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Health insurance for the self-employed: Private health insurance & sick pay

If you are not self-employed, you have no choice: you must insure yourself in the private health insurance company. What do you need to know?

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Private health insurance for self-employed

As a self-employed person, you can always switch from legal to private health insurance - only the return is more difficult because you have to be younger than 55 years and employees with a certain annual salary (currently the upper limit for 49.500 Euro).

Maybe the private health insurance but also simply more to the statutory, says the benefits can be far more extensive and the tariffs cheaper.

The basic tariff

Since the year 2009, private health insurers have to offer a so-called "basic tariff", which is open to all those who are not compulsorily insured under statutory health insurance and which are not insured voluntarily in statutory health insurance for more than six months.

If you meet these conditions, you must be included in the basic tariff - even in the case of serious illnesses, which could otherwise be used to reject you or raise expensive risk premiums.

Insurance for the unemployed

This also applies if you become unemployed as a private or uninsured self-employed person. However, the Arbeitsagentur (unlike in the statutory health insurance fund) bears only a portion of the contributions, in the case of unemployment benefits no more than 131,34 Euro; the rest is deducted from the unemployment benefit.

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If your income after the payment of the basic tariff contribution leaves you with just enough money to be entitled to unemployment benefit II, the insurance company must reduce the contribution by half.

Amount of premiums

However, the amount of contributions, here called insurance premiums, is also based on the basic rate by age and gender, but not by income. The basic rate may not be higher than the statutory health insurance (553,16 Euro per month).

Up to this amount, however, insurances are free to demand a high premium from low-income earners. There is also no family insurance, but the partner can get a discount of 50 percent. In the highest case, 829,74 euros are already available for a couple.

Attention expensive additional services

Private health insurances lure people with additional insurance so that those with statutory health insurance can afford individual treatments at the dentist - and do good business with it. The number of contracts concluded recently rose by 15 percent. Around 50 providers, reports the “Apotheken Umschau”, are competing for the customers' favor and luring them into a veritable jungle of tariffs that requires the policyholder to weigh carefully. Most important question: Does he want to cushion the costs of the "standard care" or get the highest quality and visually appealing dental prosthesis? Many consumer advocates recommend only insuring the really expensive risk of “dentures” and paying for extras such as chewing surface sealing yourself.

The first look must be at the percentage of the cost that the supplementary insurance pays. But be careful: Most of the time, the fixed allowance from the statutory insurance is included. Other providers advertise with “100 percent”, but only double the fixed subsidy. If the treatment costs more, this is at the expense of the patient. Also study carefully: upper limits that apply sometimes per year, sometimes over the entire term. Under no circumstances should customers accept contracts in which the insurer reserves the right to terminate the contract for the first three years if the customer becomes “too expensive”.

Differences depending on the insurance

The benefits you get for these bonuses are usually very different from insurance to insurance. There is only one thing that can help to compare prices and services.

The best way to do this is to get comparative offers from different insurance companies - not by means of some comparison tables on the Internet, but personally and bindingly.

What services do you need?

First consider which services you need: for example, is basic medical care sufficient for you at the basic rate or do you want treatment by the head physician in the hospital? What additional services would you like for dentures? The more services, the more expensive it becomes.

For certain ailments and pre-existing illnesses, private insurance companies also require risk supplements, which can be counterbalanced by the beautiful sample calculations from the tables. Or they refuse to take a shot at the risk. And: Women pay up to 60 per cent more than men, and even in the elderly the contributions are higher.

Health insurance in statutory health insurance

In statutory health insurance, self-employed self-employed persons have the option of obtaining a sickness benefit from the first day of sickness with a special tariff.

The proposed health reform bill obliges all statutory health insurers to make such offers. So far, one can only speculate whether these tariffs will be affordable by anyone. In the standard tariff, which now includes sick pay from the seventh week of illness, the claim to sick pay should no longer apply. So far this is only a draft law!

Contribution classes for sickness benefit in the GKV

As a rule, three draft classes, ie a low (without a health claim), the standard contribution (with sick pay from the 7 illness week) and the increased contribution (with sick pay mostly from the fourth week), are now being determined :

"Full-time self-employed people are not entitled to sick pay."

Your cash contribution should be 0,6 percentage points below the normal contribution. The health insurers have to offer “optional tariffs” for immediate sick pay, the amount of which the draft law is silent on.

New regulation and media panic

The new regulation should not apply to insurance through the artist social fund - here the draft leaves the law unchanged.

Then a panic message in the media: According to § 44 SGB 5 have full-time independent From January 1, 2009, those in gainful employment are no longer entitled to sickness benefit in the statutory health insurance scheme. And now? Change to private health insurance, take out private daily sickness allowance insurance?

Sick pay entitlement remains

Nonsense, says the information service Mediafon. Because at the same time also § 53 SGB 5 is changed. Its paragraph 6 now reads:

"In its statutes, the health insurance company has to offer tariffs for (these members) that give rise to a claim to sickness benefit (from the first day) or at a later point in time, but for those insured under the Artists' Social Insurance Act no later than the beginning of the third week of incapacity for work . "

So if everything remains the same, it means only different! And one must know that - whoever wants to be entitled to a sick pay - has to convert his previous insurance into the standard tariff into an insurance in the elective tariff with a claim for sickness benefit.

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3 responses to "health insurance for the self-employed: private health insurance & sick pay"

  1. Cortez Stargell says:

    The new year is going well. Thank you for the great article.

  2. PKV rate comparison says:

    Statutory health insurance for the self-employed: Part 3 - Private health insurance ...

  3. Competencepartner says:

    Statutory health insurance for the self-employed: Part 3 - Private health insurance: ...

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