Health insurance: insurance liability additional contributions and hardship cases

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The statutory social insurance system includes health, pension, care, unemployment and accident insurance in Germany. The most important insurance, however, is health insurance. Because she is a compulsory insurance for everyone.

Health Insurance: Insurance Duties Additional Contributions and Hardship Cases Health Insurance: Insurance Duties Additional Contributions and Hardship Cases

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Simone Janson Simone JansonSimone Janson is publisher, German Top20 blogger and Consultant for HR communication.


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Health insurance

Until a few years ago, you could also stay without health insurance, for example, if you were self-employed or had a mini-job.

Since the April 2007 is unfortunately something else: Now absolutely everyone has to insure except without exception health insurance. For health insurance, if necessary, everyone should catch a parachute. The consequences, however, can be correspondingly hard.

Pay back contributions retroactively!

Since April 2007, people who have not previously been covered by health insurance are compulsorily insured. Only: Not everyone knows so far. But: ignorance does not protect against payment.

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Even if you do not know that you are now subject to health insurance, as soon as you are “caught” you have to pay the contributions retrospectively since April 2007. This also applies if you still take out voluntary insurance. A few hundred or even far more than 1000 euros quickly come together.

For whom applies which insurance?

  • If you have a pre-insurance period (see the contribution to the statutory health insurance), you can voluntarily continue to take out insurance at the beginning of your self-employment in a statutory health insurance.
  • If you are not insured for more than six months voluntarily in a statutory health insurance, you can insure yourself with a private health insurance company for a cheaper basic tariff.
  • In all other cases, you must be privately insured for conventional rates. Of course, you can choose this option voluntarily.

Free choice among all insurance companies

Apart from these rules you now have the free choice among all insurance companies. If you are looking for the best insurance and the cheapest fare for you, please fill out the application form - for many insurance companies, this is quite straightforward online.n

Quite clumsily, the legal situation was changed again - if only temporarily. Actually, since 2007 all, yes really all health insurance should be.

What does the scheme look like?

Since April, all those who have not been there until then, but who were at some point before in a health insurance - and be it as a baby ... In July, should the rest, who had never, never really been in a public health insurance to insure in a private - forced by law.

The private health insurance companies should develop a special standard tariff and change the 2009 into a basic tariff again. A rate that is not more expensive than a statutory health insurance so that it is affordable.

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Too complicated for the insurance ...

That was probably too complicated for the private insurance - or too expensive, since the private course have no interest in insuring poor and sick people. Apparently, there seems to have been a few complications because now:

Who ever was in a private health insurance and can never (or must?) Remain in a statutory health insurance until 2009 is uninsured and has to be accepted.

The agony of choice

Only those who have never been previously insured with health insurance have the choice to be insured legally or privately, or decide which job they have.

Those who need to or want to go to private health insurance must be included in the comparatively low standard tariff since July 2007. This standard tariff is then to convert 2009 to the base tariff.

The choice rates of health insurance

With some health insurance companies are now electoral tariffs to relieve the insured in the costs. As of mid-June 2007 election tariffs have been approved by the regulatory authorities only at six national health insurance funds.

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National supervisory authorities have also approved offers from the respective regional AOK. Further tariffs are to follow. However, many offers are confusing. What are the possibilities for saving money?

Tempting but expensive?

Many offers sound tempting. However, according to Info.markt, the consumer magazine of the SWR, it can very quickly become very expensive - namely, if you had to go to the doctor and lose his bonus.

With a change to a more affordable cash register, most expensive insured persons can save more. At choice rates, it is also necessary to calculate exactly what is really to be saved. Anyone who regularly needs medical treatment can hardly benefit from the election tariffs.

No additional costs?

Some health insurance funds, such as the Commercial Health Insurance (KKH), offer a contribution reimbursement if you do not have to see a doctor. There are no additional costs for insured persons. Other funds make reimbursement dependent on participation in precautionary measures, such as the Gmünder Ersatzkasse (GEK).

Additional contributions to health insurance

Various health insurance funds have already announced the levying of supplementary contributions from February this year. However, if you get unemployment benefit II, the supplementary contribution can be accepted in case of hardship. How does it work?

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The supplementary contribution can be taken over by recipients of unemployment benefit II or social security benefits by the primary insurance authorities if the change to a health insurance fund, which does not charge additional contributions, is particularly hard.

This is the case, for example, if the current health insurance provider offers special forms of treatment that are required, expectancy periods for premium payments are lost, or the benefit is terminated in the foreseeable future.

What are the hardships?

In agreement with the Federal Ministry of Labor and Social Affairs, further cases of hardship have now been described which do not necessarily require a change of health insurance. This also applies, inter alia, if:

  • the previous health insurance has already granted certain benefits, such as a rehabilitation measure or cure,
  • certain benefits or resources for the severely handicapped should be returned or
  • this would mean the termination of a commenced permanent treatment.

The particular hardness must be proven by the recipient of the service. Application forms are provided by the basic social security agencies or can be found on the BA's Internet under “Forms for Citizens”.

Supplementary contribution is deductible from income

If a person receiving Unemployment Benefit II earns income that is counted towards Unemployment Benefit II, the additional contribution, like the general contributions to the statutory health insurance, can be deducted from the income. Therefore, no reimbursement will be made by the Grundsicherungsstelle in these cases.

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In general, it is not possible to pay the costs for unemployment benefit I recipients by the Employment Agency. The supplementary contribution is therefore payable directly from the insured person to the health insurance.

family insurance

A private health insurance is required as soon as the total income (including any income from renting or capital is included) is regularly more than 350 € per month or as soon as you work more than part-time (= more than half-day).

In a mini-job you can earn 400 € a month, as an independent artist or publicist, however, only 325 €. And beware: The family insurance expires automatically, as soon as you exceed one of these limits. And that also applies retroactively, if the health insurance company notices it later! There is no free family insurance in private health insurance.

Health insurance for retirees: What is KVdR?

What is actually the health insurance for retirees and who can join your? The KVdR is the statutory health insurance for pensioners. Compulsorily insured are retirees who were compulsorily insured under statutory health insurance during their working life (= 9 / 10 of the second half of the time since the first time a work was taken).

The periods of compulsory membership include family insurance (in the case of a compulsorily spouse).

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As a self-employed person in the KVdR?

Self-employed persons only have a chance if, for example, they were compulsorily insured through KSK. Retirees and pension insurers contribute half of the contributions.

Retirees, who are voluntarily insured under statutory health insurance or privately insured, receive a subsidy for their pension.

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