side effects that Part 5 returns to.

From total points to care grade

Under section 15(3) SGB XI, the total points determine the care grade. Table 1 sets out the bands and, in the last column, adds the care allowance under section 37(1) SGB XI, which Part 3 discusses in detail.

Always read the thresholds as lower limits: ‘from 47.5’ includes the value 47.5, ‘under 70’ excludes 70. A person with exactly 47.5 total points therefore already belongs to care grade 3, while a person just below this still belongs to care grade 2. Anyone who does not reach the lower limit of 12.5 total points does not, under this system, meet the minimum severity of section 14(1) SGB XI. This reading is important for conversations with relatives because it helps avoid misunderstandings about ‘rounding’ or ‘goodwill’ – the assignment follows fixed bands.

From application to care grade: the procedure

Figure 2 shows the process in six steps. It begins with the application for long-term care insurance benefits. As described in Module 3, under section 16 SGB I applications are accepted not only by the responsible benefit agency but also by all other benefit agencies and by all municipalities, and are forwarded without delay; the date of application is the date of receipt by the first office. This gives a simple rule for practice: an application should not be left lying around just because responsibility is still unclear.

In the second step, the situation is assessed. As a rule, this is done by the Medizinischer Dienst (MD, the medical assessment service of the health and long-term care insurance funds); using the assessment instrument from section 15 SGB XI, it records how independent the applicant is in the six areas. In the third step, the partial ratings produce the total points, and in the fourth step these are assigned to one of the five care grades. In the fifth step, the Pflegekasse communicates the result in writing, and in the sixth step the benefits and counselling services follow. Anyone who disagrees with the result will find information on the deadline and form of an objection (Widerspruch) in the decision notice. The deadlines that apply in the procedure are determined by law and by the decision notice; they are deliberately not listed here because they are decisive in the individual case and must be checked there.

PART 3 – Benefits and counselling: care allowance, counselling visit and care counselling

Care allowance under section 37(1) SGB XI

The care allowance is the cash benefit of long-term care insurance for people who are cared for at home and organise their care themselves – often through relatives. Since 1 January 2025, the monthly amounts under section 37(1) SGB XI have been 347 euros in care grade 2, 599 euros in care grade 3, 800 euros in care grade 4 and 990 euros in care grade 5. Table 1 has assigned them to the respective care grade. No care allowance is listed in this table of amounts for care grade 1; the people concerned can find out from the Pflegekasse which benefits apply there.

In addition to the care allowance, SGB XI provides for further benefits, such as services from home care services (ambulante Pflegedienste) and residential care benefits. Their amounts are not the topic here; for counselling it is more important to convey the logic: the benefits are linked to the care grade, they are limited, and the Pflegekasse is the body that provides binding information on their type and scope in the individual case.

Counselling visits for care allowance recipients (section 37(3) SGB XI)

Those who receive care allowance are not left on their own: under section 37(3) sentence 1 SGB XI, care allowance recipients in care grades 2 to 5 must request a counselling session in their own home once every six months; in care grades 4 and 5, counselling every three months is possible. From a professional point of view, this visit offers an opportunity to discuss the care situation, clarify questions and point out ways of obtaining relief. This classification is an interpretation; the wording of the law specifies the frequency, not the content of the conversation.

Care counselling under section 7a SGB XI: the care plan as a bridge

Care counselling (Pflegeberatung) must be distinguished from counselling visits. Under section 7a(1) SGB XI, anyone who receives benefits under SGB XI is entitled to individual counselling and assistance from care counsellors in selecting and making use of social benefits and support services. Their tasks include systematically recording and analysing the need for help, taking the assessment into account; drawing up an individual care plan (Versorgungsplan); working towards its implementation and approval by the benefit agencies; monitoring and adjusting the plan; and providing information on relief services for carers.

Anyone who has studied case management will recognise the logic: record needs, draw up a plan, support implementation, adjust the plan. Module 8 takes this up again as part of the navigator role. The following comparison helps you keep the two forms of counselling clearly apart in conversation.

Worked example: from score to care allowance

Before you practise yourself, here is a complete demonstration of how a score is translated into information on benefits. Figure 3 goes through the five steps using the example of David Zimmermann (fictitious). His assessment report shows 52 total points. The task is: determine the care grade, read off the care allowance and identify follow-up questions for the conversation.

Note what the example does not do: it does not calculate an entitlement in the individual case, but places a value in the statutory bands and reads off the amount stated in the law. The binding decision is made by the Pflegekasse. The sequence of steps – record the value, find the band, look at the limits, read off the benefit, clarify follow-up questions – can also be transferred to other situations and provides the pattern for the following exercise.

PART 4 – Care in reality: figures for planning, conversations and casework

How many people are in need of long-term care – and where are they cared for?

For planning and counselling, it is worth looking at official statistics. According to the care statistics (Pflegestatistik) of the Federal Statistical Office (Statistisches Bundesamt, Destatis), just under 5.7 million people were in need of long-term care within the meaning of SGB XI in December 2023 (Destatis, 2024). Compared with December 2021, this represents an increase of 730,000 people, or 15 per cent. 61 per cent of people in need of care were women, and 78 per cent were aged 65 and over. The care statistics are published every two years; December 2023 is the current status on which this module is based.

On the type of care, the statistics state: 86 per cent, or 4.9 million people in need of care, were cared for at home, of whom 3.1 million received care allowance only, mostly cared for by relatives, and 1.1 million were cared for together with or by home care services. 14 per cent, or 800,000, lived full-time in nursing homes (Destatis, 2024). Figure 4 shows the three groups as bars.

Text summary of the values: In December 2023, 3.1 million people in need of care were cared for at home with care allowance only, 1.1 million at home together with or by home care services, and 0.8 million in full-time residential care. The three groups shown do not add up to the total number of people in need of care; other types of care are not shown here. The bars are therefore an extract, not a complete picture.

Finding and interpretation: The finding is that the large majority of people in need of care live at home and that care allowance is the most frequently documented type of care there. An interpretation – and therefore not part of the finding – is the conclusion that care in Germany depends heavily on the availability and resilience of relatives. For managers, this has a plausible consequence: counselling and relief do not belong only at the end of the chain of care, but in the work with families. The figures alone do not show why the types of care are distributed in this way; further data and analyses would be needed for that.

Consequences for management and teamwork

Parts 1 to 3 give rise to tasks for managers. First: build communication skills. Staff should be able to explain without hesitation what a care grade is, that it is derived from total points and that the benefits are linked to it. Second: mark boundaries. Information and orientation are tasks for practitioners; binding information on entitlement and amount in the individual case is given by the benefit agency. Third: clarify interfaces. Who in the organisation – nursing service management, social services, counselling – handles which conversations, when is a referral made to care counselling (section 7a SGB XI), and how is it documented? Fourth: keep information up to date. Reform projects sometimes change responsibilities and benefits faster than information material is updated. An agreed schedule in which the team discusses new legal positions is therefore useful; employment law issues, for example on responsibilities and the allocation of tasks, should be clarified with your legal department or staff representative body (Mitarbeitervertretung).

Conversations with relatives: explaining the care grade clearly

A care grade sounds like a judgement of the person, but it is an administrative result with consequences. In conversations with relatives, a simple four-step structure has proved useful, which you can use without additional aids: What has been determined? (care grade and, if known, total points), What follows from it? (benefits such as the care allowance, entitlement to counselling), What remains open? (personal contributions, needs not covered, questions for the Pflegekasse) and What is the next step? (appointment, application, referral). Speak in short sentences, explain technical terms such as ‘total points’ or ‘need for long-term care’ once in everyday language, and ask the other person to repeat what they have heard in their own words. If your organisation provides for this, summarise the most important points in writing and file the content of the conversation in line with your organisation’s procedures.

PART 5 – Critical evaluation: limits, areas of tension and current developments

Partial-benefit system: why long-term care insurance does not pay for everything

Anyone who understands the need for long-term care solely as an insured event overlooks the basic principle of this branch: long-term care insurance grants benefits within a legally defined framework. It therefore does not automatically cover all costs; in everyday counselling, there is often a remainder that the people concerned must pay from their own income and assets – particularly visible in residential care. How high this remainder is in the individual case is deliberately not discussed here; it depends on factors that the care setting and the benefit agency can specify.

Assistance with care under section 61 SGB XII and the subsidiarity of social assistance

Supplementary protection is provided for in SGB XII. Under section 61 sentence 1 SGB XII, people in need of care within the meaning of section 61a SGB XII are entitled to assistance with care insofar as they and their spouses or civil partners who do not live apart from them cannot reasonably be expected to raise the necessary funds from income and assets in accordance with the provisions of Chapter Eleven of SGB XII. The interaction follows the principle of subsidiarity of social assistance (Nachrang der Sozialhilfe), which you know from Module 1: under section 2(1) SGB XII, social assistance is not granted to anyone who can help themselves or who receives the necessary benefit from others, for example from providers of other social benefits. Long-term care insurance is therefore the primary form of protection, and assistance with care fills a gap insofar as income and assets do not have to be used. You can read more about securing a basic livelihood in general in Module 7.

Figure 5 places the two systems side by side. The cards are a memory aid for counselling conversations: they make it clear that these are two different logics – an insurance logic with a care grade on the one side, and a welfare logic with a check of financial need (Bedürftigkeitsprüfung) on the other.

Areas of tension and open questions

Standardisation and the individual case. The points system creates comparability and transparency: the same characteristics lead to the same results, and the thresholds are visible to everyone. At the same time, every threshold creates borderline cases, because a difference of a few points can lead to a different care grade and therefore to different benefits. Both perspectives are legitimate; practitioners can help the people concerned to put the result into context without either glossing over the procedure or criticising it wholesale.

Snapshot and course over time. An assessment describes the situation at a particular point in time. Care needs can change. Changes are a reason to take a fresh look at the situation and to clarify with the Pflegekasse how to proceed. The procedures that apply are governed by law; in conversation it is sufficient to point out that the people concerned can obtain advice on this.

Home care and relatives. The statistics show that a large proportion of people in need of care are cared for at home, mostly with care allowance (Destatis, 2024). The obvious interpretation is that the system relies on the willingness and resilience of relatives. This raises questions for practice and policy: How can relief be made accessible? How can counselling visits and care counselling be designed so that they really reach people? There are no simple answers to these questions, and the data used here do not answer them.

A structured system and access. The Pflegekasse, the social assistance agency and, where applicable, rehabilitation agencies are separate bodies with their own procedures. This is difficult for the people concerned to keep track of, as you know from Module 3. Module 6 shows how rehabilitation and participation are organised with their own agencies, and Module 8 shows the role of care counselling as a signpost.

Current (as at October 2026): extension of powers and the Long-Term Care Reorganisation Act

Figure 6 places the developments on a timeline. Solid circles represent what already exists, dashed circles represent drafts and plans. The timeline is not to scale; its main purpose is to make clear what applies today and what is only planned. You already know about the planned contribution surcharges from Module 2, where they were also explicitly identified as a draft.

Evaluation. The arguments on such a project can be set out side by side objectively. In favour of an adapted assessment is the wish for more accurately targeted classifications; in favour of protecting existing entitlements is reliability for people who already have a care grade. Critical questions concern, among other things, what ‘more accurately targeted’ means in concrete terms, how higher benefits are to be financed and what a contribution surcharge means for contributors, as well as how a community-based budget instead of the previous relief amount would affect access and handling. Whether and in what form the project becomes law is open; content may change in the further legislative process. For your counselling, therefore: inform people about current law, explicitly label draft content as a draft and refrain from making forecasts about amounts or thresholds.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – Participation instead of welfare: concepts and core idea

More than treatment: what rehabilitation and participation are about

People who are chronically ill, have had an accident or live with a long-term impairment often need more than medical treatment. The aim is to take part in society again, or for the first time: in work and vocational training, in education, in community and everyday life. This very goal is at the heart of Book Nine of the Social Code, entitled ‘Rehabilitation and Participation of Persons with Disabilities’ (SGB IX). For you as a manager, practitioner or student, this means a change of perspective: the yardstick is not the administration of deficits but the question of what support a person needs in order to pursue their own goals.

In Module 1 you got to know the insurance, welfare and provision (Versorgung) principles as a classification scheme. Participation law cuts across this scheme: the rehabilitation providers include statutory health, pension and accident insurance as well as the Federal Employment Agency (Bundesagentur für Arbeit) and the providers of social compensation (Soziale Entschädigung), public youth welfare and Eingliederungshilfe (integration assistance for persons with disabilities) (section 6(1) SGB IX). The Act therefore bundles benefits that stem from very different system logics under one common goal. That this bundling does not happen by itself in everyday practice is the subject of Parts 3 and 5.

Figure 1 gives you an overview in advance: at the centre is participation, grouped around it are five building blocks – the definition of disability, the benefit groups, the rehabilitation providers, the clarification of responsibility and the Federal Participation Act with the supplementary participation counselling. Feel free to return to this graphic if you lose the thread in the following parts.

The definition of disability under section 2 SGB IX

Before benefits can be discussed, it must be clear who is meant in the first place. The Act defines in section 2(1) SGB IX: persons with disabilities are persons with physical, mental, intellectual or sensory impairments which, in interaction with attitudinal and environmental barriers, can, with a high level of probability, prevent them from participating equally in society for more than six months. An impairment exists if the physical and health condition deviates from the condition typical for the person’s age.

The definition contains several building blocks that you should distinguish in counselling. First, the impairment itself: a deviation of the physical and health condition from the condition typical for the person’s age. Second, the barriers: attitudes, spaces, communication channels, forms or procedures that make participation more difficult. Third, the duration: what is meant is a limitation that will, with a high level of probability, last longer than six months. Disability within the meaning of the Act therefore only arises from the interplay of these elements – not from the diagnosis alone.

In professional discussion, this understanding is often contrasted with a purely medical view that describes disability primarily as a characteristic of a person. The statutory wording opens up the view to the environment: where barriers exist, disability arises; where they are removed, participation can succeed. For managers, this leads to an uncomfortable but productive question: what barriers does your own organisation create – for example through forms that are hard to understand, a lack of sign language or Easy Read (Leichte Sprache) services, opening hours or premises? It should be noted critically that the concept requires a prognosis (‘with a high level of probability’) and therefore leaves room for judgement in individual cases. Moreover, a legal concept says nothing about how people describe themselves. Use labels, therefore, only to the extent that access to benefits requires it.

Severe disability: a narrower concept

Severe disability must be distinguished from the general concept of disability. A person is severely disabled within the meaning of Part 3 of SGB IX if they have a degree of disability (Grad der Behinderung, GdB) of at least 50 and meet the statutory residence or employment requirements (section 2(2) SGB IX). The value of 50 thus belongs to the definition of severe disability and not to the general definition. The question of which specific benefit a provider grants depends in each case on the requirements of the individual benefit; providers and advice centres clarify this in each individual case. In conversations with people seeking advice, a simple rule helps: neither the diagnosis nor the degree of disability alone answers the question of which service is suitable – what matters is which participation needs the person names themselves.

PART 2 – Legal framework: benefit groups, rehabilitation providers and the Federal Participation Act

The five benefit groups under section 5 SGB IX

SGB IX organises support not by provider but by the purpose of the benefit. Section 5 SGB IX names five benefit groups for participation in life in society: first, benefits for medical rehabilitation; second, benefits for participation in working life; third, maintenance and other supplementary benefits; fourth, benefits for participation in education; and fifth, benefits for social participation. This order is also the numbering to which section 6(1) SGB IX refers in relation to the providers. Table 1 presents the groups with examples and shows which providers can in principle deliver them under section 6.

The fact that the groups stand side by side has a practical consequence: a single person rarely has only one need. Someone who is retrained after an accident (group 2) usually also needs financial security during the measure (group 3) and perhaps support in everyday life (group 5). Good counselling therefore thinks in bundles of needs, not in individual applications.

Rehabilitation providers under section 6 SGB IX: who can deliver which benefits?

Which bodies can act as rehabilitation providers is governed by section 6(1) SGB IX; you already know the list of providers from Module 3. What matters here is that the Act assigns certain benefit groups to each provider. This interplay is confusing when read as continuous text. Figure 2 therefore translates the provision into a matrix: the rows show the providers, the columns the five benefit groups, and a tick indicates that the provider can in principle deliver the group.

How to read the matrix: row by row, you see the profile of a provider. The providers of social compensation and soldiers’ compensation (Soldatenentschädigung) are named in all five columns, whereas the health insurance funds appear only for medical rehabilitation and maintenance benefits. Column by column, you see how many bodies are possible for a group: for medical rehabilitation it is almost all the providers listed, for participation in education only three (plus, as a special case, accident insurance for insured persons under section 2(1) no. 8 SGB VII, such as pupils and students). Support for education and everyday life therefore comes mainly from social compensation, youth welfare and Eingliederungshilfe; maintenance benefits are not named for youth welfare and Eingliederungshilfe in this list. Bear in mind, however: the matrix only shows what a provider can deliver in principle. Whether there is an entitlement in an individual case depends on the requirements of the relevant benefit laws.

A brief look back is worthwhile: in Module 2 you got to know statutory accident insurance with its tasks of prevention, restoration of health and compensation (section 1 of Social Code Book VII, SGB VII). Its broad involvement in the benefit groups in the matrix is the logical continuation: anyone tasked with restoring health must also consider work and everyday life. How applications arrive at the ‘first point of contact’ and are forwarded was covered in Module 3; Part 3 of this module explores the rehabilitation-law part of this route in more depth.

The Federal Participation Act: from welfare to participation law

The Federal Participation Act (BTHG) has fundamentally reshaped participation law. According to information from the Federal Ministry of Labour and Social Affairs (Bundesministerium für Arbeit und Soziales, BMAS, n.d.), it came into force in four staggered reform stages up to 2023. Three innovations are particularly significant for your work. First, Eingliederungshilfe is no longer part of social assistance (Sozialhilfe), i.e. the welfare system, but part of participation law in Part 2 of SGB IX (BMAS, n.d.). The providers of Eingliederungshilfe are therefore rehabilitation providers under section 6(1) no. 7 SGB IX. Second, specialist support services (Fachleistungen) are financed separately from benefits for living costs: the actual support for participation and the securing of living costs follow different rules. How living costs are secured is the subject of Module 7. Third, benefits are based on individual need rather than on the type of housing – this is what is meant by ‘person-centredness’ (BMAS, n.d.).

For everyday life in organisations, the third point in particular has far-reaching consequences. If the type of housing no longer sets the framework, the focus shifts to what the person wants to achieve and what support they need for this. This requires conversations on an equal footing, joint planning and a willingness on the part of organisations to design services flexibly. Figure 3 contrasts the two ways of thinking, which often operate side by side in practice.

This comparison is a didactic simplification. It helps you understand the direction of the reform but does not reflect every rule. In the spirit of multiple perspectives, you should be aware of two readings: from one point of view, moving Eingliederungshilfe into SGB IX is a consistent step because it no longer treats persons with disabilities as welfare recipients. From the other point of view, separating specialist support services from living costs requires additional coordination between bodies, which can overwhelm people seeking advice. Both views are plausible; which carries more weight depends on local conditions and cannot be decided on the basis of the sources available here.

PART 3 – The route to the benefit: responsibility, time limits and counselling

The structured system as an everyday experience

Depending on the cause and the aim of a benefit, a different provider is responsible – you got to know this in Module 3 as a feature of the structured (multi-branch) system. This applies with particular force to rehabilitation, because the same benefit group can be delivered by several providers (Figure 2). A person after an accident at work, a person with a chronic illness and a young person with support needs at school may therefore end up with quite different bodies, even though they are all seeking participation. For those affected, this is hard to see through; for practitioners, knowledge of where to refer becomes a core competence.

The legislator recognised this problem and provided a procedure in SGB IX intended to prevent applications from being left lying between providers. Its core is section 14 SGB IX on the lead rehabilitation provider (leistender Rehabilitationsträger).

Lead rehabilitation provider and time limits under section 14 SGB IX

You got to know the time limits of section 14 SGB IX in Module 3: two weeks to determine responsibility (subsection 1), three weeks for the decision if the application is not forwarded and no expert report is required (subsection 2). For rehabilitation, one concept is particularly important: the provider with which the application was first received and which does not forward it thereby becomes the ‘lead’ rehabilitation provider. Figure 4 shows the procedure step by step.

Three rules of action follow from this for practice. First: the date of receipt counts. Record when and where an application was made, and ask for confirmation of receipt. Second: a ‘wrong’ application is not a lost application. Anyone who is unsure about responsibility should submit the application early rather than spend a long time researching; clarification is the providers’ task. Third: following up pays off. If the time limits mentioned have passed without any notification, it is appropriate to make an enquiry with the provider. Do not confuse the provisions here: section 14 SGB I governs the right to counselling, section 14 SGB IX the clarification of responsibility by the rehabilitation providers. Always state the relevant code book in letters and documentation.

Counselling before and alongside the application

Anyone who wants to apply for benefits first has a right to counselling from the competent benefit provider (section 14 SGB I) and can obtain information under section 15 SGB I; you are familiar with both from Modules 3 and 4, and Module 8 explores them in more depth. In the field of rehabilitation there is, in addition, a separate service that deliberately stands outside the benefit providers.

Section 32 SGB IX provides for supplementary independent participation counselling (ergänzende unabhängige Teilhabeberatung, EUTB). The Federal Ministry of Labour and Social Affairs funds counselling services that are independent of benefit providers and service providers and serve to strengthen the self-determination of persons with disabilities or at risk of disability. The counselling is available even before specific benefits are applied for and exists alongside the right to counselling from the rehabilitation providers; in funding decisions, peer counselling by and for people affected is to be given particular consideration (section 32(1) and (3) SGB IX). For practice, independence is the decisive point: anyone who doubts whether a provider or a service provider sufficiently has their interests in mind can turn to a body that neither grants nor delivers benefits. For organisations that offer benefits themselves, this is both a relief and a challenge: they may refer people to this counselling but must accept that people seeking advice will also learn about alternatives there.

PART 4 – Practice: sorting needs and planning participation together

Eingliederungshilfe in figures

Before we turn to methods, it is worth looking at the scale of Eingliederungshilfe. According to the statistics of the Federal Statistical Office (Statistisches Bundesamt, Destatis), around 1,056,000 people received Eingliederungshilfe benefits in the reporting year 2025; that was 2.6% more than in the previous year (Destatis, 2026). Net expenditure amounted to EUR 31.5 billion, an increase of 10.0% (Destatis, 2026; cash-based accounting). In each case, people were counted over the course of the year. Figure 5 shows two subgroups: the number of recipients of benefits for social participation and the number of people employed in recognised sheltered workshops for people with disabilities (Werkstätten), which are counted as participation in working life.

In summary: in 2025, 806,215 people received benefits for social participation and 273,250 people were employed in recognised workshops (Destatis, 2026). Both figures come from the same count; their sum would be greater than the total number of recipients. From this it can be concluded that the groups overlap and the figures must not be added together. This is an interpretation that follows from the figures – the statistics themselves give no reasons here. Likewise: the fact that expenditure rose by 10.0% and the number of recipients by 2.6% is a finding. Why expenditure grew more strongly is not apparent from the available data, and no conclusions about the quality of support can be drawn from the statistics alone.

Worked example: assigning needs after a stroke

Complex responsibilities are best learned by working through a case step by step. The following example shows a five-step working method; afterwards, you apply it in an exercise of your own.

Note what the example shows: the matrix only provides a framework; the narrowing down only comes about through the questions about cause, insurance status and age. In addition, needs are recorded in full, even if they turn out not to be current – this prevents the mistake of seeing only what your own organisation offers.

Exercise: assigning needs to benefit groups and providers

Planning participation together: what management can contribute

The best assignment is of little use if the person is not involved in shaping it. The guiding principle of the BTHG is person-centredness: not the organisation but the person with their wishes and goals is at the centre (BMAS, n.d.). In practice, this means planning participation together: the person formulates goals, the practitioner assigns support needs, relatives or trusted persons are involved if the person so wishes, and the providers are informed at an early stage. Procedural rules on planning are not explored in depth in this module; what matters is the attitude: practitioners support, the person decides.

Managers shape the framework conditions for this. These include time for conversations, clear responsibilities within the team for knowledge of where to refer, simple documentation of application receipts and enquiries, understandable information in plain language and a culture in which employees and service users are allowed to report barriers. In addition, teams should know when they need to refer to advice centres, to the providers or – for employment law questions concerning their own employees – to the legal department and employee representation body.

PART 5 – Critical analysis: limits, areas of tension and consequences

Complexity as a barrier to access

The strength of SGB IX – bundling the benefits of different providers under one roof – is at the same time its weakness: the matrix in Figure 2 shows that several providers come into consideration for many benefit groups. The procedure under section 14 SGB IX, with its time limits, is intended to absorb this complexity by ensuring that applicants do not have to find out for themselves who is responsible. In practice, however, a knowledge gap remains: practitioners and providers know the system, people seeking advice usually do not. Anyone who experiences language, administrative procedures or digital applications as an obstacle finds it harder to obtain their rights. This obstacle can be reduced above all through counselling, simple information and coordinated cooperation between bodies.

A further critical question is how closely aspiration and reality match. The Act sets out time limits and procedures; whether they are complied with in everyday practice cannot be judged from the sources used here, and statements on this would be speculation. If you experience delays in your region, it is worth documenting them objectively and discussing them with the providers or the participation counselling service.

Areas of tension: self-determination, protection and resources

Person-centredness requires negotiation. An area of tension can arise between a person’s wishes and what providers grant. Practitioners move between advocacy for the person, loyalty to their own organisation and the responsibility not to promise anything they cannot decide. Honest conversation names these roles: ‘I will support you in describing your needs clearly; whether and to what extent a benefit is granted is decided by the provider.’

A second area of tension concerns the separation of specialist support services from basic income support. It strengthens the clarity of responsibilities but can create additional interfaces (see Module 7 on basic income support). Whether the advantages outweigh the disadvantages remains open in professional debate; here you can only take away the question of where interfaces arise in your field of work and who coordinates them. A third area is the data situation: figures such as those on Eingliederungshilfe (Destatis, 2026) describe scale and costs but say nothing about satisfaction or participation achieved. Statements on the effectiveness of the reform are therefore not possible on this basis.

Consequences for practice, study and management

Four consequences for practice can be derived from this. First: participation asks about goals, not diagnoses. Second: needs are recorded in full and assigned to the five benefit groups. Third: procedures such as section 14 SGB IX and section 16 SGB I are tools with which practitioners secure access without giving legal advice. Fourth: the link to counselling remains central, whether through the benefit providers themselves, through independent participation counselling or through your own team. How this navigator role is designed systematically is the subject of Module 8. For your studies, the following structure lends itself to a term paper: provision – responsibility – benefit – access barrier – action step.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – The last safety net: terms and fundamental right

When nothing else is enough: subsistence support in the overall system

The social insurance schemes from Module 1 and Module 2 provide cover for specific life risks – but only where an insurance relationship exists and the insured event occurs. Some people have never acquired sufficient entitlements, for others the benefits do not cover their living costs, and still others fall between two systems. For them, the welfare state provides tax-funded, needs-based subsistence support – the last safety net. It belongs to the welfare principle (Fürsorgeprinzip) from Module 1 and applies subsidiarily, when self-help and other benefits are not sufficient.

For managers, this field is particularly important: it concerns people in acute emergencies, for whom an incorrect referral has an immediate effect; the rules are currently changing noticeably (Part 4); and legal entitlement, duties to cooperate and questions of professional stance meet directly here.

Terms: subsistence support, subsidiarity and basic income support

In this course, we use subsistence support (Existenzsicherung) – as a working definition specific to this course, not as a statutory term – to mean all benefits that secure the subsistence minimum of people who cannot support themselves by their own efforts. You know the legal anchor for social assistance from Module 1: the right to personal and financial help under section 9 of Social Code Book I (SGB I) for everyone who cannot help themselves and does not receive sufficient help from other sources. The help is intended to enable self-help, and those entitled to benefits must cooperate to the best of their ability (section 9 SGB I). The idea of help towards self-help is therefore already contained in the law.

The second key term is the subsidiarity (Nachrang) of social assistance (section 2(1) SGB XII), introduced in Module 1: self-help and benefits from others take precedence. In practice, this means that before an application for subsistence support is prepared, it is worth checking for prior-ranking entitlements, for example to social insurance benefits from Modules 2, 4 and 5.

You will encounter the umbrella term Grundsicherung (basic income support) in two variants that are easily confused. Grundsicherungsgeld in SGB II is the benefit for beneficiaries who are capable of work (erwerbsfähig) (section 19(1) SGB II). Basic income support in old age and in the event of reduced earning capacity (Grundsicherung im Alter und bei Erwerbsminderung), by contrast, is set out in Chapter Four of SGB XII (section 41 SGB XII). Both secure subsistence, but they belong to different legal domains with different groups of persons and agencies. This ambiguity is a frequent source of misunderstandings – in teams, too.

The subsistence minimum as a fundamental right

Why is subsistence support more than an act of charity? The answer is given by the Federal Constitutional Court (BVerfG) in its judgment of 9 February 2010 (1 BvL 1/09, 1 BvL 3/09, 1 BvL 4/09). According to headnote 1, the fundamental right to the guarantee of a subsistence minimum compatible with human dignity, derived from Article 1(1) of the Basic Law (Grundgesetz, GG) in conjunction with the principle of the social welfare state in Article 20(1) GG, secures for those in need the material conditions that are indispensable for their physical existence and for a minimum level of participation in social, cultural and political life (BVerfG, 2010). The principle of the social welfare state itself rests on the brief sentence: ‘The Federal Republic of Germany is a democratic and social federal state.’ (Article 20(1) GG).

Headnote 2 adds that this fundamental right is, in principle, not at the legislator’s disposal (dem Grunde nach unverfügbar), but must be given concrete form and regularly updated by the legislator, who has a margin of discretion in doing so (BVerfG, 2010). Two ideas are important for you. First: that an entitlement exists is not open to negotiation – how it is shaped in detail is the task of the legislator. Second: the subsistence minimum covers more than food and shelter, because the minimum level of participation is expressly included. We will come across both points again in the standard needs rates (Part 2) and in the debate on the New Basic Income Support (Part 4).

For your stance in advisory work, this means: subsistence support is not alms but a legally secured entitlement; anyone who claims it is exercising a right. This perspective takes pressure off conversations in which people seeking advice express shame. At the same time, it limits your role: you inform and accompany, but the benefit agencies (Leistungsträger) decide on the entitlement.

Figure 1 arranges the building blocks of this module around the key concept of subsistence support: the fundamental right, the two legal domains SGB II and SGB XII, the standard needs rates 2026 and the New Basic Income Support. It serves as a map for the following parts.

PART 2 – Legal fundamentals: basic income support and social assistance

Grundsicherungsgeld under SGB II

Social Code Book II (SGB II) governs basic income support for jobseekers. Its benefit for beneficiaries who are capable of work is called Grundsicherungsgeld (section 19(1) SGB II); ‘Bürgergeld’ (citizen’s income) is the former name. So if you still come across this word in older information leaflets or in conversations, it refers to the former name of the benefit. Who may be entitled is determined by section 7(1) sentence 1 SGB II through four requirements: the person has reached the age of 15 and has not yet reached the age limit under section 7a SGB II, they are capable of work, they are in need of assistance (hilfebedürftig), and they have their habitual residence in Germany.

Roughly speaking, a person is in need of assistance if they cannot secure their living costs from their own resources and means and do not receive sufficient help from other sources. How income and assets are taken into account in detail is governed by law and clarified by the benefit agencies in the procedure – this is not a calculation task for advice centres, and you should not take it on.

The Bedarfsgemeinschaft (household benefit unit) is particularly revealing for advisory work. Beneficiaries who are not capable of work and live in a Bedarfsgemeinschaft with persons who are capable of work also receive Grundsicherungsgeld, provided there is no entitlement to basic income support in old age and in the event of reduced earning capacity under Chapter Four of SGB XII (section 19(1) SGB II). A child under 15 who lives with their mother, who is capable of work, therefore falls within the Jobcenter’s benefit system, even though the child is not capable of work. The simple rule of thumb reaches a limit here.

In addition to securing subsistence, SGB II pursues integration into the labour market – through advice, training and job placement. The Jobcenter therefore has a dual mandate: it grants a subsistence benefit and is at the same time expected to work towards gainful employment. We take a critical look at this area of tension in Part 5.

Sozialhilfe under SGB XII

Social Code Book XII (SGB XII) is the classic welfare law for people who do not fall under SGB II and cannot meet their living costs from their own means. Its principle is subsidiarity (section 2(1) SGB XII). The most important part in practice is basic income support in old age and in the event of reduced earning capacity under Chapter Four: it is received by persons with habitual residence in Germany who cannot meet their necessary living costs, or cannot meet them sufficiently, from income and assets and who have reached the age limit or who, from the age of 18, have a permanent and full reduction in earning capacity (section 41(1) and (3) SGB XII). The responsible body is the social assistance agency (Sozialhilfeträger), locally often referred to as the Sozialamt.

In addition, there is social assistance for special life situations. You know one example from Module 5: help with long-term care costs (Hilfe zur Pflege) under section 61 SGB XII, which supplements where the necessary funds cannot be raised from income and assets. Since the Federal Participation Act (Bundesteilhabegesetz), by contrast, integration assistance for persons with disabilities (Eingliederungshilfe) no longer forms part of social assistance but of the participation law in SGB IX (BMAS, n.d.) – as described in Module 6.

Standard needs rates 2026: six levels and a zero increase

The amount of the standard needs rate (Regelbedarf) is the figure most frequently asked about in advisory conversations. For 2026, a zero increase (Nullrunde) applies: the standard needs rates remain unchanged compared with 2024 and 2025 and apply both in social assistance under SGB XII and in SGB II (Federal Government [Bundesregierung], 2026c). There are six standard needs levels. Level 1 for single adults and single parents is 563 euros, level 6 for children aged 0 to 5 is 357 euros per month. Figure 2 compares these two benchmark values, and Table 2 shows the complete scale.

In summary, the chart shows that in 2026 level 1 is 563 euros and level 6 is 357 euros per month. The difference results from the scale by group of persons, not from an individual determination of needs.

There is an arithmetical reason why the previous amounts remain: according to the update calculation, level 1 would have come to 557 euros; a reduction is prevented by the protection of existing entitlements (Besitzschutz) under section 28a(5) SGB XII (Bundesregierung, 2026c). Whether an unchanged amount meets the mandate for regular updating that the Federal Constitutional Court has given the legislator (BVerfG, 2010) is a question of political and legal evaluation that this course does not decide. As a practitioner, you should be able to explain the facts without commenting on them.

PART 3 – Clarifying responsibility: decision tree and worked example

Why the correct assignment matters

In Module 3 you saw that the structured (gegliedert) system allocates responsibilities according to the cause and purpose of the need. Here this knowledge becomes concrete: an incorrect assignment costs people seeking advice time and causes uncertainty. At the same time, section 16 SGB I, which you know from Module 3, eases the pressure: an application submitted to a body that is not responsible is forwarded and is deemed to have been made at the time it was first received. This does not replace careful assignment, but it relieves you of the pressure to do nothing at all when in doubt. In addition, there is the entitlement to advice from the benefit agency (section 14 SGB I).

The decision tree ‘SGB II or SGB XII?’

Figure 3 translates the legal provisions into four questions that you can ask in this order. The tree is an orientation aid for the initial conversation and for team agreements; the binding decision is made by the benefit agency. Question 1 clarifies the starting conditions required equally by section 7 SGB II and section 41 SGB XII. Question 2 leads, where the age limit is reached or there is a permanent and full reduction in earning capacity from 18, to basic income support in old age and in the event of reduced earning capacity. Question 3 takes up the core of section 7(1) sentence 1 SGB II, and question 4 the members of a Bedarfsgemeinschaft who are not capable of work (section 19(1) SGB II).

The tree also shows its limits. Capacity for work and reduced earning capacity are legal concepts that the responsible agencies determine in a binding manner; an estimate during the conversation can only be a working hypothesis. Special cases, for example concerning residence status or special life situations, require clarification with the benefit agency or through legal advice. And: the tree says nothing about the amount of an entitlement. Anyone using it remains in the role of navigator, which Module 8 will explore in more depth.

Worked example: assigning two people step by step

Before you practise yourself, you will see the procedure applied to two fictitious people. Hannah Meier, 32, lives with her three-year-old daughter in a rented flat. She has lost her job, currently has no sufficient income, and nothing in her account suggests a reduction in earning capacity. Paul Herrmann, 41, was found to have a permanent and full reduction in earning capacity following a serious illness; his benefits from the pension insurance scheme (Module 2) do not cover his living costs.

Figure 4 summarises the procedure as a sequence that you can use regardless of the case.

PART 4 – The New Basic Income Support since 1 July 2026

What has applied since 1 July 2026

The legislative process is shown in Figure 5: the Federal Cabinet dealt with the proposal on 17 December 2025, the Bundestag (Federal Parliament) on 5 March 2026 and the Bundesrat (Federal Council of the Länder) on 27 March 2026 (Bundesregierung, 2026a). The Act was signed into law on 16 April 2026 and published in the Federal Law Gazette on 22 April 2026; it has been entering into force in stages since 1 July 2026. So the entire Act did not take effect on that day, and individual provisions may apply at different times.

The core rules at a glance

Table 4 summarises what the Federal Government lists as the key points of the New Basic Income Support (Bundesregierung, 2026a) and links each rule with a note for your advisory practice. Reproduce the rule on missed appointments (Meldeversäumnisse) accurately: according to the Federal Government’s account, the reduction starts from the second missed appointment; in the case of three consecutive missed appointments, a staged procedure up to a possible withdrawal of the benefit is provided for.

For and against: objective and politically neutral

Reforms of subsistence support law are politically contested. As a practitioner, you need to know the arguments without taking sides. Figure 6 compares typical lines of argument as they appear in the professional debate; they are deliberately worded in general terms and not attributed to any person or organisation.

Note the distinction between findings and interpretation: the arguments listed are expectations and fears, not findings on effects. The New Basic Income Support has only applied for a few months and in stages; the material used for this course contains no robust evidence on its effects. For your practice, this means: describe rules objectively, name uncertainties openly and avoid predictions.

Advice during the transition: methods for practitioners and managers

How do you support people through a transition that they may experience as threatening? Four methods help: translating (explaining new terms in simple words and separating what has changed from what has not), structuring (an overview of appointments with contact points), delimiting (questions about assets, housing costs and reductions in individual cases belong with the benefit agency or in legal advice) and documenting (recording, in line with your organisation’s procedures, what was explained and where the person was referred).

For managers, there is an additional organisational task: dating information leaflets and stating their legal status, updating them promptly when changes occur, using case discussions to build a shared understanding and involving the legal department or external specialist advice in case of uncertainty. As the New Basic Income Support is entering into force in stages, knowledge remains in flux.

PART 5 – Critical appraisal: barriers, areas of tension, limits

Barriers and shame: when the right does not reach people

An entitlement that is not claimed protects no one. Reasons for this include lack of knowledge, shame, complicated applications and language and digital barriers. For cases in which eligible people do not use their entitlements for such reasons, the term ‘hidden poverty’ (verdeckte Armut) is used. Statements on its extent are deliberately not included here, because no evidenced figures are available for this course. Nevertheless, practice suggests where practitioners can start: informing, encouraging, accompanying – and making access as easy as the organisation allows. The duties to provide advice under sections 13 to 16 SGB I are the legal basis for this, which we bring together in Module 8 as the navigator role.

Areas of tension and open questions

Viewed from several perspectives, subsistence support operates within four areas of tension, which you should not resolve but should name and reflect on.

• Demanding and supporting versus inalienability. Section 9 SGB I requires cooperation to the best of one’s ability, and the New Basic Income Support emphasises commitment. At the same time, the subsistence minimum is, in principle, not at the legislator’s disposal (BVerfG, 2010). Where the line runs between a legitimate expectation of cooperation and inadmissible pressure is a legal and political question that remains open.
• Flat rates versus individual need. Standard needs levels are averages. They create equal treatment and administrative simplification, but do not always do justice to individual circumstances. The zero increase in 2026 with protection of existing entitlements illustrates how much latitude the legislator has.
• Structured responsibilities versus seamless help. The separation of SGB II and SGB XII follows capacity for work. When capacity for work changes, the legal domain changes – a moment in which people can get lost between responsibilities. Section 16 SGB I mitigates this, but does not solve it.
• Subsidiarity versus access. Subsidiarity (section 2(1) SGB XII) strengthens personal responsibility and the priority of other benefits. However, it can create barriers when clarifying prior-ranking entitlements takes time during which people have to manage without means.

Consequences for management and practice

Managers can derive tasks from this: establishing a uniform initial procedure (for example using the decision tree), maintaining contacts with benefit agencies and advice centres so that referrals succeed, and paying attention to the stance within the team. Addressing people seeking advice as holders of rights makes access considerably easier.

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

PART 1 – From rights to reality: access in the segmented system

Why rights alone are not enough

The German social system is comprehensive but highly branched. In the previous modules you have seen how many bodies can be involved: health insurance funds (Krankenkassen) and long-term care insurance funds (Pflegekassen), rehabilitation agencies, Jobcentres and social welfare offices (Sozialämter). You know the basic idea behind this from Module 1: the welfare state principle (Sozialstaatsprinzip) creates an obligation to provide social protection, and assigning benefits to the logic of insurance (Versicherung), needs-based assistance (Fürsorge) or state provision (Versorgung) helps you to understand them. Between the abstract entitlement and the decision notice (Bescheid) on the kitchen table, however, lies a path: people need to know about an entitlement, find the right agency, submit an application, provide documents and be able to make sense of a decision. Anyone who cannot walk this path has a right on paper, but not in their hands.

The law recognises this problem. It explicitly gives every person a right of access to social insurance (section 4(1) SGB I) and assigns benefit agencies duties of public information, advice, information and referral, and accepting applications (sections 13–16 SGB I). These provisions are the legal basis of what professional practice often calls the ‘navigator role’ (Lotsenfunktion). This module draws together the threads of the first seven modules: it shows how you can translate your knowledge of responsibilities, benefits and procedures into concrete support – and where this support reaches its limits.

Definitions: access, advice, referral knowledge, navigator role

Before we use these terms, we will define what they mean in this course. Access here means the actual possibility of recognising, claiming and enforcing an existing entitlement under social law. The right of access to social insurance is laid down in section 4(1) SGB I; in a broader sense, however, access also covers the needs-based assistance benefits you know from Module 7. Advice (Beratung) is a legal entitlement in German social law: ‘Everyone is entitled to advice on their rights and obligations under this Code’ (section 14 SGB I; own translation). Responsibility lies with the benefit agencies against which the rights are to be claimed or towards which the duties are to be fulfilled.

Referral knowledge (Verweiswissen) means knowing which body is responsible for which need, where an application belongs and which point of contact can help – it is the practical fruit of the logic of responsibilities from Module 3. Finally, the navigator role is not a legal term but a professional description. It refers to the task of practitioners to guide people through the system: informing, structuring needs, referring them to the right agency, connecting services and, where necessary, advocating for the rights of those seeking advice. It is important to draw the line on two sides: the navigator role replaces neither the statutory advice provided by the benefit agencies nor legal advice in individual cases. It makes rights accessible; it does not decide on them.

Five typical access barriers

Access barriers are not isolated cases of personal failure but features of the interplay between the system and a person’s life situation. Five groups come up particularly often in advice work. Lack of knowledge: people do not know that they have an entitlement or that there is any body at all for their concern. Complexity: responsibilities are spread across several agencies, forms and technical terms are hard to understand, and applications require documents from different sources. Language and education barriers: officialese (Amtsdeutsch), foreign words and a lack of confidence in reading or writing make every step harder. Shame: anyone who has to ask for help often feels this is an admission of their own failure – especially with needs-based assistance. Digital barriers: where applications are to be submitted online, access, devices or practice are sometimes lacking.

The barriers rarely occur alone; they reinforce each other. An exhausted family carer who hardly has time for phone calls is more likely to fail at a confusing online form than someone with a clear head. This course deliberately does not give reliable figures on how many eligible people do not use benefits for these reasons; such statements would need their own evidence. For practice, it is enough to recognise that you can identify barriers early and reduce them in a targeted way. The following table assigns a typical manifestation and a possible response to each barrier.

The key concept at a glance

Figure 1 shows the mind map of this module. At its centre is the navigator role; from there, five branches lead to the building blocks that we will work through one by one in the following parts: the access barriers, the statutory duties in SGB I, specialist advice under section 7a SGB XI and section 32 SGB IX, the navigation process itself and the critical appraisal. Treat the graphic as a map and return to it later to locate your knowledge.

Three orders of magnitude, three worlds of responsibility

Three key figures from earlier modules show how wide the field is in which you navigate. They do not measure access barriers; rather, they illustrate how different the worlds are between which people seeking advice move: statutory health insurance (Module 4), care at home provided by relatives (Module 5) and subsistence support (Module 7). Anyone who feels confident in one of these worlds is far from knowing their way around the next.

The first tile stands for an insurance system with contribution-based entitlements, the second for a form of care that is mainly provided by relatives, the third for the tax-funded subsistence minimum. Each of these figures stands for its own logic, its own applications and its own points of contact. Navigation means translating between these worlds.

PART 2 – Duties to advise as the legal basis of the navigator role

Public information, advice, information and referral, applications: the framework in SGB I

The General Part of the German Social Code (SGB I) provides a common framework of four duties for all areas of social benefits. They build on each other and can be read as a path from the general to the specific. Public information (Aufklärung, section 13 SGB I) is addressed to the population as a whole: benefit agencies, their associations and other public-law bodies are obliged, within their remit, to inform the public about rights and duties under the Social Code. This is about general information, still without a specific individual case.

Advice (Beratung, section 14 SGB I) is the individual entitlement of the person concerned. It relates to their rights and duties and is to be obtained from the benefit agency against which the rights are to be claimed or towards which the duties are to be fulfilled. Information and referral (Auskunft, section 15 SGB I) goes beyond the agency’s own remit: the bodies responsible under the law of the federal states (Länder) and the bodies of statutory health insurance and social long-term care insurance provide information on all social matters under the Social Code, including naming the responsible benefit agencies. In doing so, they cooperate to ensure that information is provided as comprehensively as possible by a single body (section 15(1)–(3) SGB I). Finally, submitting applications (Antragstellung, section 16 SGB I) ties in with the logic of responsibilities from Module 3: applications are to be submitted to the responsible agency, but they are also accepted by all other benefit agencies and by all municipalities. Bodies that are not responsible forward them without delay, and the application is deemed to have been submitted at the time it was received by the first body. In addition, the benefit agencies work towards ensuring that clear and relevant applications are submitted and that incomplete details are supplemented (section 16(1)–(3) SGB I).

The table summarises the duties to advise and assigns each a responsible body and an example from practice. The examples are deliberately kept general and do not constitute a review of entitlement in an individual case.

What the provisions mean for you in practice

Sections 13 to 16 SGB I place obligations on the benefit agencies, not automatically on every organisation in which you work. Whether your organisation is itself a benefit agency or merely advises and accompanies determines which duties apply to it directly; if in doubt, clarify this with your manager or the legal department. Even if your organisation is not an agency itself, the provisions are useful to you in three respects. First, you can point out to people seeking advice their entitlement to advice from the agency and encourage them to use it (section 14 SGB I). Second, you know that an application submitted to a body that is not responsible is not lost but is forwarded, and that the date of first receipt remains decisive. It is therefore sensible to document receipt, for example with a copy or a note of when and where the application was handed in. Third, section 15 SGB I provides the model of information ‘from a single source’ – a benchmark against which you can critically measure procedures in your region.

Care counselling under section 7a SGB XI: case management logic in the statute

You know the entitlement to care counselling under section 7a(1) SGB XI and its tasks from Module 5. For the navigator role, the workflow described in the statute is of particular interest: recording and analysing the need for help, drawing up an individual care plan, working towards its implementation, monitoring progress and adjusting the plan.

Professionally, this corresponds to the case management cycle: assessing need, setting goals and a plan, linking services, monitoring progress, adjusting the plan. Section 7a SGB XI is therefore a good model, including for practitioners in social services who are not care counsellors themselves. They do not replace the care counsellors’ statutory task, but they can adopt their working logic and specifically point people seeking advice to the entitlement. A further anchor for advice in long-term care insurance is the advisory visit (Beratungsbesuch) for recipients of care allowance (section 37(3), first sentence, SGB XI; Module 5). It is a good opportunity to take up open questions from family carers.

Independent participation counselling under section 32 SGB IX

The rehabilitation agencies provide advice themselves; alongside them there is the supplementary independent participation counselling, EUTB (independent participation counselling, ergänzende unabhängige Teilhabeberatung), whose features you know from Module 6: independent of benefit agencies and service providers, available even before an application and in addition to the entitlement to advice from the rehabilitation agencies (section 32(1) and (3) SGB IX).

The distinction matters for your navigation work: advice from the agency comes from the body that will later decide. Independent counselling lies outside this decision-making role. One possible interpretation is that the two services meet different needs in terms of trust; whether people seeking advice experience it this way is an empirical question that this course does not answer. As a practitioner, you can name both routes and leave the choice to the people seeking advice.

PART 3 – The navigation process: inform, refer, connect, advocate

Five steps from concern to plan

Navigation does not follow a fixed statutory procedure, but it does follow a recognisable logic. Figure 2 shows it in five steps: you first clarify the concern, then organise needs and responsibilities, enable access through clear information and support with applications, connect the bodies involved and finally secure progress. The return arrow beneath the steps is a reminder that a navigation plan is never finished: when a person’s life situation or the legal situation changes, the loop starts again. This corresponds to the cycle of monitoring and adjustment that section 7a SGB XI describes for care counselling.

Informing and enabling access

The first step after clarifying the concern is clear information. This means short sentences, one topic at a time, explaining technical terms and, at the end, checking what has been understood – for example by asking the people seeking advice to repeat the next steps in their own words. Enabling access goes further: going through forms together, pointing out entitlements to advice from the agency (section 14 SGB I), arranging language mediation where needed and supporting applications as far as possible. Keep in mind the self-determination that participation law from Module 6 also emphasises: you do not take action away from people; you expand their options for action.

Referring and connecting: the link to case management

Because the system is segmented, the right agency often has to be found and several forms of help have to be coordinated. This is where the navigator role meets case management: bundling help, bridging interfaces and keeping the common thread. A ‘warm’ handover works well here: you do not merely refer people seeking advice to a body but, with their consent and in line with your organisation’s data protection procedures, make contact in advance and pass on the essential information. Document who has promised what and when the next update is due. In this way, individual referrals become a plan that holds even if one of the people involved changes.

Advocacy: in individual cases and at the structural level

Advocacy has two levels. In individual cases, you support people seeking advice when an application is rejected: you help them understand the decision notice, inform them that legal remedies such as an objection (Widerspruch) are possible, and refer them to the advice and legal services responsible for the legal questions. Take the deadlines from the decision notice and clarify them immediately with an expert body. At the structural level, you bring recurring access problems to your organisation, networks and committees: if the same form fails again and again or an interface regularly loses people, that is information for those in charge. Structural advocacy is therefore also a management task, to which we return in Part 5.

PART 4 – Reforms 2024 to 2026 and transfer to case work and term papers

Current (as of October 2026): five reform steps at a glance

Referral knowledge goes out of date quickly. Figure 3 arranges the five reform steps that play a role in this course on a timeline. Filled circles stand for law in force, the dashed circle for a draft. For navigation, what matters is less every detail than the question: where are responsibilities, terms or benefits shifting that you have mentioned in conversations so far?

What the reforms mean for advice work

The hospital reform is relevant to navigation above all because it affects the interfaces between inpatient, outpatient and nursing care. Service groups, remuneration for maintaining capacity and cross-sectoral care facilities change the landscape in which transitions of care take place; planning lies with the federal states (BMG, 2026d). An open question, to be discussed in the professional debate, is the tension between quality and accessibility, particularly in rural areas. The sources used here do not reveal what this means specifically for your region; you will need to clarify this locally.

The Act to Extend Powers and Reduce Bureaucracy in Nursing Care allows nurses, depending on their qualifications, to take on independently tasks that were previously reserved for physicians, for example in the management of chronic diseases. Which services these are in detail is laid down in contracts of the self-governing bodies (Selbstverwaltung) with the participation of the nursing professional associations. At the same time, reporting obligations in long-term care are to be reduced and shared forms of care housing promoted (Bundesregierung, 2026b). For your referral knowledge this means: watch how the contractual specification progresses before you promise people seeking advice who may take on which task.

The New Basic Income Support is based on the Thirteenth Act Amending Book II of the Social Code and Other Acts (Dreizehntes Gesetz zur Änderung des Zweiten Buches Sozialgesetzbuch und anderer Gesetze) of 16 April 2026 (Federal Law Gazette, BGBl. 2026 I No. 107). According to the Federal Government (Bundesregierung, 2026a), breaches of duty lead to a reduction of 30 per cent for three months; missed appointments are penalised from the second missed appointment onwards with a reduction of 30 per cent for one month, and after three consecutive missed appointments a graduated procedure applies, up to possible withdrawal of the benefit. In addition, there is priority for job placement combined with training, especially for people under 30, the abolition of the one-year grace period (Karenzzeit) for assets, with age-dependent protected assets, and a cap on housing costs during the grace period. You will find the details on entitlement and benefits in Module 7. The responsibility of the Jobcentres does not change as a result, but the name and rules of the benefit do.

The reform is assessed in different ways, and you should know both lines of argument without taking sides. Supporters emphasise the greater commitment required and the focus on job placement and training. Critics point out that reductions place a strain on advice relationships and can particularly affect people facing access barriers. Both are interpretations and expectations; this course lacks the evidence for reliable statements about effects. For your practice, this results above all in an advisory task: informing people seeking advice clearly about their duties to cooperate and about appointments, without providing individual advice on legal consequences.

The draft Long-Term Care Reorganisation Act (officially: Gesetz zur Neuordnung der Pflegeversicherung, Act on the Reorganisation of Long-Term Care Insurance) was adopted by the Federal Cabinet on 30 September 2026; a ministerial draft had been available since June 2026. According to the BMG (2026c), plans include an adjusted eligibility assessment system (Begutachtungssystematik) with protection of existing status for people already assigned a care grade, higher care allowance and benefits in kind in care grades (Pflegegrade) 2 to 5, a community-based budget (Sozialraumbudget) instead of the relief amount (Entlastungsbetrag) from care grade 2, a higher contribution surcharge for childless people (planned 0.9 per cent from 1 January 2027), a contribution surcharge for co-insured spouses or civil partners (planned 0.52 per cent from 1 January 2028), clarification according to the principle of ‘rehabilitation before care’ (Reha vor Pflege) and a digital ‘Pflege-Cockpit’ (care cockpit). All of this is a draft. Do not advise people seeking advice to base their decisions on planned rules, and clearly mark drafts as such in your materials.

Worked example: the structure in five steps

For complex cases – in timed written papers at university, term papers or case discussions in the team – a fixed framework helps. It prevents you from mixing up provisions, agencies and measures. The structure is called ‘legal basis – responsibility – benefit – access barrier – action step’ and is shown in Figure 4. First you see the structure in general terms, then it is worked through in full using a case; only after that comes your own exercise.

The case: Lina Walter is 79 years old, lives in her own flat and has care grade 3. She receives care allowance; her son Elias Walter provides most of her care. He is exhausted and asks at a social advice service what he is entitled to and who can give him some relief. Online forms overwhelm him.

1. Legal basis: As a recipient of long-term care insurance benefits, Mrs Walter is entitled to care counselling (section 7a(1) SGB XI), which also provides information on relief services for carers. In addition, there is the advisory visit for recipients of care allowance (section 37(3), first sentence, SGB XI) and the general entitlement to advice and to information and referral (sections 14, 15 SGB I).
2. Responsibility: The point of contact is the long-term care insurance fund (Pflegekasse) as the body of social long-term care insurance; under section 15 SGB I it is also obliged to provide information on other responsible benefit agencies.
3. Benefit: For care grade 3, care allowance amounts to 599 euros per month (section 37(1) SGB XI, amounts since 1 January 2025). Crucial for Mr Walter: the counselling and the care plan, not just the cash benefit.
4. Access barrier: Mr Walter does not know about the entitlement to advice, is exhausted, and the digital forms make it harder to get in touch (lack of knowledge, complexity, digital barrier).
5. Action step: With Mrs Walter’s consent, the practitioner points out the entitlement to care counselling, notes down questions and burdens together with Mr Walter and supports him in arranging an appointment with the long-term care insurance fund. She records when contact was made and agrees a follow-up date. Legal questions, for example about a rejection, go to the responsible advice or legal services.

As you read, note that each step builds on the previous one: without the legal basis, the responsibility remains an assertion; without the access barrier, the action step remains abstract. You can use exactly this linkage in your own texts.

Transfer to the term paper

For students, the structure can be used directly as a framework for a text. The legal basis forms the legal framework, responsibility clarifies the actors, benefit and access barrier form the analytical core, and the action step establishes the link to practice. Add a chapter on limits and open questions, as shown in Part 5. Pay attention to referencing discipline: cite statutes in the official version with the date of the legal status, give figures with the reference year, mark drafts as drafts and do not claim effectiveness that has not been demonstrated.

PART 5 – Critical appraisal: equity of access, limits and tensions

Equity of access in the segmented system

The law sets out as its guiding model information that is as comprehensive as possible from a single body (section 15 SGB I). This indicates that the segmentation of the system itself is recognised as a problem. Whether this model is realised in practice is an empirical question on which this course makes no statement. From a professional perspective, two positions can be distinguished. The first sees segmentation as historically evolved specialisation which, although complex, enables precisely targeted benefits; the answer to complexity would then be better coordination and advice. The second sees complexity itself as a cause of inequality in access and calls for simplification and fewer interfaces. Both positions can be justified and they are not mutually exclusive.

Limits of the conservative social insurance state

As you know from Module 1, Schmid (2020) assigns Germany, in Esping-Andersen’s typology, to the conservative continental European type, whose social rights are tied to status and strongly geared towards social insurance and paid employment. For the topic of access, an interpretation can be derived from this which should be understood as a hypothesis, not a finding: people with a continuous employment history probably find it easier to move within the familiar channels of social insurance than someone whose life situation depends on subsidiary needs-based assistance (on subsidiarity, cf. section 2(1) SGB XII). The opposing view points out that insurance entitlements exist precisely without a means test and can therefore be less stigmatising than means-tested benefits of the kind Schmid (2020) describes for the liberal type.

Limits and risks of the navigator role

First: role boundary. Practitioners do not provide legal advice in individual cases. They inform, structure and accompany, and refer legal questions to benefit agencies, advice services or legal services. Second: the compensation trap. If navigation only serves to compensate for the complexity of the system, it risks relieving the pressure for reform. Structural advocacy, i.e. reporting access problems back to those in charge, is therefore not an extra but part of the task. Third: knowledge decay. The reforms in Figure 3 show how quickly referral knowledge can become outdated. Fourth: role conflicts. Practitioners work in organisations with their own goals and resources; the independence of participation counselling under section 32 SGB IX shows that the legislature also regards conflicts of interest as relevant. Fifth: effectiveness. Whether and to what extent advice, case management or navigation actually improve access is not quantified here; such statements need their own empirical evidence. Case narratives such as those in this module illustrate the logic of action; they do not prove an effect.

Consequences for management and open questions

For managers, all of this results in a mandate to shape conditions. Referral knowledge should not depend on individual people but be anchored in overviews of responsibilities, case rounds and induction concepts, with the date of the legal status and drafts kept separately. Feedback on access problems needs a route to management and from there into networks and committees. Clarify employment, data protection and procurement law with the legal department, the staff representative body (Mitarbeitervertretung) or specialist advisers. Questions that this course deliberately does not answer remain open: how can the success of navigation be measured? Which barriers have the strongest effect in your region? And how much simplification of the system would be compatible with its segmented structure?

For your working day

• ☐ Do I have a responsibility sheet for my most frequent concerns, with legal provision, body, contact route and date of the legal status?
• ☐ Do I point out to people seeking advice their entitlement to advice from the agency, and care counselling or independent participation counselling where these fit?
• ☐ Do I document when and where applications were handed in?
• ☐ Do I clearly mark drafts and planned reforms in my materials as drafts, with their status date?
• ☐ Do I know where to refer legal questions in individual cases, and do I know my organisation’s procedures for this?
• ☐ Is there a route for reporting recurring access problems back to my manager?

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.

All texts in this course were written independently. Cited are statutes and ordinances (official works under § 5 UrhG, German Copyright Act), freely accessible publications by official bodies and specialist literature (within the right of quotation under § 51 UrhG, without reproducing text). Citation style: APA 7 (German-language adaptation). All figures and tables: own illustration. Legal status: October 2026.

Legal sources

Grundgesetz für die Bundesrepublik Deutschland (GG) [Basic Law for the Federal Republic of Germany] of 23 May 1949 (BGBl. p. 1), in the version in force on 8 October 2026, Art. 1(1) and Art. 20(1). Available at https://www.gesetze-im-internet.de/gg/art_20.html

Sozialgesetzbuch (SGB) Drittes Buch (III) – Arbeitsförderung – [Social Code Book III – Employment Promotion], § 341; Viertes Buch (IV) – Gemeinsame Vorschriften für die Sozialversicherung – [Book IV – Common Provisions for Social Insurance], § 1; Siebtes Buch (VII) – Gesetzliche Unfallversicherung – [Book VII – Statutory Accident Insurance], §§ 1 and 150; each in the version in force on 8 October 2026. Available at https://www.gesetze-im-internet.de/sgb_4/__1.html

Sozialgesetzbuch (SGB) Elftes Buch (XI) – Soziale Pflegeversicherung – [Social Code Book XI – Social Long-Term Care Insurance] of 26 May 1994 (BGBl. I p. 1014), in the version in force on 8 October 2026, §§ 7a, 14, 15 and 37. Available at https://www.gesetze-im-internet.de/sgb_11/__15.html

Sozialgesetzbuch (SGB) Erstes Buch (I) – Allgemeiner Teil – [Social Code Book I – General Part] of 11 December 1975 (BGBl. I p. 3015), in the version in force on 8 October 2026, §§ 4, 9, 12, 13, 14, 15 and 16. Available at https://www.gesetze-im-internet.de/sgb_1/__14.html

Sozialgesetzbuch (SGB) Fünftes Buch (V) – Gesetzliche Krankenversicherung – [Social Code Book V – Statutory Health Insurance] of 20 December 1988 (BGBl. I p. 2477), in the version in force on 8 October 2026, §§ 2 and 47. Available at https://www.gesetze-im-internet.de/sgb_5/__2.html

Sozialgesetzbuch (SGB) Neuntes Buch (IX) – Rehabilitation und Teilhabe von Menschen mit Behinderungen – [Social Code Book IX – Rehabilitation and Participation of Persons with Disabilities] of 23 December 2016 (BGBl. I p. 3234), in the version in force on 8 October 2026, §§ 2, 5, 6, 14 and 32. Available at https://www.gesetze-im-internet.de/sgb_9_2018/__5.html

Sozialgesetzbuch (SGB) Zweites Buch (II) – Grundsicherung für Arbeitsuchende – [Social Code Book II – Basic Income Support for Jobseekers] as promulgated on 13 May 2011 (BGBl. I p. 850, 2094), amended by the Dreizehntes Gesetz zur Änderung des Zweiten Buches Sozialgesetzbuch und anderer Gesetze [Thirteenth Act Amending Book II of the Social Code and Other Acts] of 16 April 2026 (BGBl. 2026 I No. 107), in the version in force on 8 October 2026, §§ 7 and 19. Available at https://www.gesetze-im-internet.de/sgb_2/__19.html

Sozialgesetzbuch (SGB) Zwölftes Buch (XII) – Sozialhilfe – [Social Code Book XII – Social Assistance] of 27 December 2003 (BGBl. I p. 3022), in the version in force on 8 October 2026, §§ 2, 41 and 61. Available at https://www.gesetze-im-internet.de/sgb_12/__41.html

Literature and publications

Bundesarbeitsgemeinschaft für Rehabilitation. (2022). Rehabilitation und Teilhabe – Ein Wegweiser [Rehabilitation and participation – a guide]. BAR.

Bundesministerium für Arbeit und Soziales. (n.d.). Bundesteilhabegesetz [Federal Participation Act]. Retrieved 8 October 2026, from https://www.bmas.de/DE/Soziales/Teilhabe-und-Inklusion/Rehabilitation-und-Teilhabe/Bundesteilhabegesetz/bundesteilhabegesetz.html

Bundesministerium für Arbeit und Soziales. (2024). Soziale Sicherung im Überblick [Social security at a glance]. BMAS.

Bundesministerium für Gesundheit. (2026a, 3 September). Beiträge der gesetzlichen Krankenversicherung (GKV) [Contributions to statutory health insurance (GKV)]. https://www.bundesgesundheitsministerium.de/beitraege

Bundesministerium für Gesundheit. (2026b). Gesetzliche Krankenversicherung – Mitglieder, mitversicherte Angehörige und Krankenstand. Monatswerte Januar–Juni 2026 [Statutory health insurance – members, co-insured family members and sickness rate. Monthly figures January–June 2026] (results of the GKV statistics KM1, as of 2 July 2026). https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Statistiken/GKV/Mitglieder_Versicherte/KM1_Januar_bis_Juni_2026.pdf

Bundesministerium für Gesundheit. (2026c, 30 September). Kabinett beschließt Pflegeneuordnungsgesetz [Cabinet adopts Long-Term Care Reorganisation Act] [Press release]. https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/kabinett-beschliesst-pflegeneuordnungsgesetz

Bundesministerium für Gesundheit. (2026d, 22 April). Krankenhausreform [Hospital reform]. https://www.bundesgesundheitsministerium.de/themen/krankenhaus/krankenhausreform

Bundesregierung. (2026a, 1 July). Neue Grundsicherung löst Bürgergeld ab [New basic income support replaces citizen’s income]. https://www.bundesregierung.de/breg-de/aktuelles/neue-grundsicherung-2399562

Bundesregierung. (2026b, 1 January). Qualifikationen von Pflegekräften besser nutzen [Making better use of nurses’ qualifications] [on the Gesetz zur Befugniserweiterung und Entbürokratisierung in der Pflege – Act to Extend Powers and Reduce Bureaucracy in Nursing Care – of 22 December 2025, BGBl. 2025 I No. 371]. https://www.bundesregierung.de/breg-de/aktuelles/befugnisse-pflegekraefte-2376966

Bundesregierung. (2026c, 1 January). Regelsätze der Sozialleistungen bleiben unverändert [Standard rates of social benefits remain unchanged]. https://www.bundesregierung.de/breg-de/aktuelles/nullrunde-buergergeld-2383676

Bundesverfassungsgericht. (2010, 9 February). Urteil des Ersten Senats vom 9. Februar 2010 – 1 BvL 1/09, 1 BvL 3/09, 1 BvL 4/09 [Judgment of the First Senate of 9 February 2010 – 1 BvL 1/09, 1 BvL 3/09, 1 BvL 4/09] [Headnotes]. https://www.bundesverfassungsgericht.de/SharedDocs/Entscheidungen/DE/2010/02/ls20100209_1bvl000109.html

Schmid, J. (2020). Wohlfahrtsstaat in Europa [Welfare state in Europe]. In Große Hüttmann & Wehling (Eds.), Das Europalexikon [The Europe lexicon] (3rd ed.). Verlag J. H. W. Dietz Nachf.; Bundeszentrale für politische Bildung. https://www.bpb.de/kurz-knapp/lexika/das-europalexikon/177357/wohlfahrtsstaat-in-europa/

Statistisches Bundesamt. (2024, 18 December). 5,7 Millionen Pflegebedürftige zum Jahresende 2023 [5.7 million people in need of care at the end of 2023] (Press release No. 478). https://www.destatis.de/DE/Presse/Pressemitteilungen/2024/12/PD24_478_224.html

Statistisches Bundesamt. (2026). 1 056 000 Personen erhielten 2025 Leistungen der Eingliederungshilfe für Menschen mit Behinderung [1,056,000 people received integration assistance benefits for persons with disabilities in 2025]. https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Soziales/Sozialhilfe/eingliederungshilfe.html

Thielscher, C. (2023). Sozialmedizin [Social medicine]. In M. Buntrock & K. Peinemann (Eds.), Grundwissen Soziale Arbeit [Basic knowledge of social work] (pp. 133–147). Springer.