Health insurance for foreign pregnant PhD student

23 posts in this topic

Posted

Hi guys,

Well, me and my wife came to Germany recently from non-EU country for our PhD study. We are both over 30 years old and my wife is pregnant. AOK, Barmer and Techniker refused to insure us due to our age. Actually, at the beinning, Barmer GEK insured us saying that, there's a paragraph allowing to ensure a foreign student over 30 years old, if they have permit of residence for over 12 months. We even got the document with the insurance number. Then, 10-11 days later they cancelled it according to §5 Abs.1 Nr.13 SGB V, as far as I understand. Over the phone I was told that the reason is still the age and there's no way for us to be insured through any public insurance provider. We have contacted several private insurance providers, none of them agreed to cover pregnancy and birth. The situation is frustrating, since it is expected to have any backup/solution in such condition in a country like Germany.

Would greatly appreciate your help in this matter.

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Posted

This is, unfortunately, a hopeless situation, jemil. You can get international insurance for you both -if public insurance won´t take you ( and forget private German anyway: you are not their clientele ) - but no international insurance will cover the costs of an already pregnant woman.

The situation is indeed frustrating: ESPECIALLY in a country like Germany. Public insurance is not FREE!!

I´m afraid you either have to live with the costs of the pregnancy or your wife will need to do that back home.

Don´t think I´m a horrible person but this is something you should have checked before coming here with your wife being pregnant.

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Posted

I can imagine that this is a very frustrating situation for you - but as JOhn_G already told you, some prior information-research would have pretty much told you that this is the case.

1. no private health insurance is going to cover a pre-existing condition..anywhere in the world. Germany is not special to this regards. as they say - you can't insurance a buring house against fire... so neither a German private health insurance nor an international insurance is going to cover you/your wife in this condition. Normal overall costs for a pregnancy/delivery in Germany are somewhere between 5-10 k EUR and why would any insurance offer you to pay a few hundred EUR per month to cover that with no certainty of you ever paying the rest through your premiums back in the next 20-30 years as a resident in Gerrmany?

2. A voluntary membership in German public health insurance is based on a number of requirements that you seem not to fulfill, I am afraid. If your German is good enough ( or of someone you know can help you writing this in German) you might want to try this German language forum: http://vs-24.com/forum/viewforum.php?f=1

There is a guy/moderator there named ROSSI who is extremely well knowledable in public health insurance issues and if anyone can find you a loophole or backdoor, it is him. I am not particularily hopefull, but it is certainly worth a try.

Sorry that such a wonderful thing like a pregnancy is turning into such an adminstrative nightmare for you- in nearly all other EU memberstates that would not be the case...but Germany has not a REAL public health insurance system like most other countries...

Cheerio

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Posted

Actually, I reckon universities here or ANY institution accepting foreigners ( that includes companies hiring employees ) should be able to provide accurate and up to date information on health insurance issues/laws/ options but many don´t. This problem also includes the various Ausländeramts and Consulates!

There is NO NHS equivalent here ( or Australian/Canadian etc). This is the stuff of nightmares. So the OP here is not entirely blameless, to be sure.

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Posted

should be

So, who's gonna pay for that?

loophole or backdoor

Midijob, if the specific visum permits it? Possibly with the university - it's not like there aren't budgets for such things? Being pregnant doesn't make you incapable of working...

they cancelled it according to §5 Abs.1 Nr.13 SGB V

§5 (1) Nr. 13 SGB V is the terms under which you could have been insured, not the ones under which they cancelled it. To be exact §5 (11) in combination with (1) Nr. 13.

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Posted

Should be able to provide accurate info, Kato!

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Posted

Why? Again: Who's gonna pay for that?

(i know that there are people working in such positions who are also - tied - insurance agents on the side, but those don't count)

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Posted

Firstly, I greatly appreciate your prompt answers.

Yes, I agree that I should've checked the situation before coming here, and my info is mainly based on "I heard..". But the problem is that even if I've checked it, I wouldn't find any appropriate solution, since back to my country we don't have a strong insurance system which will cover you in another country. One solution would be to delay the education for my wife and it is ridiculous, since the pregnancy should not ever be considered as a condition requesting such sacrifice. I know, there are such situations in Germany, that some gypsy pregnant women go to hospitals, give birth and pay nothing claiming that they aren't capable of doing that. I'm not gonna ever do that, but why public companies don't consider the one who is willing to pay premiums for the duration of the stay? I agree with "burning house" example, but also there's also no guarantee for the intact house not be burned one week after the insurance. I mean, person could insure and then get pregnant one week later, I don't see any difference in this case. Otherwise, my wife should go back prior to giving birth, and come back like 4-5 months later earliest and halt her education? That doesn't make sense to me.

Nevertheless, greatly appreciate your help!

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Posted

Well the difference between the already burning house and the house that 'might' burn up the next week is that the probability of the first event to happen is 100%, while in the other case it is much lower. Insurance is just a game of statistics where you pay for the probability of something to happen (+ a fee). If an insurance would give you a quote on insuring something that will happen with a 100% certainty, you would pay more than if you would just pay for everything yourself.

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Posted

I mean, person could insure and then get pregnant one week later, I don't see any difference in this case.

No - there's normally a waiting period AFTER the insurance policy is signed/paid for BEFORE coverage for pregnancy/birth begins. Pregnancy that occurs before the end of that waiting period is not covered, as is the case with other pre-existing (expensive) conditions.

Otherwise, my wife should go back prior to giving birth, and come back like 4-5 months later earliest and halt her education? That doesn't make sense to me.

Yes, this is exactly what she should do. Interrupting one's education (or work, for that matter) is not only normal, it's mandated under the Mutterschutz provisions of German law, which would effectively have your wife out of education/work for 6 weeks before the anticipated date-of-birth and 8 weeks afterward, just over 3 months altogether. This is of course in addition to the government's bribing of parents to stay home with their children under the Elterngeld scheme, which gets (or allows) many of us to postpone returning education and/or work for even longer. Though it may not make sense to you for your wife to take a break of several months it's generally the way things are done here anyway, so you might want to make friends with the idea of her taking time off of her studies (in this case, to take advantage of birth-related health care available to her in your home country).

Congrats on the pregnancy, btw. Babies are awesome. Expensive, but awesome.

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Posted

Well, liebling: there is NO waiting period for getting pregnant in the German public or private health insurance system. That is only the case with international insurances or travel insurances et al.

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Posted

John - I bow to your expertise and thank you for the point of fact. Just out of curiosity -- Has this changed in the last ten years or so? When I signed up for a private German health insurance, I could've sworn there was a waiting period. This was a key factor in timing our decision to become pregnant, in fact. We never considered international or travel insurances, so only domestic ones came into question - and yet I recall us (me coming from non-EU Ausland) being told by insurance folks (brokers? reps?) to keep this in mind in terms of family planning. Wouldn't have been a misunderstanding due to language, unless it was a case of insurancey jargon confusing us regular folks.

Anyway, OP - hope all is well and all will be well.

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Posted

Hmm, liebling...ten years is a long time ( I still had red-dish hair, then!! And I´d just fallen in love for the 14th time ). :) I can´t remember if there has been a change since then..doubt it, though: this is Germany... Maybe you signed up without a health check at a doc...then it might have been the case...dunno, to be truly honest.

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Posted

But how can this occur? Aren't public health insurances basically "forced" to accept you?

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Posted

Only if you are versicherungspflichtig, e.g. an employee, see §5 SGB V: http://www.sozialgesetzbuch-sgb.de/sgbv/5.html

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Posted

But how can this occur? Aren't public health insurances basically "forced" to accept you?

Welcome to Germany, FDG! As Panda, say, no, they aren´t and it´s a source of great annoyance for those who would prefer to be in the public system! Equally, the privates don´t have to accept everyone, even if they otherwise fit the criteria: either above the income limit but with a restricted work contract/visa or self-employed ( where income is irrelevant ) or certain nationalities ( meanwhile most...) or, of course, if unhealthy or " financially risky " ( Schufa statement )..and also a great source of annoyance to those who would prefer to be in the private system!!!

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Posted

Wow, that's absolutely horrible and screwed up :S. @OP: if you and your wife have a scholarship, could you ask it to be converted to a part-time position? Even 25% will do, and the University may end up paying less.

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Posted

FDG: I know it´s not related to this thread but I remember we had an altercation on this forum about Haftpflicht here in Germany. I remember you saying you have a Masters in Insurance Mathematics or so and that Haftpflicht is unimportant for " certain social classes " or whatever. Again, welcome to Germany! Rethink!

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Posted

Lol. Yes, I remember that. But well, in comparison to this case, Haftpflicht is really not that important (in my case I am Angestellter and have a good salary and was kind of arguing from that position) - I mean it's a pregnant woman, sure no insurance would ever be ready to take this case, so the state should force them...! I am totally of the opinion that, if health care has to be universal, any kind of "preexisting condition" matter should be forced on the insurance players by the government. They can make good profit with all the young and healthy single males anyway.

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Posted

Wrong again..aaarrrgghh! :D

FDG: for f...´s sake: being an Angestellte has nothing to do with Haftpflicht. You make a mistake and are slightly negligent out there in the streets - you cause an accident or knock over a little old lady with your umbrella on a rainy evening and she ends up in hospital with a broken hip. Who pays the hospital bill? YOU!

Forcing the State to insure a pregnant woman? I´m of an age where I agree with that ( old-fashioned ideology etc ) but who pays? YOU! :D

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Posted

Yes, I know it doesn't have anything to do with that, but I have more income at my disposal and my income + type of work class is low-risk in terms of probability of a "negative event" occurring, so I am screwed in a "pooling" insurance because I will share my risk profile with people with a higher risk profile (for example, someone who is making an Ausbilding which requires him-her to drive and walk around a lot and lives in a WG with other people can be considered "high risk"). So, since it's not mandatory, I think the amount I will have to pay is not proportional to the risk I bear. Can we drop this topic? :D I was speaking about Angestellter in terms of health insurance.

I wouldn't mind paying for that really! I already belong to the class of "young and healthy", hopefully...forever :ninja: I'd rather pay for pregnant women than for umbrella-knocked old ladies :lol:

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Posted

..., but I have more income at my disposal and my income + type of work class is low-risk in terms of probability of a "negative event" occurring, so I am screwed in a "pooling" insurance because I will share my risk profile with people with a higher risk profile

Do you then consider ca.€70 significant more yearly disposable income as well? Which formula did you use for that?

If it was about a "Berufsunfähigkeitsversicherung" (occupational disability) you can indeed talk about low-risk vs. high-risk and having more disposable income. A construction worker, for example, needs to pay ca. €300 per month to secure a €1500 monthly net income in case he can't work anymore. Insurance companies like to use 25% chance of occupational disability in one's working career in their sales arguments, but this is across all jobs, industries and gender. When you ask them, what is the percentage for an office worker, they don't know. Of course they know (they know everything what can be calculated in life :)), but don't want to communicate this significant lower percentage. They lose business. BTW- I don't have this insurance, but "Haftpflicht" I have.

PS- Do you play the lottery? I knew a British Ph.D student in mathematics who plays following lottery numbers: 1,2,3,4,5 and 6. I always use random numbers. Silly me. It's not always easy to understand the logic and reasoning of math students for ordinary people like myself :)

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