Getting public health insurance when self-employed

Hello there,

I'm from Holland and currently founding a business in Munich. I contacted an insurance agency, the AOK, to get the basic health insurance, called GKV, die Gesetzliche Krankenversicherung.

I have a question about that, because I was denied for the following reason: I had not been insured in Germany for a least one day before. I don't understand and believe that.

How does a self-employed foreigner get the GKV? I was referred to a private insurance company, like the Bayerische Versicherungskammer. But I don't want private insurance, I want the Gesetzliche thing.

Anybody ran into the same problems? I thought I'd try on this forum... Next step is to contact my Embassy of course, but perhaps you can help out.

Ask for the paragraph in the BSB backing their decision up!
BSB = Bundessozialgesetzbuch
They have to take you IMHO.
See a lawyer.

Selbstständige Tätigkeit

Während bei Angestellten das Bruttoeinkommen der Maßstab ist, wird bei Selbstständigen zunächst einmal unterstellt, dass ihre Monatseinnahmen die Beitragsbemessungsgrenze übersteigen. Wer der Kasse ein geringeres Einkommen nachweisen kann (bspw. durch Kontoauszüge oder die Einkommenssteuer-Vorauszahlungen), erhält einen angepassten Beitrag:

* Hauptberuflich Selbstständige: Mindesteinnahmen 1.863,75 € (2007: 1.837,50 €) seit 1. April 2007 auch 1.225 € möglich, aber nur nach Satzung der Krankenkasse § 240 Abs. 4 Satz 3 und 4 SGB 5 (GKV-WSG 157.) Die Pressemitteilung des BMG vom 1. April 2007 ("Mindestbeitrag wird abgesenket") ist insofern sehr irreführend.
* Existenzgründer, die Existenzgründungszuschuss („Ich-AG“) oder den Gründungszuschuss beziehen: Mindesteinnahmen 1.225 € § 240 Abs. 4 Satz 2 SGB 5. ...

couple of thoughts out of the hat, but need to check a bit more the law before being able to give you a final info on your case:
- as a self-employed/freelancer you have no general claim to be accepted by public health insurance in Germany, but you can become voluntary member.
- usually the pre-condition for you to be allowed into the public health insurance system in Germany is that you have during the last 5 years had insurance coverage from one other EU memberstate public health insurance for at least 3 years.

If you have been pre-insured with for instance a Dutch public health insurance during the last years before moving to Germany, you should be able to enter public health insurance. On the other hand, if you have lived outside the European Union for more then the last 3 years or if you had elected a private health insurance for the last 3-5 years before coming to Germany, than you will not be allowed to enter public health insurance.

Pls check which of the above conditions apply to you and if you believe you fulfill the requirements for being allowed to enter public health insurance, come back to me and I'll try to help you.
BTW: never ever try to enter AOK. Bad service for your money. If you don't care about costs, choose TKK which is the best rated public insurance, if you want public insurance for least amount of money, choose IKK DIREKT...

Cheerio

Starshollow, I noticed that your insurance articles confirmed information I had received previously from other sources that 'public insurance' is not available to 'self-employed' persons unless they have previously been publicly-insured as an 'employee' for at least a year.

However, an excerpt from the 'Health insurance' section (pg. 74) of the "Business Guide to Germany" (an "Invest in Germany" publication), which I picked up while in Hamburg last month, appears to suggest otherwise.

The bottom paragraph on that page seems to state that self-employed persons can be publicly-insured without having previously been publicly-insured as 'employees':

"The employer can also take advantage of public health insurance. In the case of self-employed people, their monthly income is initially assumed to exceed the contribution assessment ceiling. If the self-employed person can prove their income is lower (by presenting bank statements or income tax prepayments), the contribution is adjusted."

The continuity (from 'employer' to 'self-employed') is a bit odd there, but the paragraph implies that there is no exclusion from public coverage as a result of being 'self-employed' -- without regard to any prior coverage as an 'employee' (unless mention of prior coverage as a prerequisite was simply omitted by oversight in that paragraph).

Do you read it otherwise?

Thanks.

according to my info, the rule stil applies that you have to have had either the last 12 month before that insurance coverage with a public health insurance in Germany or another EU memberstate. If you have had this insurance as employee or self-employed does not matter at all, just the membership in such a public health insurance counts. For instance many British clients of mine come over to Germany and have had insurance coverage with the NHS while living there regardsless of their professional status. Upon arrival they can apply for public health insurance in Germany even if they run/open their own business in Germany... Failing to have had public health insurance for the last 12 month prior to coming to Germany you must at least show proof that you have had such public coverage for 24 month out of the last 5 years. This is what I know to be true, but to make sure that there has not been a recent change of the rules or any loophole I could have missed I will call the relevant institutions on Monday to check and report the findings back here.

The line you quote above in bold letters simply states that a self-employed person in GErmany per se has an option to apply for voluntary membership in public health insurances(if he fulfills the above mentioned requirement) and that the premium will be set based on his estimated income. For a single young person that does never make sense, for a family of four with only one income source through one of the spouses it can make a lot of sense because then one premium will cover the whole family.

Does that answer your question?

Cheerio

Yes & thanks, except that re: "(if he fulfills the above mentioned requirement)," unless I've just somehow missed it, the guidebook I referred to doesn't mention the 'previously-insured' requirement. However, given the consistency with which I've seen it mentioned elsewhere, I'll assume it was an unintentional omission.

Why is it a bad idea for a single young person to go with public insurance?

Well, socially speaking, it is not, because the current public health insurance system can only survive as it is if the young and healthy are members and pay in. For the individual's wallet it is different, though: his public health insurance premiums is based on income only and thus part of his premium obviously is needed to support the health insurance coverage for those with low incomes or bad health or both. A young and single person with an income of say more than 2.500.- EUR gross per month will always safe considerable money each month if he could elect to go with a private health insurance where the premium is computed based on age, gender and health risks. Once the single person marries and has children and if the spouse choses to stay at home with the children (i.e. does not earn taxable income), the computation is very different because in a private health insurance each person including each child would need to have (and pay for) their own health insurance while the public health insurance of the income-earner will cover also the spouse and the children at no extra costs. All in all the public health insurance system in Germany is a social system of sharing and redistributing income/wealth from the better-to-do to the poorer part of the population and thus a single, health young person will always be financially better of on the short term if he/she elects to go with private health insurance. Which is exactly why last year the law was changed in so far that now a person has not only to show proof of current gross salary being in excess of the threshold (this is for employees only!) but also has to show proof for three consecutive years before being eligible to opt out from public health insurance in order to make the switching by the young and well-to-do among the employees to private health insurance somewhat harder.

Newsflash: I just learned on Friday that one regulation-text explaining how to apply the law to foreigner/Expats employees coming in to Germany can be interpreted in such a way that only proof for 1 year before coming to Germany is sufficient to be eligible for private health insurance. Me, personally, I believe that this interpretation is an error or grave misunderstanding of the regulation text but since it has been used this way by a major German insurance company and with success, I believe it can be used at other places as well. I will put a special new thread on Toytown next week with quotes for all those Expats who have arrived after the new law became effective and who could not show proof of income in excess of the threshold for three consecutive years prior to coming to Germany.

Cheerio

Thanks a lot -- alles klar ;)

Do 'private' insurers (or rather the premiums charged) make any allowance for a good prior medical history -- 'good' meaning no history of illness or other need for special medical attention, etc.?

How sharply does 'age' alone (i.e., without regard to personal medical history) slide the premiums upward -- and how, if at all, can eventually paying very high premiums as a result of aging be avoided by someone in the 'private' system if they have not been in the system long enough to build up the 'reserve' that's intended to prevent that?

By "health risks" are you referring to risks based on the applicant's own medical history or are those risk calculations by the insurer based purely on age-related/actuarial assessments?

grerat if it helps to shed some light into the all too confusing German system...


No. They just compute an average premium based on statistical risks of a person with a certain age and gender.


With each year older that you APPLY for the first time at your private health insurance, premiums are computed a lot higher for the rest of your life (which is what the insurance assumes you will be staying with her anyway). This is why so far a switch from one insurance to another did not make any sense for Germans too if they had been insured for more then 10 years with a given insurance company already. This is planned to change, though, by next year, when it shall be possible that insurance clients can take their "old age reserve stock" with them when moving from one insurance to another. I myself do not believe that for old, i.e. existing memberships, this part of the law will survive a contest at our supreme court and thus I do not believe it will come like that.
Anyway: if you come to Germany as a, say 55 year old person and you want or need to start private health insurance in Germany, you will face severe financial constraints because of your starting late in life. On the other hand the premium is supposed to remain somewhat stable for the rest of your days...


Yes, the "health risks" are those from the applicants own medical history. And No, the insurance will not work here on age-related statistical assessment but will have you assessed by a doctor (and usually also by a dentist). The first thing to assess your health is the number of health related questions in the application form where you have to disclose if and what treatment as an out- and in-patient you have had during the last 5-10 years. Failure to disclose something can lead to total cancellation of the policy through the insurance company at a later point of time, therefore it is important to be as truthfully as possible here. And on top of that, as already mentioned, you will have to go to a doctor with a form provided by the insurance and undergo a medical check-up. If anything comes up through the check-up of which even you have not been aware, the insurance could decided to exclude this health problem from coverage, charge an additional risk premium or simply deny the application in toto.

Cheerio

Just to put some figures on this, I entered the German private health insurance system at age 45. I'm now 63 and paying just over 560 € / month with the expectation of a substantial increase to fund the transportability of the "old age reserve", in the near future.

I'm seriously toying with the idea of moving back to the UK on paper (only) when I retire, rather than see virtually all my German pension disappear to pay for the health insurance.

Do you get any assistance at all from the government in retirement to help your pay your private health insurance? I thought I read something about that once, that when it is over a certain amount, they help out. What would you be paying if you were in the public system? If you're earning even remotely decent money, you'd be hitting the cap on public too surely, which is also around 560 euros a month. You'd only have to pay half of this, but what happens to that in retirement? Do you have to pay the whole lot or does the government chip in the half that your employer used to? If so, they should surely chip in the half o the 560 euros you're paying too.

People should take private insurance only if you do not plan to live in Germany for long and if you do not plan to have a family. Otherwise it is going to be bloody expensive in the long term.

Krieg: this a bit too simple a rule your setting up here as a guideline. The right choice depends on a number of parameters, like if both spouses will be fully working/earn income or not, how high their income will be and how many children the have etc. ... If you stay forever in Germany but both partners/spouses work fully and with high incomes, even with children the pendulum will swing more in favour of private health insurance. However if there is only one of the couple earning income (regardless of how high) and more then one child, it is definetly better to get public health insurance, for example... so you are absolutely right to this regards.

Cheerio

I plan to live in Germany for long. Family, probably not. However, as a new expat resident, self-employed, I don't have the option of taking public insurance.

That's also why I asked whether any government regulations exist that limit what private insurers can charge, or alternatively, whether the government subsidizes persons who can't afford the premiums that private insurers charge.

If not, and the private system is entirely market-based, I can't see any reason why the German health insurance isn't going to slide into the same morass the American one is currently in.

mkraft: your are right that the German health system is in bloody shambles and requires a serious overhaul short of a revolution... but that won't help you in your present situation, right?

so, the costs for your health insurance will be depending on your concrete age, gender and health situation, as was mentioned above and obviously understood by you. Starting Jan. 1st 2009 there will be a "basic" health insurance tariff with all private health insurances available for all people who can not get a public health insurance coverage. this basic tariff will disregard age, gender and especially health status just like the public health insurance. But the law allows the insurances to charge up to max. 500.- EUR/month for it and you can bet whatever is dear to you that the average premium will be like 499,99 EUR eventually as a result. Whether you think that this is a bearable solution or not will of course depend on your level of income...

For German citizen with low incomes there will be some financial help - as far as I know - from Hartz IV social welfare, but I am not sure if and how this can be applied to residents with a non-permanent status yet. Others here at TT might know more about this situation and the benefits you would be eligible for or not. As a manner of last resort you could always get yourself an international health insurance which will just cover the thread of major costs as an inpatient and maybe also as an out-patient at much lower costs than German health insurances for a while, but this can hardly be a long-term solution. Thus we can only hope that after the elections in 2009 there will be a new governing majority in Berlin with the power and guts to tackle the health insurance problem...

Cheerio

I'd say that's pretty unbearable for anyone at any income level except the very rich if they have no history of health problems . . . unless it includes substantial rebates or the unused premiums are redirected into an 'old age' reserve for the insured if medical services other than routine doctor visits aren't needed/used during the policy term.

It is tax deductible of course so, once your self-employment starts generating significant cash, the "net" cost goes down in that your tax bill is reduced.

I'm also self-employed with private healthcare. I reckon that it's less than the share of my UK income tax that went to the UK NHS would have been - but that will change as I age.

I don't have money worries but a lot of people seem to want to worry for me . People suggest I run a mini-job alongside my own work if I wanted different (read cheaper) access to healthcare. Never even consideredd it so no idea of the feasibility. One thing many migrants work out quickly is that suggestions are easy for others to throw around .

The other option is to marry a German with access to the system . I certainly know non-Germans who say they'd have divorced their spouses by now were it not for their lack of alternatives to the other's healthcare provision.

Yep, you got that right... That is why I don't see that really all the currently uninsured people in Germany (of course it is a minor group compared to the US, but I still think it is a shame for a rich country like ours) will get back into some form of insurance after Jan 1st 2009. Those who were and remain not eligible for public health insurance (i.e. those who had and have lost private health insurance in the past, for instance) will be between a rock and hard place when they have to face either German new "basic" private health insurance at close to 500 EUR/month (for every family-member, by the way, in constrast to public health insurance! - yet another legal issue that will needed to be tackled by the German courts eventually) or going around with no health insurance at all. For all those I would recommend to take on an international health insurance for the time being, where you can reduce the coverage to the major threats to your life and purse and this get some premium costs that you can live with.

swimmer: if any person, whether it is a German or a non-German, marries a German who is a member of the public health insurance, he/she will not be automatically allowed as well into th public health insurance if he/she was privately insured wit a German private health insurance before. Only if - in my experience - the prior insurance was an international private health insurance which appearantly the German authorities do not count as private health insurance or health insurance sometimes at all - and/or if he/she has had some public health insurance in another EU memberstate during preceeding 5 years can he/she slip under the public umbrella as well. And that in most cases only if his/her income is wastly less then the one of the publicly insured spouse... just to set the record straight so that nobody tries to marry a German girl/boy just for the wrong reasons... its about loooooove, baby!

Cheerio

Ah, I see, ta .