Health care reform and health insurance: What changes for all those who are not compulsorily insured?

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If you are not compulsorily insured in a statutory health insurance, you have, for example, a freelancer, whether you were legally, privately or not yet insured. This changes with the health reform, because from 2009 there is a general insurance obligation. Health care reform and health insurance: What changes for all those who are not compulsorily insured? Health care reform and health insurance: What changes for all those who are not compulsorily insured?

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This entry contains content and information that may be out of date, eg due to legal or statistical changes. Because it can still be helpful to get an overview of the topic, you can still find it here.

Since 2007


For formerly legally insured and never insured, she already started in April 2007. The problem is that the real problem of the uninsured is unresolved: those who can not afford the minimum contribution of the funds are and are virtually excluded from the solidarity community and only receive emergency care.

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The (then theoretical) insurance requirement helps a little and leads only to the construction of further debts, since in the case of retirement the contributions must be paid back. And: self-employed outside of special systems such as the artist's social insurance must continue to apply the health insurance contribution alone.

health insurance


For those who have never had health insurance, 2007 has had to take out health insurance since April. On the question of whether the statutory or private funds are responsible, decides on the basis of the job: self-employed will usually need to insure privately.

The minimum wage has been lowered since April 2007 for full-time self-employed persons insured in statutory health insurance funds. This applies to all voluntarily or legally insured persons, but not for members of the KSK, the contributions continue to pay according to their real income. Since April 2007, a fictitious income of 1837,50 Euro can be used on a monthly basis instead of the previously accepted minimum income of 1242,50 Euro. The minimum contribution can thus fall from around 260 Euro per month to about 180 Euro. For other self-employed persons (for example unemployed self-employed persons), it remains with a minimum contribution of around 120 Euro.

The sick pay rate


Are you self-employed and a member of a statutory health insurance? Then there is a good news for you: From the 1. January 2009, the health insurance funds must offer an optional tariff with a claim for health insurance to all those insured who are not yet entitled to it and therefore pay a reduced rate of contribution.

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These include all full-time self-employed. In addition, so-called "undocumented workers", who are usually employed for a short period of time at this, sometimes at that employer. For the new elective rate with sick pay entitlement, the fund requires a premium surcharge.

Standard rate of private funds


Anyone who does not have compulsory insurance and wants to go to a private bank has to be admitted to 2007 since July. And to the standard rate and without health check and risk surcharges. The right to assure yourself of this tariff has those who have already been insured in a private health insurance fund and those who have never been covered by health insurance. Those who are never insured, who belong to the system of statutory health insurance, must insure themselves there. The private funds must allow access to the standard rate in addition to the previously mentioned previously privately insured as well as (for a limited time) the voluntarily legally insured.

This is an improvement especially for persons who did not return to the insurance company after a bankruptcy and the chronically ill, to whom the private funds have so far refused insurance. - But you also have to be able to afford this improvement. And: The standard rate that the health insurance companies have to offer over 55 yearlings enjoys such a bad reputation among doctors that they sometimes refuse treatment at their fees. That's probably why only about 20.000 of the approximately eight million PKV insured have voted him.

Basic rate of private insurance and compulsory insurance at the latest 2009


Formerly privately insured self-employed, who currently do not have health insurance, have to conclude a contract with a private fund from 2009. Until then, the insurance obligation applies only to those who have never previously been covered by health insurance. The general inclusion of self-employed persons in the system of statutory insurance is not provided for.

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The private funds must start from 1. January 2009 offer a "base rate" in which they must - without risk surcharges - also "worse risks" record. The scope of benefits of the basic rate should correspond to that of the statutory health insurance, the premiums may not exceed the maximum rate of SHI of about 500 Euro per month. If need be the base rate can be halved. This base rate is today's "standard rate", in a new guise.

To the 1. January 2009 is introduced by the private health insurance a base rate, which replaces the previous standard rate of private insurance. For this, the private funds are legally required.

to contract


The basic rate includes a range of services comparable to that of the statutory health insurance (GKV). The amount of the basic rate contribution depends only on the age of entry and the sex of the policyholder, not on his or her health status. This is one of the most important changes for insured persons, because in principle private autonomy prevails in Germany. That is, a contractor is not required to conclude a contract with anyone. For example, a department store or an innkeeper does not have to serve everyone. However, there are statutory exceptions such as the so-called obligation to contract. This is the legally required obligation to accept a contract offer. For example, transport companies must, in principle, carry anyone under the conditions of the public tariff. Or Deutsche Post AG has to provide universal postal services for everyone. Statutory health insurance funds are also subject to the obligation to contract: they are obliged to accept all those who fulfill the insurance conditions, regardless of their age, health status or financial performance.

From 1. January 2009 is now also in the private health insurance as well as the statutory health insurance so-called obligation to contract, that is a legal obligation of private insurance companies to take insured. There are no risk exclusions or surcharges at the base rate. With the GKV-Competition Reinforcement Act (GKV-WSG) all persons without protection in case of illness receive a possibility to return to the last insurance to which they belonged - be it a statutory or private health insurance. For this purpose, the private health insurance company must offer a basic rate according to the scope of the GKV with obligation to contract at affordable premiums - without risk surcharges and without exclusion of benefits. Private health insurance companies therefore have to accept all people who apply there for the conclusion of an insurance contract for the basic tariff.

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Contributions in the basic rate


In order to ensure the affordability of the basic rate, its contribution to individuals must not exceed the average maximum contribution in the SHI. The average maximum contribution to statutory health insurance is currently around 500 Euro. If the payment of such a contribution would trigger a need for help in the sense of social assistance or basic security for jobseekers, further regulations ensure that those affected are not overwhelmed financially.

Supply in basic tariff


The supply of insured in the basic rate (as well as for insured the industry uniform standard tariff) on the physicians 'and dentists' associations ensured. This means that these insured persons as well as those legally insured have a right to (dental) medical care. For the remuneration of the (dental) medical services, certain maximum rates of the medical fee schedule (GOÄ) and the fee schedule for dentists (GOZ) are laid down. By means of contractual agreements between the PKV Association and the health insurance associations of the Federal Republic of Germany, these requirements may be deviated in whole or in part.

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  1. Leslie Michalczik

    What a successful preparation of this important topic. Thanks a lot for this!#

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