Public vs. private health insurance

46 posts in this topic

Hi all,

 

Im in the lucky position as my salary has increased, and Im now in the bracket where I can choose to go private if I wish.

 

I would be grateful if anyone can let me know what the monthly difference in costs would be between TKK where I am currently - around 700 euros per month (half from my employer, and half from my salary). Would this be significantly cheaper if I go private?

 

Also, are there any ongoing benefits in the TKK? They obviously wont volunteer these things, but I know some health providers give benefits if you go for health checkups, or pay towards gyms etc. At the moment I pay a lot of money, and basically only get a dental checkup every 6 months. Is there anything else I can get out of them?

 

Any tips gratefully recieved.

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Well, nice to be in a position to be able to choose, lermit! It means you are earning a decent salary.

 

No one can give you an exact answer just based on your post. Private health insurance can be cheaper - and/or offer much higher cover..but it´s much more complicated than that. You need to think about your future - it may be a disadvantage to go private if you end up getting married and having 3 kids and you have to pay for the whole family. But that would also depend on how a future spouse were also health insured.

You may also find a private insurer doesn´t want you or at least not without a surcharge- eg are you seriously overweight or suffering from gout? :D . Or is your job contract only expected to go on for 1 or 2 years? You wouldn´t find it easy to get private insurance then.

 

It´s an important decision - and, under current rules - maybe one which could affect you life long. But you never know and politics can change things. Who knows?

 

In any case, you need professional advice so why not check Toytown´s Commercial ad list for a number of professional advisors on it? All of them work with expats day in day out and are used to your scenario.

I am a professional independent insurance broker and authorised advertiser. Contact me.
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The TK website is pretty comprehensive; look at Leistungun A-Z for what's on offer. There is a section in English too which will help you contact someone to answer your questions.

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I was once private. I was young free and single then.

 

Then I wasn't. I got married. I had a kid, then another. Suddenly I was paying 900 per month (on top of employers contribution of around 200). Being private seriously sucked.

 

Luckily I got out. Most won't be able to though. I left the country and happened to come back after a year - that was my luck, plus a guy called Mr Gunn who sussed this out for me.

 

I am very, very pleased to be public today.

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There is a cap, 4050 euro/month income. This is both a limit after which you can go private and a cap for public insurance premiums.

 

Here there is a table which illustrates that (Arbeitnehmeranteil is what you pay):

http://www.tk.de/tk/bei-der-tk-versichert/als-arbeitnehmer/beitrag/345740

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Plus: an extra 2.05% of gross income for long term nursing care/Pflegepflichtversicherung and an extra 0.25% for employees without children. This is shared through the employer contribution.

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

 

Can anyone advise on my situation; have TKK from a previous employer, and recently went freelance. This means I'm currently going to have to pay the full €720 a month myself and now also have to pay a couple of months of arrears whilst my situation was getting sorted out = €1600. Ouch! I'm above the earnings threshold for going private. As for my longer-term plans I don't really know, but I'm pretty sure I'm healthy enough to be accepted by a private insurer.

 

Any thoughts about my situation? Do freelancers usually have such a high healthcare bill? I can bear €300, but paying as month as my rent again for healthcare seems excessive.

 

Thanks

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Good evening, itsthejb! Just to point out that your income is irrelevant if you´re looking for private health insurance - being over the income threshold´s only essential for employees.

 

I would also urge to pay off your public insurance arrears - private German insurers often ask a question on their application form: do you owe your current insurer at least one month´s payment?

 

You can get decent private cover for much less than 720 euros a month but there are other issues to consider: first of all, you must be healthy, not obese (body mass average is heavy duty here for insurance companies!) and hopefully not have any chronic illnesses/allergies etc, which may lead to rejection of your application or to a hike in the premium. Any negative psychological issues such as depression, counselling etc are no go areas here, too.

 

Private international insurance ( but only a legal one- most aren´t ) is also a possibility, though with some weaknesses.

 

You DO need to bear in longer term issues, though - such as getting married to a partner who wishes to stay at home and have a couple of kids and not return to work----then you could be lumbered with private payments for yourself, future spouse and children OR private payments for yourself and public insurance payments for your spouse AND children if they should be publicly insured.

I am a professional independent insurance broker and authorised advertiser. Contact me.
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Thanks for your reply!

 

Yes, happy enough to find out that my premium is at least standard for public. As for going to private, seems I would have a fine chance in my current health condition. As for longer term issues, I don't know. I'll give it some thought.

 

Thanks!

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Topics merged by admin

 

When moving to or returning to Germany, you are required BY LAW to take out health Insurance. There is no public health system as in the UK or Australia. The two systems - run by multiple companies are either the state approved insurance system or the private health insurance system. Both are ones where you need to pay (what I consider an exhorbitant amount) each month as an insurance premium.

 

I wanted to point out some major differences that were not clear to me between the systems.

 

With private insurance, depending upon your age, you may well get a monthly payment amount less than in the state system.

 

To be able to enter the state approved insurance system in most cases you must be working and being paid less than about €45,000 per year. If you earn more than that, or if you are self employed or if you are UNEMPLOYED, you have to take out a Private insurance policy. So if you are unemployed, you have no income but a constant outgoing of €2-500 per month on health insurance (depending upon age). If you haven't been working for at least 6 months within the last two years in Germany, you cannot claim unemployment benefit, which if you are just moving to Germany you can't have been.

 

The other point about the private health insurance policy is that you will normally have an excess of €900 or €1200 per year. This means that unless you have to go into hospital, it is highly likely you will have to pay for all doctors visits and medicines yourself as well as paying the insurance company between €3000 and €6000 per year - for nothing. If indeed you amass the €900 or €1200 excess level in bills in a year, you would think from then on the Private Insurance would pay for the rest of the year - not so! The German private health insurance policies work the excess level out at what they would have had to pay and as we all know the private health insurance policies may only pay a part of a cost - e.g. perhaps only 60% of dental bills. So in fact to reach the €900 euro excess level you may well have to have paid out €1250 in the year before the policy starts to pay future bills within the year.

 

Here is where the State certified insurance company policies are different. Their monthly rate may be higher but there is no excess. These policies pay all but €5 or €10 of individual charges, medicines included. You can only get into a state policy if you are working however.

 

In general if you can get into the state system (that actually pays the bills), you're better off.

 

As this is a very important (and expensive) matter, I recommend you consult an insurance broker to know what is best for you. There are some European private health insurance policies, that if you are not a German national, may work out better for you, than German private health insurance.

 

Good luck!

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2 comments initially, I'm sure others will be along soon...

 

1. If you earn more than the limit you MAY take out a private insurance policy, but you do not have to.

2. Private insurance policies do not have to have such a high excess, A few hundred € (€250-€500) is probably sensible to reduce monthly costs, but there is no need to go so high unless you are old/unhealthy/trying to save costs for some other reason.

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You do NOT have to take out private insurance if you´re self-employed..unless you come to Germany directly from a system or country not compatible with enabling you to access German public insurance.

It´s 54,900 euros or less a month salary and you have to have public insurance

I am a professional independent insurance broker and authorised advertiser. Contact me.
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OK, thanks to Bob in finding my post after it was merged.

I would have liked to have amended the original to include the good input from the comments received, but that does not appear to be possible.

So here are my responses (as sent by PM to each of the people commenting).

Perhaps a little background first - my wife and I have returned to Germany after being away for nearly 20 years in Australia. My wife is German, I am English.

Australia and Germany do not have an agreement to acknowledge each others health systems as many EU countries do. If someone is moving from a country with this agreement, the best option for them would be to enter the state run health insurance system via the agreement.

When coming from a country that does not have such an agreement, the problems I described apply. I was told by the Verbrauchershutz office in Munich that about 3-4 years ago the law was changed that self employed people MUST have health insurance. As self employed they would not be in the state run system and hence need private insurance. If someone who is self-employed is moving from a country with the exchange agreement, then they should be able to go into the state controlled system if they were in a similar system in their previous country.

The excess levels that I quoted of either €900 or €1200 are age dependant. My wife and I are 60 years old (and healthy). There was no option of having a policy with no excess. The excess levels offered will be lower for younger people as will the premiums.

As regards when someone may or must take out Private insurance, this comes back again as to whether they can get into the state controlled health system though the "loop hole" of the inter-country agreement. The €45000 limit I quoted is apparently €54900 annualy (not a month John - that would be nice to have!). If not already in the state controlled system or having the inter-country agreement, my understanding is that anyone earning over this limit only has the option of going into the private health insurance system.

I think the key points I wanted to get across in my posting was that the Private health insurance is expensive and does not pay out as much as the state controlled system. The state regulated health insurers are also expensive (for younger people more expensive than the private schemes) but pay out more as they do not enforce an excess.

What is very clear, is that anyone moving to Germany, needs to engage a health insurance advisor as soon as possible to try to get the best deal possible, and consider how long they will stay in Germany.

The Verbraucherschutz office in Munich also told me that once you have been in a private health insurance policy in Germany you are not allowed to go back into the state controlled system. In the interim, this appears to be incorrect advice as I have done exactly that, so don't believe all the advice that the (paid for service) Verbraucherschutzzentral provide!

Oh yes, one more important point (unless overridden by an inter-country agreement perhaps), you can't get into the German state controlled health insurance system unless you are in employment paying taxes. Also with most companies, the employer pays half of the monthly premium and takes the other half out of your salary if you are in the state controlled health insurance system.

 

 

 

 

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It isn't as simple as you make it out to be.

 

For example, your German wife was supposed to return to exactly the German health insurance that she had when she left Germany.
If she had public health insurance before she left, then that exact public health insurance would have been obliged to take her back, under §13 Absatz 1 Nr. 13 a) SGB V:

 

    (1) Versicherungspflichtig sind
    13. Personen, die keinen anderweitigen Anspruch auf Absicherung im Krankheitsfall haben und

a)
zuletzt gesetzlich krankenversichert waren

 

    (1) Mandatory membership in public health insurance for:
    13. Persons who do not have any other claim to health insurance and
    a) who were last insured with a public health insurance

 

I suggest reading Health insurance for unemployed/returnees.

 

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My wife was self employed when we left Germany - at that time Self Employed people were not required to be health insured. In fact my private health insurance policy from my employer actually covered her as well. So she was not in the public system when we left Germany.

 

In any case, as I have stressed several times - and you have just echoed - this is a complex subject that anyone moving to Germany needs to get professional advice, and ideally from mutiple sources.

Thanks for the link in any case.

 

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You do NOT have to take out private insurance if you´re self-employed..unless you come to Germany directly from a system or country not compatible with enabling you to access German public insurance.

It´s 54,900 euros or less a month salary and you have to have public insurance

Thanks, Old Timer , for pointing out my typo! I checked it a few times and it looked right each time!!! Yes, 54,900 per YEAR!!:lol:

I am a professional independent insurance broker and authorised advertiser. Contact me.
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 Before the most recent update of Toytown's website there always was a disclosure line underneath my contributions and those by JOhn_G that showed that we both are independent insurance brokers offering our 10 cents of professional wisdom here (and of course advertising for many years on Toytown, too, in order to support the community and generate interest in our services).  Bob-the-editor told me this will soon reapear but I just wanted to  explain this upfront.

 

So, while being totally biased about this of course :) , I can only confirm and underline that anyone coming to Germany or planning to do so ought to consult an independent broker in order to get thru the maze of German insurance systems and laws. Since many folks don't understand the difference between an independent insurance broker (about 15% only of German insurance advisors have this status) and insurance agents we posted an info for everyone on our website here: http://www.crcie.com/indepence/

And now my comments on the things that OldTimer wrote...

 

 

In general I agree with you that many people are better off if they join the German public health insurance system if they have an access to it - but as always in such situations: no size fits all to this regards. Someone coming to Germany as public servant will nearly always be better of in private health insurance. And for other folks who are single and planning on staying so or DINKS, private health insurance can also make a lot more sense than public, depending on their age, health status and expectations/wishes regarding health insurance coverage.

 

The law changed in 2009 - evern since every resident of Germany has to have health insurance, either public or private (and what kind of private health insurance is acceptable under the law can be read in Section 193 Subsection 3 Insurance Contact Law (VVG)

If you are coming in as self-employed from another EU-memberstate (who virtually all run a state health system in which all residents are insured anyway) you always have the choice to enter public health insurance in Germany as a voluntary member. You have to apply, though, within the first three months upon taking  up residence in Germany, something that is often forgotten and then leads to all kind of troubles later.

If you do not come out of one of these mutlilateral-recognized health insurance systems, you still have a chance to enter German public health insurance. But in such a case you MUST not register yourself as self-employed when taking up residence in Germany. You need to register yourself as "withou income, living from savings" - in which case you can gain access as "nachrangig pflichtversichert" under Section 5 Subsection 1 Nr. 13 of the SGB V. After only 1 or two months in this status you can then switch to voluntary membership as self-employed under the new clause of "obligatorische Anschlussversicherung" as establlished in August 2013.  But not many people know that, not even many professional advisors in Germany unless they are specialized in catering to Expats. Small wonder therefore that even the Verbraucherschutz-office did not know.

I

The excess levels that I quoted of either €900 or €1200 are age dependant. My wife and I are 60 years old (and healthy). There was no option of having a policy with no excess. The excess levels offered will be lower for younger people as will the premiums.

Sorry, that is nonsense. Of course you can get private German insurance tariffs even at that age with much lower deductible/excess. It is just that premiums will then get horrifyingly more expensive. But anything from 0 to 300 or other amounts of deductible are available at 60 or older, too. I get the feeling you did not get independent advice here but rather got advice by an agent (multi-tied perhaps) or simply tried out some online-tools ?

 

 

As regards when someone may or must take out Private insurance, this comes back again as to whether they can get into the state controlled health system though the "loop hole" of the inter-country agreement. The €45000 limit I quoted is apparently €54900 annualy (not a month John - that would be nice to have!). If not already in the state controlled system or having the inter-country agreement, my understanding is that anyone earning over this limit only has the option of going into the private health insurance system.

Incorrect again.

First of all, the income only plays a role for employees. For self-employed there is no income-threshold defining whether you can go in or out of public health insurance at all.

For employees what counts is if they are employed in Germany for the first time or not. If they are starting employment with 100k EUR per year and come out of Australia, they can still enter public health insurance from the beginning. This is clearly expressed in Section 9 SGB V

Only if an employee was prior employed in Germany and was at that time before he left Germany in private health insurance would he be forced back into private health insurance again.

A self-employed person who never was insured in Germany before would depend indeed on where he was insured in the past 12 months or 24 months out of the last 5 years. If he was for either period in another EU-memberstate's state insurance system, he can enter German public insurance system. If not - see my comment above about enlisting in Germany initially as "living from savings" in order to enter German system as "nachrangig pflichtversichert" under the so-called "NUmmer 13" clause.

Of course that won't work either if last time a self-employed was in Germany and was insured in private health insurance.

I think the key points I wanted to get across in my posting was that the Private health insurance is expensive and does not pay out as much as the state controlled system. The state regulated health insurers are also expensive (for younger people more expensive than the private schemes) but pay out more as they do not enforce an excess.

Sorry to say: in some cases you are right, in others you aren't.

But if you want to recommend that everyone who has a chance to enter German public system do so unless extremely well informed and advised to the contrary: Damn right you are !

What is very clear, is that anyone moving to Germany, needs to engage a health insurance advisor as soon as possible to try to get the best deal possible, and consider how long they will stay in Germany.

:rolleyes: Couldn't have said it better myself...

The Verbraucherschutz office in Munich also told me that once you have been in a private health insurance policy in Germany you are not allowed to go back into the state controlled system. In the interim, this appears to be incorrect advice as I have done exactly that, so don't believe all the advice that the (paid for service) Verbraucherschutzzentral provide!

Sadly enough - this happens too often, even though I am personally a big fan of the consumer protection agencies in Germany (Verbraucherschutz).

While they are certainly well versed and knowledgable when it comes to "normal cases" with "normal German clients", advising Expats is a field for specialists. Even more though since the relevant laws have seen major changes 4 times since 2007 and only perhaps a handful of people in Germany are really able to advise on this issue properly.

While it is generally speaking true that you can't simply decide to go back to German public health insurance if you have before opted out and joined a private health insurance - a rule which makes a lot of sense, btw, as it tries to avoid a major "free-rider" problem otherwise for social welfare system like the German public health insurance system - there are a number of ways to get back of course:

- as employees: before you reach the age of 55 you will always become compulsorily insured again in public health insurance if your gross salary drops under the relevant threshold (which currently in the year 2015  is, as stated above, 54.900 EUR gross p.a. ). If your employer is ready to play ball, that can be arranged cleverly during a sabaticall or part-time employement reduction of just 1-2 months nowadays since the law changed in August 2013 to this regards.

- self-employed younger than 55 years can also escape private health insurance by getting employed with such a gross salary below the threshold (you'll have to give up your self-employment for a short time, though - at least legally)

- anyone over 55 years of age: you can re-enter German public system by moving out of country for a few months to another EU-memberstate with state health insurance system and then applying for "obligatorische Anschlussversicherung" in German public insurance when coming back under the EU directive 883/2004, Article 6.    Or, if your spouse is in public health insurance, you can stop your employment/occupation and become a depedent family member...in which case you, too, can reenter into public health insurance and re-start your occupation shortly afterwards under the same rule of "obligatorische Anschlussversicherung".

Oh yes, one more important point (unless overridden by an inter-country agreement perhaps), you can't get into the German state controlled health insurance system unless you are in employment paying taxes. Also with most companies, the employer pays half of the monthly premium and takes the other half out of your salary if you are in the state controlled health insurance system.

Again, incorrect - due to the option of "nachrangie Pflichtversicherung" under Setion 5 Subsection 1 Nr. 13 SBG V

 

 

Guess we really need to write a serious update of the Toytown WIKI now soon...

 

Cheerio

 

 

PS: still having some problems with new "QUOTE" working here on Toytown, but starting to getting the hang of it now...

 

 

 

 

 

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