Moving from public to private health insurance

This is about health Insurance
I can understand there is no definite yes or a no answer. What would you do if some of you were in a situation like me?

Well then here is my situation.

Family of 3 which includes a 4 year old brat. Excellent health condition Infact for the last 2 years we have not visited the doctor, except for the child who had a couple of visits to a doc for some precautionary checks.

I assume I could save a bit with the private insurers. So what would you say? It would be nice to hear from someone who made this move and is unhappy about it.

Well I am a single woman and also considering it.

However my boss says that it has only cost him more since going private with the children and he wishes he had never changed

Also is there a reason why this is posted in Munich section? Surely it is something relevent to the whole of Germany and other people elsewhere might have the same question?

There are lots of threads on this, but I wouldn't be so sure you will save money going private if you are a family. If you are a single, young male it will most certainly be cheaper, but probably not in most other situations. The only way to tell is to get a quote. There is (was) an advertiser on this board called Sebastian Stiphout (works for OVB). I used him, he speaks perfect english and gave a very good service. I would recommend him.

I chose private, but I'm not happy with it. The premiums are unbelievably high whether it's private or public (it would have cost the same for me either way), and when I chose private I expected that absolutely everything would be covered. That's not turning out the be the case -- it seems only about 2/3 of the doctor bills and prescriptions I claim are refunded, with no explanation thank you very much. And it's a total pain in the *ss to have to deal with all the bills -- pay them and then try to get my money back.

The only rip-off with public insurance is that not all doctors will take you. I'm not sure why this is tolerated by the government, but that's the way it is.

I choose private because I do not intend to stay here for the rest of my life. However I have chosen a premium that covers 100% of doc's bills, maximum 2 people room in hospital etc. there are various add ons that one can do.

However a word of advice for people who plan staying here forever(?) is that if one switches from public to private it is near on impossible to switch back (so i have been informed, i do stand corrected if that is not the case). That means that you have to plan to continue with your private premiums when one reaches retirement age.

I can't believe people are missing the obvious. Don't get health insurance it's a scam, all you have to do is not get sick (if you do tough it out) or not be involved in an accident (if you do, tough that out also) I'm saving a fortune using this method.

If you earn well (pre-condition) are single & not intent on getting married or staying then private is fine.

Otherwise...

I came to Germany for only a year. Was single, went private.
25 years later I'm married with 2 children. I have to pay individually
for each of them (If you think about it its fair in a way & thus no wonder
that the so-called "gesetzliche" are in financial trouble).

Result is I am paying an enormous amount on insurance and its
pretty crippling - without that our lifestyle would be severl levels up

The funny thing is that they keep telling you how great the "gesetzliche" are
but there is no chance to switch to them.

The one advantage is that I get into doctors quicker but ans someone
else wrote its a pain to muck about with the bills & the doctors ALWAYS whack
their charging factor to maximum complexity...

i didn't know there was private insurance 25 years ago available for the general public. thought that was a pretty recent trend (maybe 10 years).

I would really like some hard evidence about this "not being able to switch back to public after having private insurance" business. I've heard so many times that people have 'heard' that you can't switch back, but where is the rule that says this? I'm half inclined to believe that this is merely a rumour that gets continually passed around. The public scheme is a government scheme, so there should be a rule somewhere if you are unable to switch into it.

Further to this, there is one 100% way of getting back into public - start earning less than 47k a year. In this case you're not allowed public, so they'll have to let you back in. If its really crippling you that much, this is always an option.

Hutcho, I spoke with my tax consultant about it a few years ago, who was found out more for me. It's not exactly hard evidence, but I'm pretty sure it's acceptable.

Basically, they told her the way to get back onto public insurance (disregarding the less than 47K idea) was to pay back all the payments you hadn't made up to that time. So say you went private at the end of 2003 and decided to switch back in 2007. You could do it by making 3 years of back payments to them.

I came here in 1987 and took out private insurance as a single person. I was working freelance at the time and the premiums were about the same as for the "Gesetzliche". I married and we have 4 children. Once the insurance company discovered that I was private (my wife was TKK - Gesetzliche) I was forced to put the children private also. In the end we all went private. It ended up costing ca. 900 Euros/month for all of us, but when we needed it we got top treatment and with 4 cesarian(sp?) sections (my wife!) we've got our monies worth.

Anyway, in 2002 my freelance work came to a logical end and I became an employee. I thought OK the employer will have to pay half now so maybe we can manage. Wrong, they only pay up to a certain limit (250 I think). I took a chance and stopped paying my private premiums and they cancelled the contract after about 3 months. Anyway, I then phoned the TKK said I had no insurance and that I was about to start my first "angestellte" job in Germany and could I join them as a "freiwillige", and thats where we are today. So it is possible to change back. If you are unemployed you can also get back in, I believe.

If you think that you might have kids and that maybe you're wife/husband might not work in the future then think seriously about going private. I personally would take "gesetzliche" + a top-up to cover whatever your needs might be (2 person room, chefartzt, homeopathetic etc...).

If you drop below the 47k limit, it is not legal for you to have private insurance and you must go back to the public. This is definitely one way to get back into the public system, if this is indeed a difficult thing to do. I think that if this is true, and there is no easy way back into the public system that you should be told this when you choose to go private.

I don't necessarily think it is unfair that private patients get locked out of the public system, but it should at least be made known or a rule on paper set about it.

it is made public (after all it is Germany - there is a law for EVERYTHING ): but no fun to read.
the deal is:
I) you were freelancing: you CAN choose whether to go public or private.
II) you are employed: you can go private if you make more than the annual threshold. if you did that and then decide to go back to public: you have to have 2 years of public insurance (within the last 5 years before you went private) or 12 month immediately before you went private.
Then you are allowed back.
unless... yes unless you are older than 55 and were not in the public system in the last 5 years.

Why? they want to make sure that you contribute to the system and not only join when your private insurance gets more expensive and you need more health care.

Why choose private in the first place then?
you pick the benefits you need/ want (so if your insurance is not paying for everything it is "your fault" for not chosing that full coverage).
you pay for what you want/ need and according to the risk you personate - not in a pay as you go system.
usually you get better benefits / treatment

if everything is so fantastic on the private side - why even thinking about going back?
well... the older you get, usually the sicker you get, the more you cost, the more your private insurance wants.

so what else is there to do?
you have the right to switch your private insurance to a "public look alike" with the average public pricing.
so you are technically private, the benefits are as in the public system, the price as well.

conclusion: there is no general rule on whether to go private or not.
If you KNOW you are never ever sick, having an accident etc, never have kids, spouse, always make enough $$... go private and choose minimal coverage.

but who knows??

Some good information there. What do you mean by the quote above? Does this mean that there is a law forcing private insurance companies to offer you the same as public and for the same price if you so choose?

The thing is called "brancheneinheitlicher Standardtarif". read more about the law here. or the standardized tariff
it is in general for people older than 65 and 10 years of private health insurance.
under special circumstances you can get that before oldage.
just as your insurance company about it.
highlights:
more or less
same benefits as the public system
same price as the public system

Generally as a rule, if you are going to settle here, have children here, you are better staying public, and if you really want private, then just get an additional private policy on top, this works well, and actually I found out my manager does this. This way all your children, wife etc are covered on the public, but you can if you choose get some private priviledges. If you do not, and reach the private threshold, change to private, its a lot cheaper which in general sense is crazy that the private is cheaper than public, but this is Germany !

God bless Canada. When I go back, I'll never take the health care system there for granted again. I honestly don't know how people manage here, especially as they get older. Brutal.

Older people manage because they are being supported by the single 20 somethings who pay through the nose for insurance. Medical insurance for older people is fine cause you'll actually use it. Paying 500 euros a month for something you don't use is not.

i think its called a caring society. one of those funny concepts where human beings get together and the strong help the weak, as apposed to everybody just being a selfish bastard and grabing what he can according to his ego. i was warned off private by so many people especialy once the kids have arrived. i personaly dont think their ethical, maybe fair in a shortterm devil take the hindmost sort of way but not good for society as a whole. what is interesting is best if you've a family is public health care with a top-up insurance for teeth and glasses (30 euros for us extra in the month.) dont be a muppet and pay for the "single bed" shit, if a hospital is full you'll share a room, and if you pay for the top surgeon, your probably being ripped off in most cases.

exactly. just find out what you want. pay as you go and be social (but then don't complain about premiums) or be "selfish" then don't complain about premiums when you have family or are old
whole topic discussed Health insurance - how much do you pay? as well.
and : can you really compare everything? public pay as you go or private insurance? are the benefits the same? or does the canadian system win only by price?

Adds another tick to the "pints I owe Gideon" list.

Private cover can seem "cheaper" becasue they can choose who to take, only cover the indvidual and take a fixed X Euro fee.

Public health care seems dearer as it is a % of salary, they take anyone and also cover dependents for the same money.

Right now the federal government is FINALLY planning to force private insurers to take anyone fror the legally defined general health cover. The medium term result will be that private cover will become more expensive and public health cover cheaper.

The system looks in the future more to be about offering the best possible care to everybody, not stuffing the pockets of some of the doctors and allowing the rich to duck their social responsibility.

I'd even grudgingly accept the grosse Koalition if it really went through.

That is good news. I was getting so peeved at the people I know who stayed private until it got expensive and they needed real medical care and then they "lost their jobs" while I've been forking into the system for 15 years.

Does this mean there will no longer be a salary cap restricting who can sign up for private health care?

dont be peeved. in all the time you've been paying you've helped others whose life's dice have not given a double six.

Technically, there is no salary cap on private health care - you can at any time choose to pay privately for a non-covered procedure or treatment. I've been doing this for years.

That's not what I meant. I was asking whether this means they've done away with the restriction of anyone earning under a certain amount not being elligible to be insured by a private KK.

Salary cap is probably the wrong word, it would be more like salary floor but I'm not sure if that's the right word either.

Yeah, I am private, and paid alot more that I should have into the KASSE system, never needing it. Now, I am private, and much happier (have a great contract where I get bonuses for being healthy -something the Kasses have no idea about).
Don't give me this crap that 'rich' don't share the social responsibilty- as a CL1 tax payer I pay fucking alot to taxes, and unemployment (That I cannot collect!) and Solidarity Tax.
Its called Private -as you have to be a member to join, just like any Private club!
We've had this talk before but man, you are so ill informed that Docs make tons of money. They are not rolling in like you say they are. They are making live saving decisions they should be paid well. What about all the IT people out there making tons of money (freelance - not paying taxes here), what is their 'social responsiblity?'

even if they have, it doesnt mean it'll be any cheaper. the whole business plan and user benefits ie "im young single and healthy fuck the rest of you i want to keep my money" is about to go bye bye if this law kicks in.

ER, YES. As far as I understand it.

But it's not law yet and the private insurance industry will change the offers they make.

Right now they make a profit because it costs them less to pay for the health care than they take in flat rate payments of X Euro a month. From people on good salaries.

Once they are forced to take EVERYONE at X % of the salary the sums won't add up.
private insurers might stay in the business but the costs WILL rise.

Likewise, as there is less attraction for younger single childless pople on decent salaries to leave the public system, thecosts there SHOULD sink.

Expect the lobbyists from the private insurance sector to start squelaing all over the press and trying to block it and the FDP to threaten to go to the Constitutional Court over this.

But it HAS to happen.

before this ends in a flame war. the advice any bean counter would give you is.

young single healthy and if wealthy also sterile = private

the rest = public with aditional for extras such as teeth and glasses and single rooms and floors and fluffy pillows or god knows what.

and it is not easy to change back into the public system just because your ill. oh but do get insurance. a friend of mine's dad didnt have any and left a nice bill on his deathbed. i guess thats the ultimate selfish cun* really.

What HAS to happen, is the government has to get out of the insurance business. At the moment they are exploiting an artificial monopoly on low income earners, charging them more for it, and legally preventing them to seek a better deal by going private, and offering them worse service for the money. Its criminal. The fact that even given this monoply, they STILL cant offer a better deal than the private providers clearly shows gross inneficiencies that you cant find in private enterprise because of competition.

I thought you usually stick up for lower income earners MT, but here all you are sticking up for is less choice, more expense, typically worse health care (as many places dont even accept public patients) when it comes to people legally restricted from going private because they dont have the privledge of earning as much.

Just goes to show you care more about large government, statism, and opressive tax and welfare structures than the people those schemes were originally presented to protect.

MT, I'm so happy to hear that.

Kza, I think the point is that a forced 2 tiered system is discriminatory and isn't working.

I can understand the attraction of private health insurance. I'd have saved a shed load of money over the years by going for it as I'm a single childless Class 1 tax pay over the threshold. I've stayed in the public system. it's called "solidarity".

There are PLENTY of people working in health care on low wages, my mother in law for one.

There are plenty of practices just scraping by, sure, though this has to do at least partly with the over supply of health care services in Germany.

However, there are also PLENTY of doctors milking the system that is designed to make it easy for them to over treat patients for their own profit. Some of the scales of fraud that go on in the provision of health care in Munich should see some of the perpetrators in prison tbh.

your looking at it from the wrong end of the stick mate. the government offers a realistic price based on the whole demographics of the country, private insurers offer a realistic price based on the demographics of their client base. if the government stopped insuring, the client dempgraphics would change for the insurers and we'd end up with a right pickle when it comes to health care. i just wish they'd stop this rubbish with sixteen million krankenkasse, i wonder what the synergy effect and cost reductions would be if they did so.

I thought you were for those with more money covering for those with less? Wouldn't sticking all of us under the same hat ensure this happens?

sorry i dont see any contradictions in my post/opinions there, you're just being pedantic and canadian again eh ;-)?
i was just pointing out i dont believe the logic that the destruction of the health insurance duopoly would automaticly lead to cheaper health care because private has always been cheaper untill now.

anyways im offski as sebia said make your choice and dont whinge.

Actually Gideon, the AOk recently reformed from 200-ish Kassen into just 17. (NRW is covered by 2).
Their admin in Munich has moved offices and become more efficient and I THINK they have just been awared some certificate by the TÜV in cutting admind and greater efficiency.

They are making great strides forwward along a path they admittedly had to go down.

Gideon is right. Private healthcare is only "cheaper" now because they cherry pick the best business.
Note to Kza: drinks in casinos aren't really "free".

Actually I was looking for information. I'm not sure I understand what this means.

then ask clearly dear! this is the internet. its the conversational equivalent of talking to the moon on a bad line.

@MK yes but there is still AOK und TKK and and and...

ER, just sit tight.

If you are in a public kasse: Your contrbutions should go down over time. Changing to a private kasse will become less attractive.

If you are in a private kasse: Your contributions will rise over time.

Oh aye Gideon, I'm in favour of ONE kasse. You could call it Bundesgesundheitskasse or similar.

I've never really understood why people only had the choice to change to private insurance if they earned over a certain amount.

But anyway, maybe the system would work better if everyone paid into the public system, for basic coverage and with the cost being a percentage of household income, and then anyone could buy additional coverage if they wanted it. In other words, eliminate the all-private option entirely. Private insurance companies could go into the business of selling the additional insurance.

In THEORY to protect the lower paid from being exposed to risk.
In PRACTICE imvho to free the better of from paying into a system based on social solidarity.

You sound like Alf Garnett..."The NHS patients, well they are poor so the doctors use them to experiment on so they don't bloody cock it up with the rich, the private patients"

Quite the opposite Canaryman.

It is commonly argued that public patients get worse access to health care, particuarly if it is not so tried and trusted and regular to fall in the price of provision becasue they are as they are less lucrative.

Indeed Alf Garnett as a charachter was a racist Tory bigot, not quite my style really hey.

I always thought he was a labour bigot, he supported west ham (not many tories in that lot) and remember, society created the character, a society that is made up of many (even Prescott, Mandelson, Blair and club!)

By the way, back on topic. I am a private patient but I have no idea why I am a private patient, I was just told by every German here that it was the way to go, so I did.

WHAAAATT!! LABOUR!! You scouse git, I`d never vote fer yer darlin `arold! And its all them foreigners whats comin` over `ere an` takin`advantage of yer National `ealth, not yer old people!! Silly Moo!

Yeah, the charachter was a reflection of societ to an extent in a time when racism, sexism and homophobia were more widespread and "socially acceptable" than today.

Prescott, Blair and Mandelson? I wouldn't piss on them if they were onon fire.

You are right though Canaryman in that it "makes sense" for a lot of people to go private under the rules that have been in palce until now.

If I've understood clearly, I can change from Private to public health insurance if I have paid public insurance for at least 2 years in the last 5. I have now been paying publically for almost 2 and a half years so I could theoretically chage to public for 3 to save myself some money, (while I am still trying to dwindle down my uni fees) and then move back to public once I have acheived this?
For the response to one spouse having private health care and the other public, is it irrelevant as to which gender pays which in regards to the children also having to be included on the private scheme? I ask this, not in a sexually discrimative way, just that if I (female) pay privately and my boyfriend (publically) and we decide to get married and start a family (if in the very distant future it happens) then i'm obviously not going to be working for a given amount of time. Would not working for a period of time after pregnancy also make it possible for me to change back to public insurance or is there a rule that children would be covered by the father?
Third question, I read that the threshold amount didn't necessarily have to be the monthly wages, but can also be the total yearly amount. Looking at my wages monthly I am just under, but taking the 13 months pay (summer and Christmas) I would be over. So would I even qualify for Private health care anyway?
Thanks

Lissy: I fear that you are mistaken there! If you are living and working in Germany and you change from public to private insurance (opting out in a manner of speaking) there is no way that any public insurance will take you back voluntarily after three years of private insurance. This rule with being publicly insured in a EU member state for at least 2 years out of the last 5 years is only meant for people coming from abroad to Germany and who have to apply for German insurance for the first time. But even there the new rule seems to include also the need to be also insured in a public insurance system outside of GErmany directly before entering Germany. Read that as 2 of 5 years plus being publicly insured right before moving to Germany...

Only way for you and in your case the child to get public health insurance after opting out would be to get a 500EUR job right before you give birth or anytime shortly thereafter. But you are correct, gender does not play a role, if simply one of the parents is privately insured, the children must be so as well. There is a disput about the constitutionality of this rule going on, but it might be years before a result comes out from there...

To your third question: once again this rule does only apply to people moving in from outside of Germany. It appears that at least German authorities understood that it would get far to complicated to check every foreign pay check for including parts of salary that would not be counted for the threshold in Germany. Therefore in order to simplyfy things, for the proof that your salary outside of Germany was over the threshold for three consecutive years if you want to opt out from public system while entering Germany, the total of the end-of-the-year payslip is accepted. For payslips from Germany this is not the fact. These are the parts of your salary that are counted for the threshold:

* Lohn und Gehalt
* vermögenswirksame Leistungen
* Bereitschaftsdienstvergütungen für Klinikpersonal
* Sonderzahlungen (Weihnachts- und Urlaubsgeld, 13. u. 14. Gehalt etc.)
* Pauschalen (Spesen- Überstunden- oder Fahrtkostenpauschale)

And these are the parts that are not counted:

* Vergütungen für Überstunden
* Fahrtkostenersatz
* Zuschläge für Nacht-, Sonn- und Feiertagsarbeit
* Zuschläge, die mit Rücksicht auf den Familienstand gezahlt werden
* pauschal bestimmte Direktversicherungsbeiträge

As you can see 13. salary does count!

Cheerio