Moving from private to public health insurance

128 posts in this topic

I am curious about this BASIS tariff.

 

I understood that there is this option for retiree to stay with their private insurance company and pay the average premium of maximum premium charged by the public insurance companies. In exchange, this person will only enjoy the benefits that a publicly person will enjoy. (I hope I am correct, I have been reading about it only).

 

I am a little curious about the charges that the doctors make. Would the doctors still allowed to charge the private rates on these patients who opted into the Basis tariff?

 

If so, then those who opt for the Basis tariff will end up with a big medical bill isn't it? (i.e. doctor charges private rates and only public services benefits are enjoyed)

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I am a little curious about the charges that the doctors make. Would the doctors still allowed to charge the private rates on these patients who opted into the Basis tariff?

The doctor charges do not depend (initially) on what insurance you have - for normal treatment they are the same for public and private insurance patients. it is only that some private insurance tariffs allow (not all, btw) for higher charges at certain specialists or at the hospital (Chefarzt). It also happens more and more that even the normal GP tries to make the patients from public insurances say that they want a special prescription (the one they always had in the past instead of the generic stuff he is prescribing now) because than he can charge them additonal charges, too.

Having said that: you are right that nowadays private insurance patients are getting overcharged even for simple treatments. But the isnurance companies are putting more and more pressure on those docs who overegg the pudding here...

 

With regards to the BASIS tariff: since it mirrors the public insurance coverage it will not allow for extra charges thru doctors. But if someone on a basis tariff will present his insurance to the doctor, the doctor will know that this is like an AOK patient and act accordingly.

 

Cheerio

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

 

May I trouble yourself with one further question.

 

GKV will only take people who are younger than 55.

 

If I were in Germany for the next few year (5 perhaps) and would be working outside German thereafter (due to job assignment) and plan to return again when I am after 56 yo (just a theoretical question). I am a non-German national.

 

If I was told that if I were GKV insured (based on the current laws), I would not need to have an Anwartschaft for GKV when I am not in Germany. When I return to Germany, even if I were over 55, the public insurance company would still have to take me as I was last insured with them before leaving Germany.

 

I am just wondering if this is correct or is this another urban legend?

 

As always, look forward to your wise words.

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Private insurance doesn't get more expensive as you get older anyway (not any more than the usual rises anyway). This is all factored into the calculation, they are putting money away now to cover your old age.

This is one reason why German insurance is a lot more expensive than international policies.

"Private insurance doesn't get more expensive as you get older anyway" I do not know where you get your info, but IIRC you are dead wrong on this point. I hear from fellow workers who are in the private health insurance sector who are over fifty are asking themselves how they going to afford the private ins. premiums after they retire, and wish they were in the public ins. system.

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"I hear from fellow workers who are in the private health insurance sector who are over fifty are asking themselves how they going to afford the private ins. premiums after they retire"

 

But that's not the same as saying it gets "more expensive" though, is it? It's about funding the premium. What you mean is that there is still the premium to be paid after retirement but no salary - but even that wil be paid in part by the government. My German family have a large % of theirs met.

 

Your reply to your peers is, of course, that they chose "jam today instead of jam tomorrow" and now that "tomorrow" is almost here. They knew how it worked all along. They got the benefit of much lower payments from lower private sector premia when younger (compared to forking out 7% of salary into the public system). It might have been a good idea to have put some of that saving aside for later life. And so on. Easy way to stop them griping. Remind them about the extra holiday they had instead or whatever they bought with it.

 

I have private insurance and have no sympathy for the likes of your peers who start whinging when the light dawns that it's not a one-way bet, not a "win-win". It's just a different model. If they wanted cheaper cover in later life, they should have stuck to the public system - and thus paid more when younger in order to ensure cheaper pension age care.

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"Private insurance doesn't get more expensive as you get older anyway" I do not know where you get your info, but IIRC you are dead wrong on this point. I hear from fellow workers who are in the private health insurance sector who are over fifty are asking themselves how they going to afford the private ins. premiums after they retire, and wish they were in the public ins. system.

 

Hi jmjdk

 

From what I have read and from this forum, the private health care insurances are obliged to provide a coverage that is the same (i.e. price and service) that is equivalent to that of the public insurance when the member reaches 55. If I recall correctly, it is called "Basis Tarif". So these older colleagues could effectively "switch over" when they cannot afford private insurances anymore.

 

 

My German family have a large % of theirs met.

 

Hi Swimmer

 

I am just curious, were these family members worked before their retirement as Beamters (civil servants)?

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anaidross: I am taking a couple of days off for Easter holiday. Will answer your question by Tuesday or Wednesday, ok?

swimmer: well said - this is exactly the problem. What people also do not understand that the increase in premiums for public insurance was huge over the last 10-15 years, both from direct increases and form indirect ones (like cancelling on certain areas of coverage, especially dental).

 

Cheerio

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

 

Im new to Germany (since march 2010) and to TT, and man is my head spinning after reading all this insurance stuff. I know i should have gone to bed hours ago but this stuff is going to keep me awake anyway thinking about it. plus it seems i have lots of reading to do!

 

I admit i haven't reasearcherd the topic much elsewhere, but given the comprehensiveness of the posts here, I doubt im going to find better information anywhere (certainly not in English!?). So, in that frame of mind im posting some questions here now, in the hope to get a bit of a handle on it, and a nudge in the right direction. Any help anyone can provide is of course greatly appreciated. I hope(ed) the matter is relatively straight forward, but im starting to doubt...

 

Background: I moved to Germany (from Australia) to work as a "Local hire" for Siemens. I have a 2 year contract at present (with promises of an unlimited one in the future).

When prompted by HR dept, i signed up to the company standard SBK insurance. i have a letter and a member card already.

I havent had a chance to look at what im paying (been paid but havent see the payslip yet), but what i got paid was slightly better than estimated, after tax (where my estimate included a 14% health ins contribution). My before tax salary is above the most recent quoted threshold for going to private. No idea what im curently covered for exactly. At the time i was too busy (looking for a place to live) to check it out.

 

So i have a few questions,

Is SBK "public Insurance"? (a dumb question but im bewildered now)

Approximately what would you pay for basic private cover? (ballpark range) - im under 25 and completely healthy.

 

Also, My girlfriend is planning to move here to live with me. Can i get cover for her with SBK (or another) if she is not working?

 

Generally, im not expecting to stay more than a few years. So i just want a basic cover, short term outlook, and minimal premiums, since i dont know how the budget will go if i have another 150 to??? monthly premium to pay for my girlfriend for health insurance.

 

Was thinking private would be better, since (if i understand right) you can get a lower premium now and possibly better cover, plus excess options etc. But, it also seems if i use public, my girlfriend can be covered by my premium (or do we need to be married?). Is it just a matter of comparing quotes?

 

So, i know it a messy lot of question, and i have to do a LOT more reading, but i'll be glad if anyone can guide me a bit.

 

Thanks for all the posts so far. Great resource.

Cheers,

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Anaidross - will reply tomorrow, sorry about delay.

 

kib928: here are some answers for you, hope that eases the pain from the head-spinning a bit...

 

Is SBK "public Insurance"? (a dumb question but im bewildered now)

 

Yes, it is. If, as you say, your current gross salary is over the threshold, you'll be paying over 300 EUR from your paycheck each month for this insurance. Please be aware that there is only very low or even zero coverage with this abroad. if you travel outside Germany, make sure you have a decent travel health insurance set up (costs maybe 20-30 EUR per year only!)

 

 

Approximately what would you pay for basic private cover? (ballpark range) - im under 25 and completely healthy.

Well, the answer to this is not as easy as you may think. If you are ok with a high deductible around 1200-1500 EUR(i.e. the insurance will only pay all your medical costs once the total is in excess of a certain amount per year) you could get an insurance that is already euqal or even better than public insurance for a total of 113 EUr per month, out of which you pay only half- Thus, if saving money is your prime concern, you can save up to 250 EUR per month for yourself.

A really good alternative for you would be to go with a bit lower deductible, say 600 EUR, but with a huge no-claims-bonus and far superior coverage (better hospital treatment, far better dental etc). The total for such an insurance per month would be around 310 EUr in your case (always bearing that there are no medical risks in existence)out of which you pay around 155 Eur per month yourself, which means you yourself save around 150 EUR each month compared to know. Your own total payments into this insurance would run up to about 1863 EUr per year. But the insurance would award you with 6 full monthly premiums paid back if you did not file and that total bonus comes to 1763 EUR for a full year(paid out in April/May following year) and if you take the difference between what you paid and what you get paid out and divide it by 12 (month) you get your actual net costs. For employees this can be rather attractive...

 

 

Also, My girlfriend is planning to move here to live with me. Can i get cover for her with SBK (or another) if she is not working?

Assuming that she is an Aussie, too and since you guys are not married, she can not join you at SBK (unless she has at some point in the past been insured with a public health insurance in Germany, but even then she'll need to have her own membership and pay for it). She will thus need her own private health insurance.

 

 

 

 

Generally, im not expecting to stay more than a few years. So i just want a basic cover, short term outlook, and minimal premiums, since i dont know how the budget will go if i have another 150 to??? monthly premium to pay for my girlfriend for health insurance.

 

 

Well, as you can see above, you can save more than enough money to pay for your girlfriends insurance and have some money left each month still (first example)

 

 

Was thinking private would be better, since (if i understand right) you can get a lower premium now and possibly better cover, plus excess options etc. But, it also seems if i use public, my girlfriend can be covered by my premium (or do we need to be married?). Is it just a matter of comparing quotes?

First you have to assess if you can actually get out of the public health insurance. In order to do so you must meet the following criteria/requirements:

during the last three years you must have had a gross salary which, converted into EUR, exceeds certain thresholds? These threshold were:

2007: > 47.700 EUR

2008: > 48.150 EUR

2009: > 48.600 EUR

and for this year 2010 your gross salary should be in excess of 4.162,50 EUR per month or totaling 49.950.- EUR at the end of the year

 

If your gross salary (and it must have been a gross SALARY, not an income from any other source) has not met this requirement in any of these past years or even now, you do not have a choice: you’ll have to stay< with public health insurance now. Only if you can show proof of gross salary in excess of these thresholds for the past three years and with your new job are you eligible to opt out from public insurance.

 

When it comes to finding the right private health insurance, get the help of an independent broker. Unfortunately it has become a minefield what with so many insurance companies having different rules which foreigners to accept under which condition etc. You yourself might not be a problem as an employee, but if you enter an insurance that does not allow your girlfriend in later, tings can get messy. Plus: the comparing of coverage (i.e. what you get for your money) is important and you should use the help of someone who is experienced in dealing with expats and can offer info in English for you. Several such splendid individuals are advertising here on Toytown, you should find someone who you like...

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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Just wanted to add some questions to the discussion:

 

First, the case of a free lancer with private insurance, who is then hired with a permanent contract.

 

Could he in this case get back into the public?

 

Would that be dependant on his gross salary being above or below the threshold, or could he get in any case - if he wants - back into the public?

I mean, if his gross salary is below, I know he must get back in the public, but if the gross salary is above, does he have a choice, or is he forced to keep his private insurance?

 

Second, the case of a free lancer with private insurance, who ceases his free-lance activity, and his wife is in the public.

 

Can he join her in the family public insurance, or would he have to keep paying his private insurance?

 

Third, the same odd free lancer, who then moves abroad.

 

Does he need to deregister to get out of his contract?

In getting back to germany after some years, would he be able to get into the public if he is able to prove he was in the NHS of the country he lived in?

 

Thanks for your answers, I researched a bit but could not find the answers to these specific questions in the forum.

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Careful:under current rules,if you´re self-employed and privately insured and take up employee status,you MUST go into the public system.It´s irrelevant whether you´re above the threshold or not.The three-year-rule means you could even be above the threshold as an employee but you would have to wait three years and remain above that income level to be allowed to opt back into the private system.If you stopped freelancing?It depends..whatdo you mean? Stop working?Or becoming an employee?If you left the country,you would have to deregister( abmelden) from Germany- then you can quit either the public or the private system with no problem.Whether,on returning to Germany,you could reenter the public system having paid into another EU´s public system would depend on the time frame.If you went to the UK,for example,and camer back here after 2 years,you could get back in.If you went to Canada for 5 years,for example,and came back here - you couldn´t unless on employee status.These are all questions which are answerable from the current point of view but there´s no way of knowing 100% which rules wil change and which will stay.The only tbing I know 100% is that the whole system could do with being simplified!

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First, the case of a free lancer with private insurance, who is then hired with a permanent contract. Could he in this case get back into the public?

 

Would that be dependant on his gross salary being above or below the threshold, or could he get in any case - if he wants - back into the public?

 

I mean, if his gross salary is below, I know he must get back in the public, but if the gross salary is above, does he have a choice, or is he forced to keep his private insurance?

 

If one's status has changed from being full time self-employed and to that of an employee, one will have to get back into public insurance, regardless how much one earns.

 

 

 

Third, the same odd free lancer, who then moves abroad.

 

Does he need to deregister to get out of his contract?

In getting back to germany after some years, would he be able to get into the public if he is able to prove he was in the NHS of the country he lived in?

 

I wrote to SBK (public insurance), they told me the following.

 

One could get out of the public insurance if the person has an employment outside Germany / EU.

 

They further add that one can stay in the public insurance when returning to Germany after a period of time, even without Anwartschaft and even after age 55, on the condition that:

 

1. He was last insured under public insurance scheme for more than 1 year and:

2. Nationality of the person

a. The person insured is a German or EU national then, first condition would suffice;

b. Non German / EU nationals must further provide a valid Niederlassungserlaubnis or a valid Aufenthaltsgehnehmung from Germany.

 

Perhaps some experts could help to confirm this.

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Whether,on returning to Germany,you could reenter the public system having paid into another EU´s public system would depend on the time frame.

Hi John g

 

This is what I got as a reply concerning being publicly insured when returning to Germany after a long while.

 

Question:

 

Falls ich anschließend wieder nach Deutschland zurückkehre und über 55 Jahre alt bin, kann ich mich dann wieder bei XXX versichern?

 

Answer:

wenn Sie zuletzt in Deutschland gesetzlich versichert waren, ins Ausland gehen und dann wieder dauerhaft nach D zurückkommen, kommt es auf Ihre Staatsangehörigkeit an, ist sie Deutsch oder aus der EU können sie ohne Probleme sich wieder bei uns versichern haben Sie eine andere Staatsangehörigkeit, dann können Sie nur beitreten, wenn sie eine Niederlassungserlaubnis oder Aufenthaltsgenehmingung von mehr! als einem Jahr haben. (§ 5 Abs. 1 Nr. 13 und Abs.11 SGB V)

 

Does the answer sound correct / up-to-date?

 

Or could you provide me with where the 2-year requirement is stated so that I could ask them further and keep everyone posted once I get the reply.

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both are correct: what jon_g wrote and what you got from the SBK - because both are depending on different circumstances.

What you john_g wrote is the case if you leave Germany (i.e. give up residence) while under PRIVATE German health insurance. If you want to get into public health insurnace some years later upon your return to Germany, you would have to show proof that in the meantime you had at least 2 years worth of public insurance in another EU member state.

What you received is based on the case that when you leave Germany you are leaving the PUBLIC insurance behind. In this case when you come back you can always re-enter the public insurance based on the info they gave you. Wiht one exception not mentioned here by SBK: if during the years abroad you were 1) employed and B) during this employment always over the legal threshold and 3) during the entire time private insured, they would -according to cases I have seen, reject your re-entry into public insurance as an employee. Whether they would re-accept you as a self-employed person then is anyone's guess...

 

Cheerio

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

 

After three years away from Germany, I've recently returned and again face the challenges of health insurance. From the postings on TT it looks like it's actually managed to become more complicated in that time :) As I was away for a few years, I'm not too sure how this affects my eligibility for private or pubic insurance, so I'd appreciate your advice. Here is my background story:

 

- Australian citizen, 32, married, planning to stay in Germany for at least 5 years.

- Lived in Germany from 2004 - 2006, with private health insurance, working as a 'local hire'

- Lived in Asia from 2007 - 2009, with expat insurance (AXA PPP), and salary less than the German private health insurance threshold

- Came back to Germany in March 2010, earning more than the private health insurance threshold as a 'local hire'.

- Up until now, I've been covered by my AXA PPP expat insurance, but I guess should be switching to something local.

 

What I would like to check is:

 

1. Because I previously had German private health insurance (about 22 months in the 5 years since March 2005), and am now earning more €4.162,50, am I now required to join into private health insurance?

 

2. Because I have not been earning more than €4.000 while in Asia for the past 3 years, am I now required to join into public health insurance?

 

3. I travel a lot (non business), so need to have international health insurance. From the postings, I understand I can pay some low supplement (~€60/year), and may also need to sign a contract committing to 18 months with the Krankenkasse. Is this kind of supplementary insurance available for all public health funds, and are some better than others?

 

4. I'm thinking it is best to join into a public insurance, as this will cover the wife & any family that may get started (assuming the laws don't change). I've seen (much older) posts saying this is a good idea, and others that it may still work out cheaper and better to take a private insurance and pay extra to cover the whole family. What is the current feeling on this?

 

Thanks for your help!

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Wiht one exception not mentioned here by SBK: if during the years abroad you were 1) employed and during this employment always over the legal threshold and 3) during the entire time private insured, they would -according to cases I have seen, reject your re-entry into public insurance as an employee. Whether they would re-accept you as a self-employed person then is anyone's guess...

 

Oh, my god this is so complex.

 

So Starshollow, does this mean that if I do not fulfil one of the above conditions (e.g. not being insured at all when I am abroad or not being employed) would mean that they must take me back into GKV?

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Mischinab:not sure about your eligibility for "pubic insurance" either!!!Complicated laws here! :D

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Mischinab:more seriously now..are you self-employed?I presume so if you´re still with AXA but just in case...?

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