Returning to the public health insurance system

Hello I am so glad to read all the info on this forum and realise I am not alone in my frustration with the German health insurance system!

I came to Germany without a job and took an intensive German course for 7 months. During this time I took out the cheap health insurance offered by my language school, as I had read that health insurance was compulsory for everyone. Now of course I am realising what a mistake that was . . . I had no idea that getting a bit of insurance could cause me so much trouble!

Now I am training as an English teacher and starting to pick up freelance jobs. I have work lined up for January and should earn about 1000 euros per month.

Is there any way for me to join the public health insurance system now? I have applied to several companies and they all say I have to stay with private insurance.

The only thing I can think of is to lie and say I haven´t been insured at all yet, and to try to backpay until April 2007? Although obviously it makes me miserable to think how much that will cost me now, it would save me money in the longer term I suppose.

My (German) boyfriend is in full time employment, and is insured with the public system - and we are planning to stay here for the long term, start a family etc. Would it make any difference if we were married? I know its not very romantic to get married for beaurocratic reasons but it seems a lot of people end up doing that in Germany to make life easier!

Any advice or ideas very gratefully received

Kate

I'm really confused as I thought you weren't allowed to go into the private market unless you earned quite a bit. Something like 55K of the top of my head. Am I missing something?

Hi Kate,

You need to provide the name of the language school, probably better by pm. I know several offer short term travel insurance but not health insurance; maybe they acted as a broker in your case but i think it unlikely.

Do you have any pre existing medical conditions? I cannot understand at this point why public insurers are refusing you cover because i know no language schools that sell health insurance even as a broker. Maybe a good idea to give me the name of your current provider as well, whatever they provide and i will try and help.

I also need to know where you originally come from and if it was private or public care and if you intend to live in germany permanently.

Stick with private!!! ...besides, with what you will make teaching English, private is by far cheaper anyways. ...but freelancers = private insurance...that's just how it is.

Sorry mike you are totally wrong freelancers can apply and receive public insurance. there are a lot of different factors and private will only be cheaper if she is young single and does not take out all the cover she may need.

That's a load of crap, sorry.

"Cheap" private health insurance sounds intriguing ... what´s the name of that rare animal ?

Well as i guessed Kate had travel insurance and Mike, if you think i am wrong bet me ten beers on it and one of us can get drunk at the others expense some night.

Ps i do not like giving away beer!!!

what do you pay, miwild? under 72 euro a month? (for full coverage)

...and topcat, read the insurance thread, it's not worth your beer. Private is cheaper for nearly anyone...AND you get better care. (I have personal experience)

72 euro a month: you are young, the cover is not great and it is short term i.e. limited to a year or two and then it will go up I am afraid because you will have to apply again.

Edit: I know you have personal experience but that is for your personal circumstances. read the thread and you will see that i know as much as the two brokers selling their services and i am not trying to make any commission either, just giving free advice about something i have very good knowlege of...

unfortunately not ...

I love how you have no idea what you're talking about. Do yourself a favor and don't listen to him.
You don't have to believe me, call a professional. There's ads on this site.

I really can't get my head around that one but my financial advisor keeps telling me the same.

So after you two finish fighting and one of you ends up in hospital will you be covered private or are you in the public system?

Fact: Freelancers can have private insurance regardless of income threshold.
Fact: Having had to switch from private to public, public is more expensive and provides less benefit

Thus, stay with private.

Private here, thank god...been the public route, not going back.

(listen to hams...tis true.)

Private is cheaper as long as you are single and only have to pay for yourself and if you earn a lot of money (over 48K per year). Once you have family public is cheaper because it is only a percentage of your income.

Look I have no axe to grind here but if someone is looking for free advice where I will not sell anything or earn no commision but give them the best value solution for their circumstances then pm me. That solution may be "contact a broker" depending on the circumstances (some bloke earning 48K a year or more).

Point one absolutely true.

Point two absolutely true but depends how considerable your income was and if you are on your own. You cannnot make a judgement on fact just because it is your circumstances Hams.

Final point: it absolutely depends on your circumstances, if you earn over 48K a year consult a broker and go private.

I am gone from this one. anyone who needs advice completely free please pm. Arguing in this case is pointless

I'm sorry topcat1 but if I was paying less on private with a better service, and am now below the threshold and thus on public (paying more in premiums) but receiving less of a service in terms of quality, how is that in any way questionable. The fact that I've experienced both surely means that I can speak from a unbiased standpoint.

I concur with Topcat1. Private is cheaper and better, but only if you´re single. If you plan on getting married and having kids, then public is cheaper because with private you have to insure everyone in your family whereas with public the whole family is insured by one person.

The threshold is 48k as Topcat1 pointed out. It is usually difficult to go back to public once you´ve gone private unless you´re unemployed, so you need to think carefully about it. Another catch with private is that while it is cheaper when you´re young, it´s more expensive as you get older.

So, to answer the original question, as a freelancer you can go on private. By getting married, you can go on to the public medical of your husband.

Well my husband and son are private, and I'm public... so how does that work considering I as an individual am now paying more?

When i've been looking at the options for trying to cut costs during my separation I've been advised that it's really the wrong place to look for the reasons hams is saying. The one time my eldest child was really ill it more than payed for itself as he got straight to the big boss and the best possible service.

I am not saying public service is better than private and often private means that you will get a private room, quicker appointments, the consultant will come and love you because he gets paid more for it etc. etc. but that is not to say the quality of the public system is bad; it is actually very good.

the argument is not about quality but cost taking into account an individuals circumstances and in that situation i can offer impartial and free advice.

Now i am going for that smoke

As I say hams it depends on your circumstances, you were probably insured under your husband's health insurance but I would need to know more and in your case PAS, even though you are now separated the fact you had private the federal law would not allow you to change to public except in some exceptional circumstances.

Which , without knowing the full details of hams and my positions, would seem like sexual discrimination?

True Pas there are parts of the law regarding separation that are highly discriminatory to males: IMO opinion Germany is a bit better than the UK. The new law on health insurance was passed in June so it is still a bit imperfect and does not take account of every circumstance and it is hard for me to advise without knowing all the details of people, i am just surmising on the limited info that I have. For example hams could be employed by a company now and in the public system and that has nought to do with her sex as her hubby could have been the private insured. i don't know: each case is individual...

This may or may not be relevant to this particular thread but I'll stick my neck out anyway for the heck of it:

I am a student here in Germany but I am insured by a private company in Belgium (with international coverage, of course). It is, in fact, cheaper than the public health system in the Bundesrepublik if I compare the annual costs. However, my question is with regard to upfront payment. Apparently, with my private insurer, I would have to pay for the doctor and prescription medication upfront and then have it reimbursed by filing a particular form to Belgium. I understand that with public health insurance, I don't have to pay for anything at all (usually, anyway).

So, take the typical case of...oh, I don't know...the flu, for example. How much would I have to spend going to the doctor and buying the prescription medication? As a student, by definition, we're poor. Will I be able to make this upfront payment and wait for the Belgians (assuming their country still exists in a few months) to reimburse it or would I have been better off by being publicly insured?

Krankenversicherung der Studenten ...

Hi miwild,

I assume your reply is directed at me and while I appreciate it, I couldn't make heads or tails of the web page even after running it through the Google translator. A quick explanation in English?

Far too complex a matter for a "quick explanation in English" ... better ask a German friend/acquaintance familiar with German legalese to take the time and go through this important subject with you.

The facts above are correct and the advice good... I'm also speaking from experience

The link that was provided doesn't directly address your question, but it does provide information on the cost of public health insurance for students in Germany. The cost is a flat rate of 58,49€/month.

If you are privately insured, you generally do have to pay up front and wait for reimbursement, but you may find a physician who is willing to let you delay payment. A pharmacy would be less likely to do so, I would think. An office visit might be 50-100€, I think, depending on complexity, etc.

yep, this is your choice: either you stay with the "cheaper" private health insurance from Belgium and pay your fees with reimbursment by the insurance to you or you enter public health insurance in Germany where the doctors and hospitals will bill the insurance directly (even though you will have to pay some money since public insurance does not cover everything anymore in full).

What Miwild, I think, was hinting at is also that this website and chat is mainly used by professionals and therefore the combined knowhow of the TT crowd is well able to advise an ExPat freelancer or employee in Germany but that the problems of students are usually dealt better at other web communities and web sites. At least that is my experience.

Having said that; for professional reasons I am of course curious how a Belgium private health insurance can beat the subsidized low health insurance with public health insurances from Germany - I at least have never seen a competitive private insurance coverage beating this low budget student insurance. Would be great if you can enlighten me/us

Cheerio

I have Private Health insurence from Norwich Union in the UK.
Me, my wife and 3 kids (14, 12 & 10) pay £340.22/month.

How does that compare to what other people are paying?

Thanks. This is exactly the information that I was looking for. So, yeah, I think I can quite possibly afford random visits to the doctor. Great!

Surely, students are not unwelcome here. ;-) Besides, I saw quite a few posts from students themselves so, presumably, they would have some experience on this matter and could quite possible advise me as well.

ACE European Group from Belgium insures me for about EUR570 per year under their Student Insurance Program.

Don't forget, though, that the real reason to have health insurance is not to cover the random 50€ visit to a physician...the real reason is to provide cover in case of serious illness or accident.

lazybum: you can not compare health insurance just by premium, you have to put the premium into correlation with the coverage. I just had a case where a client though he would beat public German health insurance with a health insurance plan from InterGlobal and when comparing the small print we found that this not so... Therefore nobody can answer your question in earnest with an answer that would be truly helpful to you, I am afraid. For instance, if you would be eligible for public health insurance in Germany and if you are the sole earner of income in the family, your total costs with IKK DIREKT would be around 477.- EUR per month to cover the whole family. But it might well be that the coverage provided by your plan is far superior then German public insurance and thus the comparison does not work. Health insurance is no area for quick online comparison, because difference between coverage/benefit can be huge.

ebtg: tks for the info on ACE. Seeing the monthly premium with public insurance for students set at 58,49 EUR p.m. the difference per year appears to be some 130.- EUR which for a student is of course a lot of dough. But as mentioned above to lazy bum, the question is about differences in coverage, really. If you have a deductible in general, some deductible on certain medical conditons, coverage for dental and maternity (if required;-) ) or not will make all the difference if you have signed up for a good deal or not. With my knowledge from many private health insurance, both German and international, my educated guess is that if we compare coverage we will find that in many scenearios of being really ill and in need for insurance/coverage/help the public health insurance will prove to be the better deal. But I do not have the facts of your insurance, therefore it is only an assumption at this stage.

Cheerio

some topic,

well to start with i am trying to become freelance english trainer and i have been doing some research, i am currently on public insurance - tagged on my wife's insurance as she is german and i am auslander.

- i am on TK as of now and they say that if i work more then 14hrs a month or if i earn 350euros a month i am out of it. so makes no sense being a freelance trainer for that kind of money.

- once i register as a freelance trainer i must get a private insurance - which is no longer a compulsary thing from the govt, infact i could go without insurance as far as i know. private insurance is available for anywhere between 100euros gto abt 300euros a month, the one at TK right now is 270euros. and i speak to one of the insurance agents on this forum and he has offer me a pretty good insurance covering dental for abt 150euros.

so getting married will not help with your insurance if you are going to work as a freelance trainer.

I think I'm covered pretty well under the current scheme but, to be honest, I haven't done my homework and compared coverages. But, just in case you're interested in having a look at ACE's package, here's a link with some pertinent files in English (and French, just in case). Maybe you can recommend it to your student-clients if you find it worthwhile.

I'm not an insurance expert, and I'd be curious to know Starshallow's reaction, but I, personally, given the relatively small premium savings compared with German public insurance (and you can choose any of the public insurers for the same price--good deal!) would prefer the public health insurance.

Here are some red flags for me:
-no coverage for pre-existing conditions (this also excludes, under their terms, treatment received prior to an extension of the policy)
-some sports are excluded (e.g., winter sports (skiing, ice hocket, etc.--extra cost waiver available), rugby, climbing)
-no coverage for AIDS & "diseases for which treatment can be postponed" until return home
-exclusion for inpatient mental health
-accidents are not covered when intoxicated (don't get drunk and break your arm, "unless [you] can prove that there is no causal link"!)
-12 physical therapy visit maximum per year
-9 psychotherapy/outpatient mental health visit maximum per year (says they can grant more)
-provides only emergency dental care
-excludes coverage for a hernia of any type
-excludes coverage for disease by insect bites (lists typhus, malaria, etc., but there are also some tick-borne illnesses in Germany)

There are simply too many exclusions for my liking.

edited to add: Based upon the premium you said you were paying, I think you have the winter sports coverage rider (and the trip cancellation option).

hopefully I can check it out at the end of the week, am curious myself to make a comparison. The exclusions "highered" mentions seem already severe in some cases and it needs to be seen, for instance, how new chronic conditions are covered too. Tks for the link, ebtg.

Cheerio and good night

Based on my cursory reading, it appeared that after renewal of the policy, such conditions would be excluded as pre-existing conditions.

As I have said before it depends entirely on individual circumstances and it is impossible to cater for every possible scenario in a post but what I posted here and the other Health insurance for pregnant women and babies is completely correct.

There are two points that I will highlight which I am sure that Starshollow will confirm:

Health insurance whether it be private or public is compulsory in Germany although the infrastructure does not exist at this time to police it. For EU citizens there is the possibility of using their own country's system for up to two years but if you are from outside the EU you are taking a huge risk if you are not covered for health insurance.

International Health Insurance (a la carte, AWC or any plethora of others available) is only a temporary solution if you intend to remain in Germany permanently since it does not provide for the Plegeversicherung (long term care) element that is present in private and public insurance here. International private health insurance is designed and intended for ex-pats living abroad but who intend to return home. At some point in the future you will have to pay for this element if you move to the private or public system here and it will have an adverse effect on your premiums.

'Pnydu' Nov 13 2007, 4:11 pm

well to start with i am trying to become freelance english trainer and i have been doing some research, i am currently on public insurance - tagged on my wife's insurance as she is german and i am auslander.

- i am on TK as of now and they say that if i work more then 14hrs a month or if i earn 350euros a month i am out of it. so makes no sense being a freelance trainer for that kind of money.

Hello Pnydu, I started this thread with a question about health insurance for freelance english teachers; further investigation of the tax and insurance situation for freelance language teachers in germany has brought me to the sad conclusion that it is definitely not worth it - and health insurance is the least of the problems.

It is extremely difficult to get a contract as an English teacher in Hamburg BUT the schools expect you to work as if you are an employee. I recently had an interview with one of the better language schools in Hamburg and they gave me a 15 minute lecture during the interview about how they get really angry when teachers take on other work outside the school - even though as a freelancer you are supposed to have at least 3 different clients.
"
But the main problem is the pensions tax: freelance language teachers must pay 20% of their gross income into the German state pension scheme as soon as they earn more than 400 euros per month. Once you have gone over this 400 euros limit you must continue paying into this fund, even if your income is normally much less than 400 euros.

Most of the language schools in Hamburg are offering about 12 euros per teaching hour for new teachers. I can only work a20 to 25 teaching hours a week, because I need time to prepare each lesson, and sometimes travel around to different clients too. So you can see if you pay this tax and get full insurance it is impossible to make a living wage. And of course as a freelancer they won´t give you any sick pay, holiday pay, maternity pay etc.

I have asked all the language teachers I know, and also asked at schools - their official advice is "no one pays the pensions tax, you just need to risk it". A lot of teachers have never even heard about this pensions tax. But people are getting caught and having to backpay thousands of euros. I looked for information on the British Embassy website, which directed me to the official Hamburg English pages, which had this advice:

"Top Tip. Do not work as an English teacher on a self-employed basis. Many schools do not tell you what is really required by law. Many teachers work illegally without knowing it, or cause serious problems in later life, in reference to retiring. Tax, health and retirement payments etc, plus the resultant paperwork in German, is mostly a daunting and difficult process. A school should show serious interest in your services by offering an employed contract. There are exceptions, but very many reasons not to. Be careful and fully informed first. Don't be take for a ride!"

Back to health insurance: my original question was about how to get back into the public health system - I had private Dutch health insurance that covered my first couple of months in Germany. The answer is I can´t as a freelancer - I have to either get a job with a contract or register as unemployed. I´m disappointed to find out how difficult it is for language teachers here and now I am looking for a "proper" job . . . .

Good luck with it all! Kate x

Firstly, not all public insurers are the same price, they all take different percentages. Secondly, I'm not sure why you think this is a good deal seeing as they all basically offer exactly the same product.

The "small premium savings" are not small, they are often very big. I know the difference for me is hundred's of euros a month.


Some international policies may have conditions like this, but I don't believe by law German private insurers are allowed to offer anything less than the public system, hence the reason why German private policies are more expensive than the international ones. The German ones are also putting money away for later so that your premiums don't go sky high as you get older.

Hi Kate

Good post and some valuable information for those considering freelancing as a language teacher and the pension, tax and to a lesser extent health insurance implications. It would be good to hear the experience of other language teachers. Sorry that there was not positive information for yourself and good luck with the job search.

TC

I think you misunderstood the context of my posts. I was responding to a very specific situation in a sort-of subthread within the thread. A foreign student asking about his health insurance situation, comparing his private, international student health insurance to the health insurance options available to students in Germany in the public health insurance system.

Students who are insured under the GKV pay a flat rate that is independent of choice of Krankenkasse. You are absolutely right that the coverage is basically the same at all of them, but some Kassen offer little benefits like homeopathic care, choice of hospital, travel vaccination coverage, etc. If there is no price difference at all, why not choose a Kasse with the bells and whistles?

For this specific case, the premium savings are small--maybe 10€ per month. The GKV is being compared here not to standard private health insurance in Germany, but to a stripped down international student health insurance plan.

I agree that for many workers in Germany (especially those who are single or are married to a spouse who works but have no children) a private health insurance policy is a great choice. I just think that for this particular case of a student, this international student health insurance policy is not such a great deal.

public insurance - private insurance and then back to public insurance.

ok as i have mentioned before, i am on TK from the Govt, desperately clinning onto my wife's insurance pakage.

- well if i start working as a english trainer i obviously get a lesser insurance fully paid by my self and on top of it i am aware of having to pay the pension fund...non sense
- getting out of the pub insrn easier, all you have to do justis let them know but getting back into the public one is far more work, tons of paper work to be done and you have to be either unemployed or have to earn less then 350 to 400 depending on the insurance company that you will want to be in. but it is not impossible.
- i am not sure abt kate's situation but in my case i can becoz my wife will still be on that insurance, when i want to return to it.

so getting married may make this process easier but ...double check on it and don't take my word for it.

before becoming a freelance trainer you have to consider problems like VAT, rembursement, income tax and pension funds and lots of crap.

- as far as i am informed regardless of how much i earn as atrainer i can choose not to claim VAT from my employee, which would make it easy for me...meaning i do not have to pay VAT if i do not claim it.
- as long as i keep my rembursements to be less then 17500euros per annum i am exempt from paying VAT other then that all other crap i will have to pay - pension fund, tax and stuff

- also i found out that i can get out of paying the pension for for a year as i am married, but has several restrictions but this offer is only if you are registered as unemployed at the arbeitamt and you have to talk the people their into giving this offer to you, plus you can also get some intial funding to setup your company but that is all at the discretion of the arbeits amt leute.

- in koeln i am getting paid or will get paid at 18euros an hour and some of the trainers i have spoken to make around 2500 plus a month...sounds promising.
- getting a online TEFL will cost abt 150 to 200 eurosonce you get it you will be paid lot more but that depends on the performance.

regards