Health insurance and pre-existing conditions

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Given that it's now required for an expat to purchase German health insurance (and if I'm not mistaken, from a German -- i.e., not international -- health insurer), how are pre-existing conditions treated by those insurers?

 

That is, will they deny any and all claims that seem to relate to that condition?

 

If so, where does that leave the expat if he/she needs medical care for a recurrence of a former problem, or for a new problem which the insurer decides has a cause-&-effect relationship to the former condition?

 

Are any regulations in effect to limit the ability of insurers to deny such claims?

 

Thanks.

 

[if there's a difference, I'm primarily interested in private insurers a/o/t public ones.]

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I strongly recommend you PM Starshollow about this. As I understand it, you have to disclose pre-existing conditions and such disclosure will often result in copver being refused OR in increased premiums.

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SteveRay: you are opening a whole can of worms here...

 

Yes, you are right that Expats, especially those from outside the EU, have to use German health insurances since Jan 09 since only these insurances entirely fulfill all legal requirements. If you want to stay only for a very limited time and if you are lucky that the local Ausländeramt (immigration authority) accepts this, you might still get through with some of the really good international health insurance like ALC (particularily since GErman ALLIANZ stands behind ALC). But most local offices demand now German health insurance as sufficient proof of coverage when issuing VISA and residence/work permits and all... on the other hand only very few German health insurance companies will accept non-EU Expats now who can not already show that they have a residence permit of at least 2 years duration... Joseph Heller would love this! But an experienced advisor/broker can still find you a way that works.

 

Pre-Existing conditons: it will entirely depend on the kind of condition. Some will indeed lead to denial of insurance accross the board, others will "only" lead to exemption of that ocndition or additonal risk premiums charged. Of course you also have now the right to enter the so-called BASIS tariff of a German private insurance which has to accept you and cover you (similar coverage like public health insurance) not matter what. But this good news is a bit marred by the fact that this insurance will cost you around 580 - 600 EUR/month.

 

Public insurance is most likely not a feasible option for you unless you'll get employment in Germany.

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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Is there any detailed comparison between private & public KV? As in, what benefits are normally covered and what not...

 

It seems that switching to public KV would save us a loooooot of money but I am not sure what all will be covered in comparison to the private KV we (couple with 2 kids) have currently. Any suggestions?

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I googled quite extensively and couldn't find a single website from a public insurer in english. Never mind a comprehensive comparison. But given the fact that coverage is up to 98% identical for all public insurances as required by law and the fees are also identical, it doesn't matter so much which one you chose in the end. And children and spouse (if he/she is not working and therefor has his/her own insurance) are included without extra fee. Coverage is 100% for dependants (Familienversicherte). The littel difference in services covered concerns most of all stuff like homeopathy/alternative medicine. If you're into that you should ask at any insurer specifically if they cover treatment. Also certain insurers might offer special programms for certain chronical illnesses, cardio/ weight loss/ fitness. I guess the best way would be to go to one insurer for intensive consultation on the 'main body' of 98% of mandatory coverage. And from there think about what specific services you might want in addition and go ask each insurer specifically.

 

English Links:

 

Federal Ministry of Health

TT

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I googled quite extensively and couldn't find a single website from a public insurer in english.

No reason to expect this from *German* public healthcare insurers, of course. That's why starshollow et al say repeatedly: you may need a broker. Probably anyway. Certainly if you can't read the information or talk about it in German. Or at least strong input from one who knows the system very well.

 

I'm not in the public system but I'd presume what you say is right. Once you've stumped up your 7,5% for public or c130 min or whatever it is, you should expect fairly comp coverage although it's not a given that any "public healthcare" covers everything (no more than it does in the UK of France where many of us may had to pay for bits and pieces like a drug charge, dental care, some vaccines etc). You have to pay a small regular doctor's fee, I believe, 10 Eur or something?

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switching to public KV would save us a loooooot of money but I am not sure what all will be covered in comparison to the private KV we (couple with 2 kids) have currently. Any suggestions

Problem for you here will be that you can not voluntarily switch to public health insurance if you have private health insurance. Unless you/your husband take up an employment with compulsory public health insurancve, you can not enter public health insurance now anymore.

 

 

I googled quite extensively and couldn't find a single website from a public insurer in english

try this: http://www.tk-online.de/tk/tk/english/germ...nsurance/156466 TKK also really has a great folder with valuable information for Expats in English, including lists of English speaking doctors and all. They have service personal to deal with you in English - but I would recommend you contact my colleague Mike Woodiwiss who is licensed by TKK to sign up people with the TKK. Thus you even have a broker specialized on Expats taking care of you...best of two worlds ;-)

 

 

Never mind a comprehensive comparison

Well, indeed such comparison are always made by German magazines like FOCUS Money or Finanztest and are of course only in German - but the details are really so special and minor that they don't make much sense for the average Expat anyway...

 

Of course the public health insurances are still in a deep downturn.. premiums go up constantly while coverage is being reduced just as constantly and more and more specialists among the doctors do not accept you with public health isnurance unless you pay substantial private contributions to them as well. this may not always be entirely legal, but if you are in pain or dire need of a specialist you will not argue, trust me...

If you decide to go with public health insurance (if you have the choice, that is), here is what you need in addition:

1. you should always have a full year travel health insurance in place. German public health insurance only offers some protection within the EU and virtually none outside. Such a travel-heatlh isnruance can be obtained for little money (15-20 EUr per person and year) and is a must for any publicly insured

2. since the coverage for dental replacements in any way or form are nowadays really only ridiculous with public health insurance, anyone planning to stay for a longer time in German ought to have a suplementary private dental coverage

3. in my opinion any self-employed person should also have a private suplementary upgrade as inpatient (Chefarzt/1- or 2-bedroom) because it allows you to keep up some level of work in the hospital if you are in a single-bed-room with full internet access and phone etc. Of course, if you are in a coma, you won't bother...

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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Of course the public health insurances are still in a deep downturn.. premiums go up constantly while coverage is being reduced just as constantly and more and more specialists among the doctors do not accept you with public health isnurance unless you pay substantial private contributions to them as well.

The reality is of course that public healthcare, wherever, is just expensive and going to become more so as we live longer. Those of us from the UK know how vast and bloated the UK NHS system is and going to become even more so. The difference here is Germany is we have visibility of the cost whereas UK taxpayers just pay one tax sum. I reckoned 10-15% of my tax bill was paying for the NHS so I don't consider German rates (public or private) unusual.

 

It's already a big issue in western European welfare states that have it and it's not going to go away. It's a reality. On demand healthcare for all your (increasingy long life) ife and for your kids and possibly a spouse and posibly for 20 years after you retire is inevitably going to be very (increasingly) expensive in the years you earn.

 

I understand why a lot of dental cover is not paid for. We're far beyond the cost of a bit of amalgam or, at worst, falsies if your teeth decay. If you want to grind your own teeth into stumps and have wonderful veneers and crowns, maybe you (and your dentist) probably should not expect that to be funded by a mutual scheme.

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SteveRay: you are opening a whole can of worms here...

OK, but in fairness to myself, I didn't create either the can or the worms.

 

 

Yes, you are right that Expats, especially those from outside the EU, have to use German health insurances since Jan 09 since only these insurances entirely fulfill all legal requirements. If you want to stay only for a very limited time and if you are lucky that the local Ausländeramt (immigration authority) accepts this, you might still get through with some of the really good international health insurance like ALC (particularily since GErman ALLIANZ stands behind ALC). But most local offices demand now German health insurance as sufficient proof of coverage when issuing VISA and residence/work permits and all...

Can I assume that I will be able to start my emigration plan on a standard 90-day 'tourist' visa with health coverage provided by a standard 'travel insurance' policy (American -- not German) and then figure out what to do next within my allotted 90 days?

 

 

only very few German health insurance companies will accept non-EU Expats now who can not already show that they have a residence permit of at least 2 years duration... Joseph Heller would love this!

Is it particularly difficult to get a residence permit for 2 years? Can't one get a letter from the Aüslanderamt stating that the applicant (me) will be considered for a 2-year residence permit if the insurer provides coverage for that period?

 

 

Pre-Existing conditons: it will entirely depend on the kind of condition. Some will indeed lead to denial of insurance accross the board, others will "only" lead to exemption of that ocndition or additonal risk premiums charged.

I should clarify what I was really driving at: I wasn't referring to someone who has diabetes or some clearly-established disease, etc. My concern was more whether, e.g., someone who has had treatment for a knee problem in the past could be refused coverage (or required to pay an increased premium) for any future medical treatment of knee problems once in Germany (especially if they appear to be of the same type previously treated) simply because the private insurer would take the position that it constituted treatment for a 'pre-existing condition.'

 

 

Public insurance is most likely not a feasible option for you unless you'll get employment in Germany.

Right, that was why I pointed out that my interest was in how the pre-existing conditions issue would be dealt with by 'private' insurers, as I assume they have more leeway (i.e., right to reject) than public insurers do.

 

Thanks.

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I am vitally interested in this topic as well-- what to expect from a private German KV provider when receiving treatment for something that could be linked to a pre-existing condition.

 

In my case, the subject is more than hypothetical. I had a small basal cell carcinoma removed in 2003, and after finding a new dermatologist here, I learned that it had come back (they can do that). In April I had it surgically removed, which involved a hospital stay. Now I am half-expecting a letter from the insurance telling me this treatment is out of their coverage. A broker arranged the policy, and at the time I informed him of the 2003 occurance. What he may have told the insurance though is unknown to me.

 

I suppose my main question is this: If they do challenge the claim, is this something I can win by dint of vigorous correspondence? Since it was a hospital case, I did not have to front the costs. Thanks for any replies.

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As far as I understand it the new basic tariff of the Private Krankenkasse is available without any assessment of pre-conditions. But within this tariff the service is about the same as in the Public insurance and probably even more expensive. At the same time a pre-condition doesn't automatically mean you will be refused membership if you want to go for more than 'basic tariff' in a Private. While one insurer will refuse you, the other will accept (maybe with hihger rates for the risk). If you haven't been hospitalized within the last 10 years or in ambulant treatment within the last 5 for a certain illness your pre-condition might be considered non-existent anyway. I would recommend to answer the questions truthfully in your assessment. But don't give more information than asked! If you're refused, try another insurer. In the end who is wihtout flaws? Those Insurance companies need customers. They cannot just take the perfectly healthy ones. They would be broke in a day.

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Yes, but who can afford the Basis tariff at 580 - 600 EUR/month? Also, the issue is not so much one of 'outright refusal of coverage' but of what (regulations, etc.), if anything, limits the ability of private insurers to add arbitrary rate hikes based, e.g., on 'pre-existing conditions,' thereby making policies out of reach of all but the wealthiest expats.

 

It seems to me that if there are no mandated limits, the private insurers can essentially hold hostage those people caught in the Catch-22 that Starshollow referred to above by offering 'take it or leave it' policies.

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Those Insurance companies need customers. They cannot just take the perfectly healthy ones.

not quite right - because this is not really a market situation with overall competition. German private insurances more or less rely on the fact that the biggest risks are taken over by the public health insurances. In order to keep their tariffs lean and clean, they do try to bar as many people as possible from the good/cheap tariffs - which makes economically sense for them and the people insured with them. All others are being left for more expensive tariffs, newest solution now being the BASIS tariff at close to 570-600 EUr/month. They do need customers, but only those who don't cost them much...

 

It really entirely depends on the pre-existing condition. I have not knowledge about the kind of cancer Kleena describes and can not say how big the statistical risk is that this turns into something big/serious and thus in seriously expensive treatment. Based on the statistics the insruance will say yeah or nay to an application - not based on your individual case, something often misunderstood.

 

If oyu have told the insurance agent about your condition and he left it out, he/she is also liable in case the insurance finds out and makes it a case to deny the claim or even cancel the insurance.

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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I am vitally interested in this topic as well-- what to expect from a private German KV provider when receiving treatment for something that could be linked to a pre-existing condition. In my case, the subject is more than hypothetical. I had a small basal cell carcinoma removed in 2003, and after finding a new dermatologist here, I learned that it had come back (they can do that). In April I had it surgically removed, which involved a hospital stay. Now I am half-expecting a letter from the insurance telling me this treatment is out of their coverage. A broker arranged the policy, and at the time I informed him of the 2003 occurance. What he may have told the insurance though is unknown to me.I suppose my main question is this: If they do challenge the claim, is this something I can win by dint of vigorous correspondence? Since it was a hospital case, I did not have to front the costs. Thanks for any replies.

 

 

I am in a similar situation. I'm being currently treated for cancer (different type). Hopefully it will not return but if it does it would of course be considered a pre-existing condition and the treatment could potentially be quite expensive. I will also need regular tests including CT scans. So what are my options for health insurance? Most likely I will not be working in Germany but my wife will be making a very good salary.

 

 

A broker arranged the policy, and at the time I informed him of the 2003 occurance. What he may have told the insurance though is unknown to me.

 

I realize this post is a year old, but I would definitely suggest finding out exactly what the terms and conditions of your policy are.

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MIke: sorry to hear about your cancer and hope you have won the battle for good!

 

If your wife is employed AND if you don't earn more than 375 EUR/month from any source whatsoever AND if she is eligible for public health insurance (the latter could be the main problem here) then you could become conveniently co-insured as a family member under her public health insurance with no extra costs and would receive most of the check-ups etc paid by the insurance if and when a local doctor prescribes such check-ups/treatment etc (which is highly likely as the medical standard in Germany is certainly about the same level as in the US).

 

But as you have seen in my phrase above, there are a number of consecutive qualifiers in this sentence and that's where the problems start. If either she cannot become a member of public insurance or you cannot become co-insured, there are only two ways left to get you insured in Germany as a normal private health insurance will not accept you at all.

 

1. you or your wife could try getting you a >410 EUR jobby somewhere in Germany. I just had the case where a spouse could not get into a normal private insurance because of a simple genetical disorder which can only be considered as a potential problem somewhere in the future (genetically much higher risk for trombosis) and her husband's company agree to reduce his salary in such a way that they could hire her pro forma with a 401 EUR job to get her insured at all. Depends on how much your wife's employer wants/needs her services and how much leverage you have in negotiatiing something like this. Oterhwise perhaps you can find such a job in any other way or form...

 

2. Or you can sign up with the BASIS tariff in a private health insurance. Same coverage like public health isnurance, but costs around 650-700 EUR/month for you. BUt at least you'll know that all treatments are covered like in a public health insurance

 

There is one last option, a bit in a legal grey zone right now due to some stupid laws in Germany about health insurances: you could, for instance, sign up with ALC ( an ALLIANZ subsidiary located in Ireland) who use a moratorium rule and can exclude certain conditions from coverage (which the German insurances can't properly do for legal reasons). That way you would get rather good and inexpensive coverage for everything BUT your cancer. Don't think thats what you want, but it is another option. It could just be that the local immigration office does not accept this insurance as complying to Germany laws and make a fuss with regards to your Visa.

 

So, here are your options. Check them out and best of luck,

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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I am very happy to have found this thread as I need some similar advice. My family will be moving to Germany soon and will be taking my 65 year old mother to help watch the kids.

 

We will be covered under our companies health plan, no problem, but my mother will not.

 

To make matters more complicated, she has just finished chemotherapy for breast cancer but is doing well.

 

I was hoping that Mike or starshallow could shed some light on what we might be able to do for my mothers insurance. it sounds like I'm going to have to go with a private insurance. 600-700euro/month is not an issue, just need some advice on companies I can call to get this process started. We've been paying our nanny $2000/month, so paying this for my mother would be well worth it.

 

thanks in advance for any info that you can provide, it is very much appreciated as we are having an extremely difficult time trying to get anywhere with this issue.

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It is actually quite simple: once your mother has her Visa/residence permit or at least has applied for it (so that a confirmation of the ongoing process can be shown to an insurance company) you can sign her up for a so-called BASIS tariff with any German private health insurance company. Since the coverage and price are governed by law, there is no difference with regards to costs or coverage amongst them. Public insurance is not possible, I am afraid, as your mother his too old to be allowed in anymore.

 

Private health insurances, however, hate to do this. I had to twist some arms seriously for some of my clients when I needed the first time to get someone in, they'll try to brush you off in every possible manner. I nowadays use these BASIS tariff applications to punish insurance companies who treated some of my clients badly in the past or so - if you can't get it done yourself, contact me, happy to punish them some more.... If you want to have some additional coverage for your mom, like better inpatient coverage etc than public insurance offers in Germany (which is the same coverage in BASIS tariff) than Mike can help you with that thru ALC.They would simply exclude your mothers cancer from coverage but still cover anything else.

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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thanks for the reply starshollow. my wife and i would like to pursue working with you or your company on this matter. i will send a message to the C R and Cie link below your message if that is the best way to get in touch with you. I didn't quite understand your statement about the ALC. We absolutely need the cancer tests, any treatments, etc, to be covered under the insurance so does that mean we would purchase BASIS plus the ALC?

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have received your email and will follow up during tomorrow.

With regards to your general question below: your mom would get all the coverage an average person in a German public health insurance would enjoy with the BASIS tariff. My hint towards Mike and ALC is to understand in such a way that perhaps you would like to have some better coverage for your mom as compared to German public health insurance standards, such as getting a one-bed-room in hospital and other amenities.... Since German private health isnruance would not accept your mother into a normal tariff (which could include such upgrades) the next best solution would be to book additional coverage with ALC. While German private health insurances will summarily reject coverage for your mother, ALC at least will simply exclude the existing condition but offer coverage for everything else to this regards. Sorry if I did not explain this properly before...

 

Cheerio and talk soon

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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