Hello esteemed crowd,
I have not found an answer to this question after extensive googling or toy-towning, so I'll try my luck this way. The gist of the problem is: Has anyone ever sucessfully argued with a Krankenkasse that, when it comes to the conditions of Familienversicherung, a US group plan negotiated by an employer is the next thing equal to a "gesetzliche" health care plan because in the US there is no real public health care insurance comparable to the German system?
Background: I'm a German freelance artist insured through KSK in BKK VBU, my partner is an American professor fulltime employed by a US university, insured through said group plan. Since two years we mainly live in Germany, my partner commutes half-yearly, has a befristete Aufenthaltstitel here, kept his insurance there, pays taxes in the US. The kids are insured through Familienversicherung with ME because until now my partner's insurance counted as "nicht gesetzliche" PLUS his income was just below the JAE (Jahresarbeitsentgeltgrenze, highest income threshold). The exchange rates were on our side back then. Now they are not, his income is higher. The health insurance company threatens to take our kids of the Family insurance retroactively and backcharge fees. Now the thing is: IF my partner's health insurance was a "gesetzliche" / PUBLIC plan, his income wouldn't matter. It clearly says that in § 10 SGB III*. This seems unfair to me, especially since one can't compare the German and US health case systems. In other words, he HAS to pay a lot of money over there for health insurance, and now we are being punished for this in Germany by having to insure our kids privat or with a "freiwillige gesetzliche" of around 170 Euros each per month. Why does the German state in § 10 SGB III not exclude foreign health insurance situations that are often not comparable to the German system? How could one argue this case with the German health care company, in this case BKK VBU?
* Ist der mit dem Kind verwandte Ehegatte/Lebenspartner des gesetzlich Versicherten nicht Mitglied einer gesetzlichen Krankenkasse, besteht für das Kind kein Anspruch auf Familienversicherung, wenn das monatliche Gesamteinkommen des Ehegatten/Lebenspartners
- regelmäßig ein Zwölftel der Jahresarbeitsentgeltgrenze übersteigt (3.450 Euro für 2003 bzw. 3.487,50 Euro für 2004) und
- regelmäßig höher als das Gesamteinkommen des Mitglieds ist.
Sind beide Eltern in der gesetzlichen Krankenkasse versichert, besteht unabhängig von der Höhe des elterlichen Einkommens Anspruch auf Familienversicherung für das Kind.