The Health and Social System in Germany – An Overview for Study and Practice
Self-study course · at your own pace · with confirmation of participation.
5. Module 4 · Statutory health insurance – benefits, contributions and reforms
- You can explain in your own words the benefits-in-kind principle and the principle of economic efficiency under section 2 SGB V (understand).
- You can name the contribution parameters of statutory health insurance for 2026 and distinguish their functions from one another (name, distinguish).
- You can calculate sickness benefit (Krankengeld) under section 47 SGB V step by step using an example (apply).
- You can relate everyday situations from counselling and management to the logic of statutory health insurance and distinguish it from private health insurance (apply).
- You can place the key points of the hospital reform (KHVVG and KHAG) in context and evaluate its opportunities and limits for your organisation (evaluate).
Statutory health insurance is the branch of social protection you encounter most often in hospitals, home care services, counselling centres or your studies: it governs who receives which health services, how these are financed and – through the hospital reform – how inpatient care will be organised in future. An opening question for your practice: which question about health insurance funds, sickness benefit or hospitals are you asked most often in your day-to-day work – and how confidently can you answer it?
What you will be able to do afterwardsYou will be able to give insured persons, team members and students well-founded orientation on benefits, contributions and sickness benefit, name the limits of the information you can provide and place the key points of the hospital reform in context objectively.
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.
Section 2 SGB V – Benefits, economic efficiency, benefits in kind. Under subsection 1, first sentence, the health insurance funds make benefits available to insured persons in compliance with the principle of economic efficiency (Wirtschaftlichkeitsgebot), insofar as they are not attributed to the insured persons’ own responsibility. Under subsection 2, first sentence, insured persons receive benefits as benefits in kind and services, unless SGB V or SGB IX provides otherwise. Sickness benefit is governed by section 47(1) SGB V.
Legal position: October 2026. Professionals inform and provide orientation but do not give legal advice in individual cases; for questions of entitlement, refer people to the health insurance fund, counselling centres or legal services and act in accordance with your organisation’s procedures.
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.
Under section 6(1) SGB IX, the statutory health insurance funds can be rehabilitation providers (Rehabilitationsträger), namely for benefit groups no. 1 (medical rehabilitation) and no. 3 (benefits to secure maintenance and other supplementary benefits). If an application for participation benefits reaches a fund that does not consider itself responsible, the forwarding logic from Module 3 applies. Rehabilitation is covered in depth in Module 6.
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.
The average supplementary contribution rate of 2.9 per cent is a guide value for the year 2026. An individual health insurance fund may charge a different rate (BMG, 2026a). The average therefore tells you neither the contribution of a particular person nor the burden imposed by a particular fund. If employees or clients ask about their specific contribution, refer them to their health insurance fund or their payslip.
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.
- Guiding principle: solidarity principle
- Contribution based on income (general rate 14.6 per cent, plus supplementary contribution)
- Family members co-insured free of contributions
- Benefits as benefits in kind and services (section 2(2) SGB V)
- Principle of economic efficiency as the funds’ standard
- Guiding principle: equivalence principle
- Premium based on risk and chosen tariff
- Scope of benefits follows the agreed tariff
- Access and switching regulated by law
- Income threshold for the option: compulsory insurance threshold of 77,400 euros per year
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.
Advice on sickness benefit. Lena Koch, a qualified care professional, has been unfit for work for several weeks and asks the adviser Sara Wagner at her organisation’s social counselling service: ‘Will I now only get half my salary?’ Sara Wagner first explains the logic of section 47 SGB V – 70 per cent of regular pay, capped at 90 per cent of net pay – without calculating any figures for Ms Koch. She then helps to collect the questions for the health insurance fund and points out that the fund determines the amount bindingly and provides information (sections 14 and 15 SGB I).
Context: The adviser provides information on the logic of the system and refers the individual calculation to the responsible benefit provider. This is neither passing the buck nor legal advice, but the navigator role explored in depth in Module 8. From a management perspective, it is worth agreeing such referral routes as a standard within the team.
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 hospital reform has come into force in two steps: the KHVVG of 2024 was adjusted by the KHAG of April 2026 (BMG, 2026d). The KHAG changes deadlines for provision-based remuneration, the financing of the transformation fund and exceptions and service groups. Hospital planning remains with the Länder. Which specific local changes will result cannot be derived from the federal laws alone; you should therefore find out what has been planned and announced in your federal state.
Team meeting on the hospital reform. Tim Richter manages an outpatient care service. Team members ask, feeling unsure, what the hospital reform means for the transfer of patients from hospital. Tim Richter first sets out the established key points: service groups with quality requirements, provision-based remuneration, cross-sectoral care facilities, planning authority of the Länder. He then records with the team what is not yet known and agrees to collect observations on transfer routes over a period of time and to coordinate them with the hospital’s social services.
Context: The manager provides orientation without venturing forecasts: the federal laws set a framework, and the specific implementation depends on planning by the Länder. Established facts and open questions are named separately – an approach that reduces uncertainty and creates the capacity to act.
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.
For each situation, identify which GKV logic applies (benefits-in-kind principle, family insurance as solidarity-based redistribution or sickness benefit as income replacement), name the relevant legal provision or source and formulate a sentence with which you would explain the situation to the person concerned.
- Lara Engel is treated in a practice without initially paying for the treatment herself.
- Greta Klein’s husband is insured through her membership and does not pay his own contribution.
- Tom Brandt, an employee, has been ill for a longer period and asks how his income will be secured during this time.
Hint 1
Hint 2
Show solution notes
- Benefits-in-kind principle (section 2(2), first sentence, SGB V): insured persons receive treatment as a benefit in kind and service; settlement takes place between the health insurance fund and the service provider. Example sentence: ‘You receive the treatment itself; billing normally takes place between the practice and the fund.’
- Family insurance as an expression of solidarity-based redistribution (BMG, 2026a): co-insured spouses and civil partners as well as children do not pay their own contribution. Example sentence: ‘Your husband is co-insured through your membership; there is no separate contribution for him. Your health insurance fund will clarify the exact conditions.’
- Sickness benefit (section 47(1) SGB V): 70 per cent of regular pay, at most 90 per cent of net earnings. Example sentence: ‘The fund secures part of your income through sickness benefit; it determines the exact amount and will give you information about it.’ For the individual calculation, refer the person to the health insurance fund (sections 14 and 15 SGB I).
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.
For academic papers: cite legal provisions with the subsection (for example section 47(1) SGB V), always give contribution parameters with the reference year (BMG, 2026a) and label statistics with the reference date and area (BMG, 2026b). A sound structure separates finding (figure, legal provision) from interpretation (solidarity-based redistribution, area of tension). Positions in the debate on GKV and PKV should be labelled as positions and not formulated as findings.
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.
What does the benefits-in-kind principle state?
How much is sickness benefit in principle?
Who is covered by family insurance, and what do they pay?
Which contribution parameters apply in 2026?
What are service groups and provision-based remuneration?
Who plans hospital care, and what is the KHAG?
- The GKV provides cover against illness through benefits in kind and cash benefits; benefits depend on need, contributions on income (section 2 SGB V, section 47 SGB V).
- The benefits-in-kind principle and the principle of economic efficiency shape how benefits are provided; personal responsibility is a proviso whose scope is contested.
- Contribution parameters are values for the year 2026: 14.6 per cent general, 14.0 per cent reduced, an average supplementary contribution of 2.9 per cent, shared equally for employees (BMG, 2026a).
- Sickness benefit follows a two-stage logic: 70 per cent of regular pay, capped at 90 per cent of net pay.
- The hospital reform (KHVVG, KHAG) sets a framework; planning remains a matter for the Länder, and the local effects are open.
- Professionals provide orientation, refer and document – individual calculations and legal advice are the responsibility of the health insurance fund, counselling centres or legal services.
Practice checklist for your own coordination within the team – not legal advice:
- ☐ Does your team have a binding arrangement on where people are referred with questions about sickness benefit and health insurance fund benefits?
- ☐ In counselling, do you first ask in what capacity the person is insured (member or co-insured)?
- ☐ When quoting contribution parameters, do you always state the reference year and the source and point out average values?
- ☐ In team discussions on the hospital reform, do you separate established key points from open questions?
- ☐ Do you document referrals in such a way that people seeking advice do not have to start all over again?
Voluntary self-reflection – not graded, just for your own understanding:
- Which question about health insurance funds, sickness benefit or hospitals do people seeking advice or staff ask you most often – and which answer structure from this module helps you with it?
- Where, for you, is the boundary between providing orientation and giving legal advice – and how do you notice that you have reached it?
- Which areas of tension (economic efficiency and need, GKV and PKV, quality and accessibility) specifically affect your organisation, and how do you intend to raise them in the team?
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 values 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. (2026d, 22 April). Krankenhausreform [Hospital reform]. https://www.bundesgesundheitsministerium.de/themen/krankenhaus/krankenhausreform
Sozialgesetzbuch (SGB) Erstes Buch (I) – Allgemeiner Teil – [Social Code Book I – General Part] of 11 December 1975 (BGBl. I S. 3015), as in force on 8 October 2026, sections 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 S. 2477), as in force on 8 October 2026, sections 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 S. 3234), as in force on 8 October 2026, sections 2, 5, 6, 14 and 32. Available at https://www.gesetze-im-internet.de/sgb_9_2018/__5.html
Figures and tables: own illustration. Citation style: APA 7 (German-language adaptation).
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.
Question 1. What does the benefits-in-kind principle under section 2(2), first sentence, SGB V state?
Question 2. How is sickness benefit under section 47(1) SGB V determined in principle?
Question 3. Assume that regular pay is 2,400 euros and net earnings are 1,800 euros (simplified, fictitious calculation). What amount results according to the logic of section 47(1) SGB V?
Question 4. How do the contribution ceiling and the compulsory insurance threshold in the GKV differ in 2026?
Question 5. What applies to the hospital reform as of October 2026?