Help: TK Health issue between Germany and Italy

21 posts in this topic

Hello everyone,

I have a problem which is quite significant in view of the amount of money at play, so I would appreciate any help. The situation is quite tricky, too, and came up to me today.

 

I was in Germany working as full employee until August 2011 and was a permanent resident there (I am not an EU citizen, though). I then took a position in Italy and my contract in Italy started on September first 2011. All fine, except that my insurance in Italy could not start at the same time as my employement contract (september first), mainly because I needed to get a permission for stay in Italy before getting health insurance. Concretely, I received my subscription to the italian health insurance in December 2011.

 

Now, what happenned is that I am ill with a chronical disease, and in September 2011, just when I started, I needed some medical care. After realizing that the Italian hospitals did not want to provide me medication except if I pay on my own, I checked out that my TK card was still valid until 30/09/2011, and so called my doctor in Germany and went there by car for a few days and got cured. Came back to Italy, and was happy for that despite the burden and cost of travel etc.

 

Today, I received a letter from TK sent to me in Italy, telling me that I am not insured since August 2011 and asked me to provide them with my new social security to transfer the bill of Spetember for medical expenses, and that otherwise I will have to pay the expenses on my own. Two things to notice: The amount is circa 5000 Euros, as expected for those medical expenses. This is heavy money load to me.

 

I called TK in English speaking, and the guy there started telling me that I have to pay on my own because I am not with them since August. I told him that I thought the card -and hence- the health insurance was valid until end of september 2011. He responded that there is not a one to one correspondence. After discussion for some time, he proposed me to apply for a -new- membership retro-actively with a proof that my italian insurance started only in december 2011, which I can do. He told me this should work out, and I will have to pay the period from August 2011 to end of november 2011. My salary is circa 1900 euros in Italy, I have little clue how much this would be.

 

I have several concerns, mainly about what information to present to them. For instance about residenceship. My italian work contract explicitely states that I am resident in Germany, because this contract was signed in August 2011. I still have my german residence card (a permanent one), but left the German apartment end of August. I still have a bank account in germany.

Another concern is what to fill in the delcaration for membership, they ask me to tick whether I am granted for compulsory insurance or not, and ask me to provide an address. What to answer in those cases?

 

More generally, what is the best strategy to follow? My main fear is that they refuse this to me, arguing that I have to manage this with the italian system, which I can understand, whereas in Italy they have been straight in saying that having a work contract does not mean that your insurance starts at that date, so they will also reject the bill not mentionning the difficulty -for them- of having been cured in Germany. I may find myself obliged to pay for a very painful and expensive disease (rheuma).

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I can understand TK's position. If your last month of work was August and the last money that TK received from you was for August, then I can understand they would assume since they did not hear from you after that that you no longer wished to be insured by them.

 

The expiry date of the card is completely irrelevant. My AOK card is valid until some time in 2017 but I would not assume that if I moved to Italy and started working there that I could still return to Germany and get medical services on it until expiry.

 

In any case, they seem to be offering you a way out by applying for the coverage back in time. Send them the proof you have and a cover letter explaining the whole thing. Once you are no longer working, I assume you are no longer under compulsary insurance, you probably move into freiwillig but if you are not sure about how to fill out the forms exactly, you should just phone TK and ask for the helpful guy again.

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LeonG: I see what you mean, the bug is that my TK card was valid until, and ther eis a misjudgement here from my part.

I kept working, but in Italy, so am I under compulsary insurance?

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once you end your job your membership doesn't automatically stop, you will be insured for another month without further paperwork/application. But that is only the case when you do not take up another job. Which you did, plus abroad.

 

But maybe there is a way for you in this. If you could "prove" that you spent the following month moving to Italy and started to work in your new job a month later (oct.1st) you should still be covered. Since your bills are from a german doctor you could claim that you were still "on the move" then, and maybe your new italien employer can set up some lines whcih go the same way.

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If you were clearly NOT paying for health insurance through TK, then you had absolutely no right to expect them to foot the bill!

I think that you are very lucky that they will even consider allowing you to make back-payments!

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sosarx: what you say is somehow true, I made two trips in Spetember to Germany, one for moving, and one for the doc. I slept at my apartment at that day because I know the owner very well after 7 years in germany, and also because his apartment was free.

 

robinson100: the question is whether one can be positive and find a solution. I do not want anyone to pay if he/she does not have to, the question is if I had this right in view of the situation. For instance, when does a legal residency in a country ends? Again, I left the German apartment end of August, but I was yet not a resident of Italy during September because I entered the country with a tourist visa.

 

Any insight is truly welcomed.

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I do not want anyone to pay if he/she does not have to, the question is if I had this right in view of the situation. For instance, when does a legal residency in a country ends?

 

When did you deregister at your town hall?

 

I think youve been offered a good settlement with the backpaying. Take it and run before a superior of this agents sees this. TK are still going to make a significant loss.

 

If you want to have a correct answer you will need a lawyer. No way around it.

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matajari: in Germany actually never (I did not know about that)

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sosarx: what you say is somehow true, I made two trips in Spetember to Germany, one for moving, and one for the doc. I slept at my apartment at that day because I know the owner very well after 7 years in germany, and also because his apartment was free.

 

robinson100: the question is whether one can be positive and find a solution. I do not want anyone to pay if he/she does not have to, the question is if I had this right in view of the situation. For instance, when does a legal residency in a country ends? Again, I left the German apartment end of August, but I was yet not a resident of Italy during September because I entered the country with a tourist visa.

 

Any insight is truly welcomed.

 

 

 

matajari: in Germany actually never (I did not know about that)

 

Here is what I do not understand: you say above that you have never registered yourself in Germany? (Einwohnermeldeamt...) yet you have a residence permit to live and work in Germany, right? Well, I am reasonably sure that you could not obtain the latter without the former. Everyone who lives in Germany has to register his residence within 7 days. I can't imagine that you were awarded a residence permit/Visa without registering at the Einwohnermeldeamt, too.

Based on this assumption I would take the next step and assume that you are in effect still registered in Germany as a resident since you clearly did not "de-register" yourself.

if that is a fact, there is a way out for you as TKK indicated because all you have to do is show them that you are still registered in Germany for that time when you got the treatment and then they actually HAVE to cover you and your expenses. What you need to do is to go to your local Einwohnermeldeamt where you lived in the apartment and ask

1) for a confirmation of your registration

2) and a de-registration per some time later in last year (though you might have to pay a small fine for doing this so late) and your new address in Italy

 

You will then have to pay premiums to TKK for those months that you have been legally still a resident in Germany, i.e. according to your words til December. Each months will probably cost you around 322 EUR and change because with an employment abroad you'll be computed like a self-employed person in Germany and hence your gross income will lead to this monthly premium. Still, paying 3-4 month this amount is still way less than paying for the total medical costs yourself, right?

 

BUt be that as it may, you'll have to get thru the administrative side of things and provide proof to the TKK that you have been still a legal resident in Germany during that time you took the treatment as described above.

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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When did you deregister at your town hall?

 

 

 

matajari: in Germany actually never (I did not know about that)

 

@Starshollow

 

I think he means that he registered, but didn't know that he had to deregister when he moved outside Germany, so he didn't deregister.

 

If that's the case then he will still count as resident in Germany and this would explain why TK is willing to keep him on their books beyond the end of his employment in Germany.

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Let me clarify a point which I think is important:

-apartment rental in Germany ended in August 2011

-Appartement rental in Italy started in September 2011

-In practice, I know very well the owner, who left me the keys for September that I can make the move from Germany to Italy in more than one step

 

Starshollow: Thanks very much for your insight, it gives me a good idea already. As said PandaMunich I of course registered (indeed, you cannot make a move without that except perhaps for exceptional situations) when I came to Munich a long long time ago, I just left Germany without knowing I need to de-register.

 

My doubt is that I left my apartment in the end of August 2011, and so I do not know what residence in Germany means for the month of September without having a physical location (address) in Germany?

 

This question, for instance has the consequence that I do not know what address (Italy/Germany)to put when filling up the subscription form.

 

Additionaly, I was clearly not a resident of Italy at that time since I entered with a tourist visa, without permit to stay for more than 3 months (which was extended to a full permit in December 2011, precisely when I got the new insurance), and in my employement contract I correctly wrote that I was resident in Germany (the contract was signed mid August), i.e. with my address in Germany.

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... I erroneously made an unecessary multi-quote, now removed.

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The problem is that you are not legally resident in Germany as long as you are registered,but as long as you

 

§ 8 AO

 

Einen Wohnsitz hat jemand dort, wo er eine Wohnung unter Umständen innehat, die darauf schließen lassen, dass er die Wohnung beibehalten und benutzen wird.

 

or

 

§ 7 BGB

 

(1) Wer sich an einem Orte ständig niederlässt, begründet an diesem Ort seinen Wohnsitz.

(2) Der Wohnsitz kann gleichzeitig an mehreren Orten bestehen.

(3) Der Wohnsitz wird aufgehoben, wenn die Niederlassung mit dem Willen aufgehoben wird, sie aufzugeben.

 

You do not become resident by registering. You become residence by taking up a residence in Germany with the intention of it being a permanent residence. You do not loose your residency by deregistering. You loose it by giving up your residence in Germany. The Registration is just a obligation put on you by law.

 

My knowledge does not extend to the relevant insurance laws, but it is unimaginable to me that they would state that for the purposes of insurance laws you would be resident by registering.

 

So you have actually not been resident and if what people further up in this thread say is correct, that this is precondition for you still being covered the insurance provider is under NO obligation to pay for your treatment.

 

And the stupid thing about it is that you have probably already told the insurance agent so much and he has probably also already understood and thrown you a lifeline here at his own expense.

 

That is my reading of the situation, please correct me if you find logical mistakes...

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You are making a logical mistake here:

 

As far as German law is concerned you don't have to be resident anywhere. You can be a international vagabound for all they care. The fact that you are not resident in Italy doesn't mean you have to be resident in Germany by default. The European Union is unfortunately not that far along in integration yet.

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matajari: thanks, a few questions, I am not sure I totally agree.

 

Info: I have a Niederlassungserlaubnis (permanent residence)obtained some time ago (prior to August)

 

 

The problem is that you are not legally resident in Germany as long as you are registered...

 

I agree

 

 

You do not become resident by registering. You become residence by taking up a residence in Germany with the intention of it being a permanent residence.

 

I agree

 

 

You do not loose your residency by deregistering. You loose it by giving up your residence in Germany.

 

How do by law are you recognised as giving up your residency?

 

 

So you have actually not been resident...

 

Why?

 

 

 

 

And the stupid thing about it is that you have probably already told the insurance agent so much and he has probably also already understood and thrown you a lifeline here at his own expense.

 

I do no tunderstand what you mean, can you please explain it again?

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TK does define residency by being registered: as long as you are registered in Germany, you have to pay them, until the date that you can prove that you have been taken over by another health insurance or have left the country and have proven so by deregistering.

 

That's the reason why there is this big issue of people finding themselves backcharged to the date of their registration in Germany by the health insurances as soon as they come to their attention, see TK just sent me a bill for more than 1000 euros for the most recent example.

 

TK is not allowed to let you out of your German insurance until you either:

 

  • send them your certificate of deregistration (= the piece of paper you get when you deregister), or
  • send them the confirmation from the new insurer that you have been accepted by them.

 

That is why the TK guy needs to see the confirmation from the Italian health insurance, so that he can let you out of TK from that date in December 2011.

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The problem is that you are not legally resident in Germany as long as you are registered,but as long as you

 

§ 8 AO

 

Einen Wohnsitz hat jemand dort, wo er eine Wohnung unter Umständen innehat, die darauf schließen lassen, dass er die Wohnung beibehalten und benutzen wird.

 

or

 

§ 7 BGB

 

(1) Wer sich an einem Orte ständig niederlässt, begründet an diesem Ort seinen Wohnsitz.

(2) Der Wohnsitz kann gleichzeitig an mehreren Orten bestehen.

(3) Der Wohnsitz wird aufgehoben, wenn die Niederlassung mit dem Willen aufgehoben wird, sie aufzugeben.

 

You do not become resident by registering. You become residence by taking up a residence in Germany with the intention of it being a permanent residence. You do not loose your residency by deregistering. You loose it by giving up your residence in Germany. The Registration is just a obligation put on you by law.

 

My knowledge does not extend to the relevant insurance laws, but it is unimaginable to me that they would state that for the purposes of insurance laws you would be resident by registering.

 

So you have actually not been resident and if what people further up in this thread say is correct, that this is precondition for you still being covered the insurance provider is under NO obligation to pay for your treatment.

 

And the stupid thing about it is that you have probably already told the insurance agent so much and he has probably also already understood and thrown you a lifeline here at his own expense.

 

That is my reading of the situation, please correct me if you find logical mistakes...

 

 

 

You are making a logical mistake here:

 

As far as German law is concerned you don't have to be resident anywhere. You can be a international vagabound for all they care. The fact that you are not resident in Italy doesn't mean you have to be resident in Germany by default. The European Union is unfortunately not that far along in integration yet.

 

Panda beat me to it...the German health insurances only look for proof in the form of official registration and/or deregistration. If the OP has not de-registered yet, he is for the insurance company still a legal resident of Germany and thus obliged to continue paying into his health insurance (with the nice sideeffect that also the coverage continued.

 

I would suggest that the OP

1) gets a confirmation from the Italian public health insurnace from what date on he was covered there

2) informs the local German town-office/BÜrgeramt ex post that his residence ended by THAT date which started his Italian health insurance coverage and requests a confirmation of de-registration

3) sends the documents from 1) and 2) to TKK and pays the arrears for those month in premium contribution to TKK in order to get his prescriptions paid for.

 

Cheerio

I am a professional independent insurance broker, financial adviser, and authorised advertiser. Contact me.
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So you have actually not been resident and if what people further up in this thread say is correct, that this is precondition for you still being covered the insurance provider is under NO obligation to pay for your treatment.

 

 

 

Why?

 

Because you didn't have a place to stay in Germany from September until December, when you officially took up residence in Italy. Since your rental contract expired you could not go on living in your former place of residence, the fact that you're on friendly terms with your landlord and he let you move your stuff out at a later date is irrelevant.

On the other hand, if TK is willing to pay for your treatment on the precondition that you pay your dues retroactively, then I'd say go for it. Just hope that TK doesn't latch on the fact that you were not actually resident and should not be covered, as in this case they only stand to lose by having to pay out more than they will take in, so it would actually be in their best interest to refuse to cover you on grounds of you not being actually resident in Germany.

 

Ciao,

 

Dg800

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