Details

Parent Category: Private Legalities

Created on Tuesday, 25 November 2008 03:56

Last Updated on Tuesday, 19 February 2013 08:42

Health Insurance 

When living in Germany, you are required to have sufficient health insurance (§5 AufenthG i.c.w. §2 AufenthG). We will tell you hear what you need to know.

[PPD_PAYTOREADMORE]

 I heard from my German neighbors that I must have health insurance. Can this really be?

Yup. That is a fact since 01.01.2009 (§193 III VVG)! This means that all persons living in Germany must have either statutory or private health insurance.
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Goodie, what do I care about that. What are the consequences?

Well, first of all you will either not get a residence or it will not be extended. And when you for some reason have lost coverage and want to regain it statutory coverage, then your insurer is obligated to collect a premium surcharge (§193 IV VVG). This surcharge amounts to one full premium for each month up to the sixth month without coverage. From the seventh onwards, the surcharge is 1/6 of the monthly premium. Bear in your mind, that the surcharge really is to be paid extra and the insurance company will (and may) not waive it. The only thing you can do is to offer installments and when the installments are reasonable then you can rely on that they will not sue you. Crying "ignorant"? No chance! The insurance company must(!) take the surcharge.
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What is meant by “statutory health insurance”?

“Statutory” implies that your insurance is compulsory via certain public (but not state owned) insurance companies. Most statutory health insurance companies offer mostly the same services, but the premiums have now become uniform 15.5%.
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How can I get private health insurance?

Having a yearly income above a certain amount or being self-employed, you can choose between both types of insurances. There is virtually no way to switch between the systems, so you are locked in once you have made your choice. By the way, forget about dispensing health insurance. In Germany, it is mandatory. Even though you are entitled to choose, you can remain privately insured or sign up a statutory health insurance as a so-called “freiwillig Versicherter” (voluntary insured person).
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When is statutory health insurance mandatory?

Most people belong to the public system.

• All employees with a monthly income of up to € 4,350,
• Students at state and state-approved universities until completion of the 14th semester or up to 30 years old (with some exemptions).
• People on work experience (internships) or in secondary education.
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I heard from health insurance company back home that I do not need to close an insurance policy here in Germany as my home coverage for students is also valid for Germany. Is this true?

Students from countries with which Germany has signed a social security treaty, which includes an insurance clause, can continue to be covered by their home insurance company while they are in Germany. For further information, inquire at your institution's international office. But also in these cases, you still have to present proof of insurance coverage to the foreigners office (Ausländeramt) in Germany.
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Which in general is better, statutory or private insurance?

Depends on your monthly liquidity, monthly income, how specialized your coverage is to be, and other factors. Choose a private insurance company: if you do not mind paying all and then getting the money reimbursed (except for hospital bills), or if you need flexible coverage, alternative medicine, and a private hospital room. Go with statutory insurance if you need minimum coverage, have a long-term illness or a family or older. The statutory insurance company must insure you if you are not entitled to choose. This is only a very rough differentiation. Please contact an insurance agent for more competent information before signing a contract. Statutory insurance is considered as the insurance for the poor, supplying only standard treatment. The legislation for statutory insurance tends to limit the payment of the doctor’s performance. Applying for private insurance? Be sure to list every serious illness you have had.

Do not listen to any sales agent, who might play down your medical history to get you the lowest possible rate. If you had a severe illness reckon with a surplus on the premium, if they take you at all. If you have a minor orthopedic problem, this will cause a minor surplus to your premium. And if you hide your medical history, only to get a giant bill shortly after signing the contract on to be refunded, the company will claim you cheated them. They will cancel your contract and refuse to pay for treatments and hospital stays. On top of that, you may be barred from getting insured by another private company or even by a statutory insurer. They will not even refund any premiums. All this is legal!
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Will my health insurance cover my spouse?

Depends on whether you have statutory or private insurance. Being on statutory health insurance, she can be covered in so far as she has no income. Being on private insurance, she is not. The reason for this is easy to explain because of the nature of the two different insurance systems. Statutory insurance finances itself by the solidarity of all payers. Married couples, both working, will both have to pay their premiums. The private insurance only covers the risk for the person insured.
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Here is a summary of the main points:

 Update provided by Keith Tanner