Can we get public health insurance?

27 posts in this topic

Posted

Hi,

I have been reading articles and forum posts on Toytown about public health insurance in Germany and feeling enlightened and increasingly confused at the same time! It all seems fantastically complicated.

My wife and I are trying to get insured with one of the public health insurance companies. We have private cover with an international insurer at the moment - but that cover runs out tomorrow (unless we renew for another year of course). We have been trying to get this done for months now but nothing seems to be working, so I thought I'd ask if anyone has any last minute ideas. The private insurance we have is not acceptable for us to be employed in Germany, which is one of the reasons we want to change to public insurance.

I am employed, earning under €4k per month, but I am employed by my own UK company. The company is now registered to pay contributions in Germany, but the company cannot pay any contributions for me until I have health insurance (which is accepted in Germany). My wife is self-employed and she also earns less than €4k per month.

So far, in 2 years of living here, we haven't paid any health contributions ("versicherungspflichtig") because we have private cover. We have been speaking to a health insurance advisor who said that we cannot get public health insurance because we haven't paid any contributions..! So now, we are stuck. No health insurance without contributions; no contributions without health insurance.

So we are looking for some advice on this. I think our options are:

1) Just apply for public health insurance and see what happens. I have an application form for TKK insurance for example. If we do this today, then maybe we don't need to renew our private insurance for another year. Is that right? Are you covered from the day you apply?

2) Find an advisor to help with it. So far, this has been a frustrating process. Nobody is allowed to give any advice on the public insurance and they all want to sell you private. They tell you there are differences in the public health insurers but can't tell you what the differences are or give any advice.

3) Just renew our private insurance and accept that we cannot be employed in Germany for another year. (probably the least stressful option at the moment)

If anyone has any advice on this I would be very grateful. Thanks.

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Posted

My wife and I are trying to get insured with one of the public health insurance companies. We have private cover with an international insurer at the moment - but that cover runs out tomorrow (unless we renew for another year of course). We have been trying to get this done for months now but nothing seems to be working, so I thought I'd ask if anyone has any last minute ideas. The private insurance we have is not acceptable for us to be employed in Germany, which is one of the reasons we want to change to public insurance.

Were you seconded here?

My wife is self-employed and she also earns less than €4k per month.

When your wife opted for private health insurance, she gave up her right to be insured in the public system. Her only option now is private (unless perhaps she finds a position earning more than 401€/month, however, she could be liable for backpayments).

1) Just apply for public health insurance and see what happens. I have an application form for TKK insurance for example. If we do this today, then maybe we don't need to renew our private insurance for another year. Is that right? Are you covered from the day you apply?

If they accept you (and that is a very big IF!). However, you need to be prepared that you might be liable for backcharges.

2) Find an advisor to help with it. So far, this has been a frustrating process. Nobody is allowed to give any advice on the public insurance and they all want to sell you private. They tell you there are differences in the public health insurers but can't tell you what the differences are or give any advice.

If you were eligible to apply for public, a good relocation professional could also assist you.

3) Just renew our private insurance and accept that we cannot be employed in Germany for another year. (probably the least stressful option at the moment)

Depending on your contract and your current health insurance, this may also not be an option.

You need professional help. Contact one of our expert advisors, they can at least determine whether or not you are eligible for public health insurance (I don't think you are, but there might be a loophole). If you are not eligible, they can then advise you on acceptable private policies.

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Posted

Thanks for your reply engelchen.

I wasn't seconded here. We chose to move here (unrelated to work) and plan to stay. With regard to my work contract, I can pretty much have any terms I want in that (whatever is most suitable).

I read the thing you mention about giving up the right to public health insurance if you take private cover. I thought that was only if you opt-out of the public system (which we have never been in). I am probably wrong on that though - we've been told a lot of different things from a lot of people now.

Do you have a recommendation of a professional to talk to about this?

We were really hoping to be able to get out of the private system because it hasn't been a nice experice - but we will obviously do whatever we have to.

Thanks, Alex

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Posted

I wasn't seconded here. We chose to move here (unrelated to work) and plan to stay.

Then you should have had German approved health coverage from the beginning.

I read the thing you mention about giving up the right to public health insurance if you take private cover. I thought that was only if you opt-out of the public system (which we have never been in).

By being privately insured, you implicitly opted out of the public system.

Do you have a recommendation of a professional to talk to about this?

Try Starshollow (and if he tells you he doesn't know of a loophole for you to get into the public system, it doesn't exist).

We were really hoping to be able to get out of the private system because it hasn't been a nice experice

Depending on your cover you might be able to get into the public system on the basis that you weren't insured at all, however, that would also require backpayments.

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Posted

You said from now on your company can pay contributions in Germany. If you mean by that German social security contributions, then you will be a normal employee who automatically has to be insured in a public health insurance (i.e. they have to accept you) if the monthly salary is below the Versicherungspflichtgrenze, which for 2012 is 4,237.50€. To avoid backcharges, you could play the deregistration game, see Freelance, self-employed or employee?. Regarding your wife, since she isn't yet a member of a German private health insurance, as far as I know, she can play the deregistration game and then appear at the door of a German public health insurance with a form in hand issued by the NHS certifying that she was member of it (any public health insurance anywhere worldwide will do) for at least 24 months out of the last 5 years. They will then have to accept her as a voluntary member. However, being a voluntary member means that she would have to pay 14.9% of all her income, not only of her self-employed income.

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Posted

To avoid backcharges, you could play the deregistration game, see Freelance, self-employed or employee?.

Just be aware that the "deregistration game" is also fraud and freeloading as well as could have some nasty consequences if you get caught. <_<

issued by the NHS certifying that she was member of it (any public health insurance anywhere worldwide will do) for at least 24 months out of the last 5 years.

Are you sure? I'm pretty sure that it has to be 24 months of EU public health insurance.

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Posted

Yes. The company is now registered to make social security contributions in Germany, but the comapny can't start to do that until I have insurance. It's a bit of a catch22.

Both my wife and I have paid national insurance contributions in the UK for many years - and I *think* there would be 24 months within the last 5 years of contributions.

I will read about the "deregistration game". If it is considered fraud then we won't do it. On a personal level, I don't feel that avoiding backpayments would be "freeloading" though as we have been privately insured - and every medical bill I have had since being in Germany I have paid from my own pocket. Still, my own feeling on it are not the point here...

Thanks again to both of you for the advice on this. I have also emailed your recommeded advisor, engelchen. Maybe he will have some ideas too.

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Posted

your problem is this: appart from the rule that you have to have had either the last consecutive 12 months or at least 24 months out of the last 5 years public insurance coverage in an EU memberstate in order to be able to get into German private health insurance as a voluntary member, you also have to make this move within the first 3 months upon taking up residence in Germany.

If you have already lived in Germany for about 12 months if I understand you correctly, you have given away this right to join public health insurance as a voluntary member if you remain either self-employed or employed under a foreign contract.

Having said that: if you start to get a brand-new employment contract now under German law, then the rule that upon taking up employment for the first time in Germany you have the choice between public and private health insurance would apply to your case. But make sure that your company now has a German "Betriebsnummer" for public insurance and welfare contributions etc which you may need for signing up with public insurance.

If you have not been properly informed about public insurance, you have not gone to the right independent broker, I am afraid. While my team and me, too, would not spend much time in explaining to you the small differences among the public health insurances - because it is neither worth your nor our time, to be perfectly honest - we would check for you your eligibility for public health insurance and then show you the pros and cons fairly weighed and unbiased side by side so that you can make an educated decision...something every decent broker should be doing for you. Pushing you into private health insurance is a no-go and also for the advisor, if he is stupid enough, a serious liablity problem. Unless you have only been to agents or multi-tied agents...

Cheerio

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Posted

Thanks for your reply Starshollow.

So if my company offers myself (and maybe even my wife) new employment contracts under German law, they would have to accept us into the public system?

Is there any way to know if we would be liable for the back payments? We have actually lived here for a couple of years now, so it could end up being a huge bill! =/

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Posted

So if my company offers myself (and maybe even my wife) new employment contracts under German law, they would have to accept us into the public system?

Yes.

Is there any way to know if we would be liable for the back payments? We have actually lived here for a couple of years now, so it could end up being a huge bill! =/

If your international health insurance wasn't one of the ones registered with BAFIN (see here for a list ) then you are liable for the backcharges for sure, no if about it.

The problem is when you enter a public health insurance they want to do a hand-over from your previous health insurer (German public or German private).

If you can't show proof of membership in either or show that you just arrived (of which the date on your Anmeldebestätigung is the proof), then the public health insurance you want to join has by law (they don't do it for the fun of it) backcharge you contributions all the way back to 1. April 2007 or back to whenever you first moved to Germany if that took place after 1. April 2007.

So it's your choice:

  • play the deregistration game --> no backcharges, or
  • minimise your backcharges by getting a private health insurance and let them backcharge you less than the public health insurance would and then become an employee earning less than 4,237.50€ a month which automatically terminates that private health insurance contract (see post no. 27 in Freelance, self-employed or employee?). You then tell the public health insurance your German private health insurance policy number when they ask after you previous insurer so that they can do the hand-over, or
  • do nothing and prepare to be backcharged at least 150€ per month that you have been in Germany (it will be more for you since it's 14.9% of your gross total income!)

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Posted

Thanks for your reply PandaMunich and everyone else in this thread. I feel more informed on the subject now.

Starshollow, I have just used the contact form on your website to send you a message as we are keen to get some professional advice on this and get it resolved as soon as possible.

I look forward to your reply.

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Posted

Yes.

If your international health insurance wasn't one of the ones registered with BAFIN (see here for a list ) then you are liable for the backcharges for sure, no if about it.

You may have to pay it anyway. Hardly any public insurer cares or knows about his BaFin list. It depends who you talk to, I´m afraid.

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Posted

[adminmerge][/adminmerge]

Hi,

My partner is here as a research fellow and receives a small non-taxable bursary for living costs. I am working freelance/ self-employed as a teacher and have to pay tax but not social security. We are both UK nationals and not married.

We are very confused about insurance. Are either of us entitled to public insurance and if so how do we get it? I currently pay quite a lot for some private insurance but it doesn't cover things like pregnancy (we are here for 5 years) or any pre-existing conditions. Coming from the NHS, this is a shock!

I believe that even if I did manage to change insurers there would be a 9 month exclusion on pregnancy. I'm 32 so don't really want to wait that long! <_<

Does any-one have any ideas of how we can get covered? Currently my partner is just hoping his EHIC card will cover him as no-one seems sure what to do in this situation. The society that gave the bursary said he should be covered by the NHS, but we can't seem to get a straight answer from them. Would they cover me too?

I hope this situation makes sense to some-one and you can help us. I tried looking at other threads but they seemed to be about US nationals or married couples so I'm not sure if its different.

If the only way to sort it is to get married I'll just have to persuade him! ;)

Thanks.

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Posted

[adminmerge][/adminmerge]

Hi,

My partner is here as a research fellow and receives a small non-taxable bursary for living costs. I am working freelance/ self-employed as a teacher and have to pay tax but not social security. We are both UK nationals and not married.

We are very confused about insurance. Are either of us entitled to public insurance and if so how do we get it? I currently pay quite a lot for some private insurance but it doesn't cover things like pregnancy (we are here for 5 years) or any pre-existing conditions. Coming from the NHS, this is a shock!

I believe that even if I did manage to change insurers there would be a 9 month exclusion on pregnancy. I'm 32 so don't really want to wait that long! dry.gif

Does any-one have any ideas of how we can get covered? Currently my partner is just hoping his EHIC card will cover him as no-one seems sure what to do in this situation. The society that gave the bursary said he should be covered by the NHS, but we can't seem to get a straight answer from them. Would they cover me too?

I hope this situation makes sense to some-one and you can help us. I tried looking at other threads but they seemed to be about US nationals or married couples so I'm not sure if its different.

If the only way to sort it is to get married I'll just have to persuade him!

Thanks.

You are privately insured and self-employed so you CANNOT switch to public health insurance/gesetzliche Krankenversicherung - by the way, you´re supposed to have pregnancy cover by law!

In the German system, they don´t do "living in sin"! :D You can´t share the same public insurance if you´re not married!

I don´t know about your partner - that depends on other questions. Why not call Newcastle to check on that?

-

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Posted

She says she came from the NHS, john g. - don't they both have an entitlement to public insurance if they can prove NHS cover in 2 of the last 5 years?

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Posted

She doesn´t, El Jeffo, because she´s already privately insured and self-employed..THOUGH if still paying NHS contributions ( and hiding the private insurance :) ) that could work!

Research fellow: more information would be required here - best to contact Newcastle here AND check with the university.

Chillicat: where are you privately insured ( is it only a travel insurance and are you able to prove membership of the NHS ) ?

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Posted

as JOhn alread said between the lines: oh dear, oh dear.... everything gone wrong here already - was there no-one to give you any decent info or advice at all?:

1. not sure how you partner is insured here in Germany, but it does not concern you from the (very oldfashioned and outdated) point of view of the German law, I am afraid.

2. Upon taking up your residence in Germany coming out of the NHS, you had three months to join the public health insurance voluntarily (with coverage for pregnancy and everything else from day 1, btw). I do not know what idiot and not-informed fool put you into what seems to be a travel-health-insurance (the 5-year max duration and lack of pregnancy coverage explain that this is what you get) because it it totally unsuitable for EU citizen who take up their main residence in Germany. So, not only are you basically violating German laws, you have also lost your eligibility for voluntary membership in the German public health insurance if you have been registered here for >3 months, I am afraid. What a mess!

John_G already pointed out what you can do: de-register from Germany (hoping you have continued to have coverage with the British NHS all along) and then after a short period of time "return" administratively to Germany with a prepared A1 (formerly E104) form that shows you have been covered by NHS since Noah's arc until now and join the public health insurance in Germany within the first few weeks upon "arrival". Because no real German private health insurance is going to touch you with a barge pole, either (appart from the fact that you would even in the best of case have to face penalty back-charges for the past time since you were a resident in Germany). Alternatively you can join one of the real international health insurances but with a 11-months waiting period for pregnancy...

Cheerio

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Posted

Hi,

Thanks for your replies. I contacted a broker here but I think they just wanted to sell me something even if it wasn't suitable. I have an AXA policy which is supposed to cover the whole of Europe. I arrived and registered here at the end of August.

I go back to the UK very regularly (at least every 2 months)and have property there. One of the problems with my insurance here is it doesn't cover pre-existing conditions. I have epilepsy and so whenever I have gone back to the UK I have seen my doctor for my usual check-ups. I just told him I have been travelling for language courses (I know this is not right but without my medication I would be very sick).I also have freelance work marking exam papers in the UK and I am studying a univeristy course so I have ties there.

I have emailed an enquiry to Newcastle and hope that because of all this I may still be able to get the NHS cover.

Thanks for your help everyone.

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Posted

chillicat: I´ll be interested to hear their response in Newcastle! But did you read closely Starshollow´s and my posts? As you´re already privately insured, it´ll be difficult to get into public insurance now.

Were you actually also offered the choice of public health insurance here and did you tell the insurance agent about your epilepsy?

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Posted

This is the first time I've posted here, so hope I'm in the right place. I need some advice. I am over 55 years of age and have just been offered a job in Germany and my employer says that public health insurance will be taken out of my pay. I have read that if I am over 55 years of age and not an EU citizen (ie have not been paying into an EU country's national health,) then I am ineligible for the public health scheme. Please can someone clarify this and what I should do, as I will not be earning over 53500 euros, the threshold for taking out private health insurance.

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Posted

Your employer is wrong, since you haven't been a member of a EU public health insurance sometime during the last 5 years, the public health insurance will refuse you.

I suggest you send the the link to this document, important is this sentence:


  • "Wer bereits 55 Jahre oder älter ist, kann nur dann als Pflichtmitglied in die gesetzliche Krankenversicherung zurückkehren, wenn er innerhalb der letzten fünf Jahre zumindest zeitweise noch gesetzlich krankenversichert war."

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Posted

Thanks for reply, Panda. I again contacted my employer and he says "You will have health insurance as all of our employees. There is no problem there". I have read the link that you gave - it applies to people who have left the public health and then go back. I am not in that category, so does it still apply to me? It is a real problem, as I am due to go in a few weeks time and do not want to leave job, flat , family etc here then get over there and find I am not able to get health cover. The Germans make it mandatory to have health cover, then, apparently, bar some people from getting it. This seems to indicate a black hole in the system

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Posted

This is the first time I've posted here

No, it isn't. Not only PandaMunich, but also one of our resident insurance specialists confirmed this already in 2012:

I´m afraid you can´t get public health insurance after your 55th birthday, ciari, whether an employee or not. The only solution is a private one, which may itself be a problem for an Australian here.

Unfortunately at 65 and as a non EU citizen you will find it very difficult to get health insurance here.

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Posted

Ok, let's go back to the law.


  • (3a) Personen, die nach Vollendung des 55. Lebensjahres versicherungspflichtig werden, sind versicherungsfrei, wenn sie in den letzten fünf Jahren vor Eintritt der Versicherungspflicht nicht gesetzlich versichert waren. Weitere Voraussetzung ist, dass diese Personen mindestens die Hälfte dieser Zeit versicherungsfrei, von der Versicherungspflicht befreit oder nach § 5 Abs. 5 nicht versicherungspflichtig waren. Der Voraussetzung nach Satz 2 stehen die Ehe oder die Lebenspartnerschaft mit einer in Satz 2 genannten Person gleich. Satz 1 gilt nicht für Personen, die nach § 5 Abs. 1 Nr. 13 versicherungspflichtig sind.

Sentence 1 says that if you're over 55 you have to have been a member of an EU public public health insurance for the past 5 years in order to get cover now as an employee.

However, there is the let out in the last sentence, that says that sentence 1 doesn't apply to people who fulfill §5 Abs. 1 Nr. 13 SGB V:


  • 13. Personen, die keinen anderweitigen Anspruch auf Absicherung im Krankheitsfall haben und
    a) zuletzt gesetzlich krankenversichert waren oder
    B)bisher nicht gesetzlich oder privat krankenversichert waren, es sei denn, dass sie zu den in Absatz 5 oder den in § 6 Abs. 1 oder 2 genannten Personen gehören oder bei Ausübung ihrer beruflichen Tätigkeit im Inland gehört hätten.

And here's the crux of the matter.

That section is kind of the fall-back section for people who have never before held either German public or private health insurance. Under it, these people can get into public health, as long as they have never been:

  • self-employed, or
  • an employee with a yearly gross salary of more than the Jahresarbeitsentgeltgrenze (53,550€ in 2014, but, for example, it was 39,574€ in 2000), or
  • a civil servant, or
  • a few other things that don't apply to you.

The problem here is however that the Krankenkassen apply this section 13 very restrictively, i.e. they only allow it for EU citizens (others only for German citizens) and even then only when considerable pressure is brought upon them.

Let's face it - at over 55 you will generate more costs for them than they will ever get back from you in contributions.

So even if you have an EU citizenship tucked away somewhere, you'll have to jump through hoops: they will make you prove your employment history back to your first job out of university in the hope that one of the above exclusion criteria will apply to you.

You say that your employer confirms that public health insurance will not be a problem - to me that sounds like they have either:



  • never hired a non-EU citizen over 55 newly come to Germany before, or
  • that they have a tame Krankenkassen employee in their pocket, who is willing to bend the rules for them.

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