Health insurance after the three-month sign-up deadline

17 posts in this topic

Okay... I've read all the threads I could find and I still have a question. Please forgive me if I've missed it being answered elsewhere.

 

We arrived in Germany from Canada on August 1. I thought I had done my research about health insurance, and had even signed up for Toytown, but I hadn't seen the discussions about health insurance on this forum so I didn't end up with the correct information. I bought travel health insurance which seemed to meet the criteria for living here temporarily, getting a visa etc. Then a new friend in Berlin suggested I start researching on this forum, and I started reading up on health insurance and got a huge shock!

 

So now I understand that I was supposed to sign up for German health insurance as soon as I arrived. I realize I will have to make back payments, and have made my peace with that. I have contacted a very helpful insurance broker who gave me really good information about my options. I have taken his advice and decided to try for public health insurance, since it is looking increasingly like we might be staying here long term and I don't have any plans for how to be wealthy in my old age. 

My plan is to go into one of the Krankenkassen and talk to someone in person about our situation. My worry is that it has been just over three months since we arrived. I just read a response on this forum that suggested that if you don't apply within three months then you can't get public insurance. Is that true? Do I need to leave the country and come back later and do it right? Do I need to find a German job with health insurance ASAP? But getting a job could take some time, and shouldn't I talk to the Krankenkasse right away?

We are a family of four (2 kids) with good remote full-time jobs based in Canada. The kids and I are German citizens, and my husband is not. His visa appointment is at the end of the month. I found out a few days ago (also through this forum) that we could actually have dropped in and applied for the visa any time after arriving. We had intended to do that next week, but now I am wondering if I need to apply for health insurance first. 

I would very much appreciate it if anyone has any insight into the best order of operations, or worst case scenario if anyone can confirm that we're totally screwed with regard to public health insurance. We can go back to Canada (temporarily or permanently) if we have to, but we really want to be here if we can make it work. 

 

Lay the hard truth on me please (as kindly as possible)!

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31 minutes ago, RedMidge said:

As a German citizen, were you ever enrolled in one of the public Krankenkasse- as part of family?

I have tried to find that out but haven't had any luck. My family lived in Germany when I was 8 years old, and then I came back for a year to teach after university. The year I was teaching was an exchange with the Canadian government, and they seem to have had some sort of special arrangement re: health insurance.
My parents can't remember what they did for health insurance when we lived in Germany during my childhood. My father was a teacher at a public school in Niedersachsen. Could that be a clue?

 

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4 minutes ago, PandaMunich said:

Was he a civil servant, i.e. a Beamter, or just an employee?

I'm actually not sure. He did his teacher training in Germany, but I'm guessing he was not a Beamter. I will try to find out. 

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Sorry if I am making something out of nothing. I am not absolutely sure that the three-month window applies, but I am confused and getting worried about my inability to master this. 

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The three month period doesn't apply to you (it applies to people coming directly out of another EU country's public health insurance system), but they will backcharge you back to the date you registered in Germany.

 

If he was just an employee, he was probably with AOK, so I suggest you write an e-mail to AOK Niedersachsen at AOK.Service@nds.aok.de, mentioning your dad's name, date of birth, city of birth and city he worked in, and ask them to look him up and to accept you back as a returnee member (with your kids being covered for free under your public health insurance cover as long as you earn more than your husband) under §5 Absatz 1 Nr. 13 Buchstabe a SGB V:

 

******************************************************

 

Betrifft: Antrag auf Pflichtmitgliedschaft nach §5 Absatz 1 Nr. 13 Buchstabe a SGB V

 

Sehr geehrte Damen und Herren,

 

meine Familie ist nach Kanada ausgewandert, als ich 8 Jahre alt war.

Davor war mein Vater Hans Schmidt, geboren am ??. März 1954 in city_of_birth als Angestellter in city_of_work Pflichtmitglied der AOK.

Ich war als Kind unter der Familienversicherung meines Vaters mitversichert.

 

Ich bitte Sie deshalb, in Ihren Akten nach meinem Vater zu suchen, und zu bestätigen, daß ich, Mädchenname your first name & maiden surname, geboren am your_date_of_birth in city_of_your_birth damals ebenfalls bei der AOK versichert war, und deshalb als Rückkehrerin nach Deutschland unter §5 Absatz 1 Nr. 13 Buchstabe a SGB V versicherungspflichtig bin.

 

Ich möchte der AOK beitreten, bitte schicken Sie mir die Aufnahmeformulare zu, für mich und meine beiden minderjährigen Kinder.

 

Meine Adresse lautet:

your married name

your address

 

Mit freundlichen Grüßen

your first name and your married surname

 

******************************************************

 

If, on the other hand, your dad was a Beamter, there's a 99.9% likelihood that he had private health insurance, and there is no previous German public health insurance for you to return to.

In that case you would need to apply under §5 Absatz 1 Nr. 13 Buchstabe b SGB V, which will still work out since you're not self-employed (if you were, you couldn't use that clause!).

In that case, go to your nearest Techniker Krankenkasse and tell them you are a mandatory member under §5 Absatz 1 Nr. 13 Buchstabe b Sozialgesetzbuch V, and that you and your kids want to join.

Techniker Krankenkasse in Berlin (what is it about Germany's economic black hole, Berlin, that attracts so many people?!): https://www.google.de/maps/search/Techniker+Krankenkasse,+Berlin/@52.5064068,13.2681128,11z/data=!3m1!4b1?hl=en

 

Under no circumstances should you ever mention the word "freelance" (whyever did you choose that as a user name?) or "Freiberufler" in your communications with a German public health insurance, that would be a big red flag, because self-employed are supposed to get private health insurance (they are allowed to remain members if they start freelancing after having been members, but not before!). 

 

Details of both cases a and b in this thread:

 

To find out what public health insurance would cost you, based on your monthly gross income, input it into this calculator (I know it says Selbständige, but the results are the same for employee members like you as long as you earn above 2k€): https://www.tk.de/tk/versicherung-und-beitraege/beitragsrechner/selbststaendige/208528

 

*************************************************************************

 

Your husband could only join German public health insurance if either:

  • his monthly worldwide income were below 425€, he would then also be covered for free under your public health insurance cover, or
  • if he took up a German employee job that earns at least 450.01€ a month, he would then become a mandatory member of and pay for his own public health insurance through his employment.

 

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Wow! PandaMunich, that was the most incredibly thorough and helpful response I could have hoped for. I will get right on it now that I know what to do. Thank you, thank you. 

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3 hours ago, FreelanceFamily said:

Okay... I've read all the threads I could find and I still have a question. Please forgive me if I've missed it being answered elsewhere.

 

We arrived in Germany from Canada on August 1. I thought I had done my research about health insurance, and had even signed up for Toytown, but I hadn't seen the discussions about health insurance on this forum so I didn't end up with the correct information. I bought travel health insurance which seemed to meet the criteria for living here temporarily, getting a visa etc. Then a new friend in Berlin suggested I start researching on this forum, and I started reading up on health insurance and got a huge shock!

 

So now I understand that I was supposed to sign up for German health insurance as soon as I arrived. I realize I will have to make back payments, and have made my peace with that. I have contacted a very helpful insurance broker who gave me really good information about my options. I have taken his advice and decided to try for public health insurance, since it is looking increasingly like we might be staying here long term and I don't have any plans for how to be wealthy in my old age. 

My plan is to go into one of the Krankenkassen and talk to someone in person about our situation. My worry is that it has been just over three months since we arrived. I just read a response on this forum that suggested that if you don't apply within three months then you can't get public insurance. Is that true? Do I need to leave the country and come back later and do it right? Do I need to find a German job with health insurance ASAP? But getting a job could take some time, and shouldn't I talk to the Krankenkasse right away?

We are a family of four (2 kids) with good remote full-time jobs based in Canada. The kids and I are German citizens, and my husband is not. His visa appointment is at the end of the month. I found out a few days ago (also through this forum) that we could actually have dropped in and applied for the visa any time after arriving. We had intended to do that next week, but now I am wondering if I need to apply for health insurance first. 

I would very much appreciate it if anyone has any insight into the best order of operations, or worst case scenario if anyone can confirm that we're totally screwed with regard to public health insurance. We can go back to Canada (temporarily or permanently) if we have to, but we really want to be here if we can make it work. 

 

Lay the hard truth on me please (as kindly as possible)!

Good evening, FreelanceFamily! Great post by PandaMunich, as usual! What a gem she is!

Just curious: you say you contacted a very helpful insurance broker and have decided to follow his advice. Why have you not followed up the advice with his help? Or doesn´t he want to help?

Disclaimer 1: as far as I know, I´m not the broker in question!

Disclaimer 2: I´m an independent insurance broker and an official advertiser on Toytown.

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3 hours ago, PandaMunich said:

Under no circumstances should you ever mention the word "freelance" (whyever did you choose that as a user name?) or "Freiberufler" in your communications with a German public health insurance, that would be a big red flag, because self-employed are supposed to get private health insurance (they are allowed to remain members if they start freelancing after having been members, but not before!). 

 

How strict is this/is freelancing itself actually the issue? I thought that the prohibition wasn't against freelancers in general, but that it simply usually doesn't make financial sense for freelancers to join public due to having to pay double what employees do and that it is difficult to switch to public insurance after having private insurance without fulfilling certain conditions (such as being employed at least short term). Some public insurance companies even have slight discounts for freelancers (14% vs. 14.6%) and the minimum threshold of income used to calculate (2231 euros) seems pretty established. So it seems there isn't actually some policy against freelancers joining public insurance, just that it often isn't the best or most feasible option?

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We are talking about a specific case here: a German returnee.

 

If she wasn't a member of a public health insurance before moving away from Germany at age 8, §5 Absatz 1 Nr. 13 Buchstabe b SGB V would apply, as long as nobody can prove she had private health insurance when she was 8, since if she had private insurance before they emigrated, she would have to instead go "back" to exactly that private health insurance company.

However, there is no central register and back then everything was on paper (think dusty archives) - so no way for them to prove private membership unless she tells them exactly where to look for it.

So even if she knew she had private health insurance back then, she could "forget" that fact again and start with a clean slate - because back then insurance wasn't obligatory, and quite a few people didn't have any at all, so she can pretend to be one of them --> a case of Nr. 13b.

 

However, they put some exceptions into Nr. 13b:

 

"13. Personen, die keinen anderweitigen Anspruch auf Absicherung im Krankheitsfall haben und

a.)

zuletzt gesetzlich krankenversichert waren oder

 

b.)

bisher nicht gesetzlich oder privat krankenversichert waren, es sei denn, dass sie zu den in Absatz 5 oder den in § 6 Abs. 1 oder 2 genannten Personen gehören oder bei Ausübung ihrer beruflichen Tätigkeit im Inland gehört hätten."

 

i.e. it doesn't apply to people who fall under Absatz 5, i.e. to self-employed people:

"(5) Nach Absatz 1 Nr. 1 oder 5 bis 12 ist nicht versicherungspflichtig, wer hauptberuflich selbständig erwerbstätig ist. Bei Personen, die im Zusammenhang mit ihrer selbständigen Erwerbstätigkeit regelmäßig mindestens einen Arbeitnehmer mehr als geringfügig beschäftigen, wird vermutet, dass sie hauptberuflich selbständig erwerbstätig sind; als Arbeitnehmer gelten für Gesellschafter auch die Arbeitnehmer der Gesellschaft."

 

and it doesn't apply to people who fall under §6 (1) or (2) SGB V, i.e. high earning employees, i.e. who earn above the Jahresarbeitsentgeltgrenze = JAEG = Versicherungspflichtgrenze, which in 2017 is 57,600€, nor to civil servants, nor to soldiers, nor to pastors, nor to judges.

 

So if the OP was self-employed, or a high-earning employee, or a civil servant back in Canada, they won't let her in this way.

 

If she's under 55 she can still take up German employment at at least 450.01€ a month to get into public health insurance that way, but the straightforward and immediate way for "Germans who never had any German public or private health insurance before" under §5 (1) Nr. 13b SGB V would be closed to her.

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10 hours ago, john g. said:

Good evening, FreelanceFamily! Great post by PandaMunich, as usual! What a gem she is!

Just curious: you say you contacted a very helpful insurance broker and have decided to follow his advice. Why have you not followed up the advice with his help? Or doesn´t he want to help?

Disclaimer 1: as far as I know, I´m not the broker in question!

Disclaimer 2: I´m an independent insurance broker and an official advertiser on Toytown.


I am following his advice, which was to try to apply for public insurance myself because the Krankenkassen may be more likely to accept my application if I go in person and they can have a look at me. 

I asked my question on the forum because 1) I didn't want to keep pestering him when it is possible that he isn't earning anything from me, 2) it was the end of the work week, but I really wanted to find out as soon as possible what my next move should be so that I could be ready to spring into action Monday morning, and 3) I wanted to get more perspectives if there was more than one. 

I hope it wasn't against the spirit of this forum to ask here when I was already working with someone. Apologies if it was. I'm guessing there are many unwritten rules that I will unknowingly break since I'm new to posting here. 

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:rolleyes:No problems at all, FreelanceFamily...I was just curious!  You have done no wrong on here at all -quite the opposite!

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8 hours ago, FreelanceFamily said:


I am following his advice, which was to try to apply for public insurance myself because the Krankenkassen may be more likely to accept my application if I go in person and they can have a look at me. 

I asked my question on the forum because 1) I didn't want to keep pestering him when it is possible that he isn't earning anything from me, 2) it was the end of the work week, but I really wanted to find out as soon as possible what my next move should be so that I could be ready to spring into action Monday morning, and 3) I wanted to get more perspectives if there was more than one. 

I hope it wasn't against the spirit of this forum to ask here when I was already working with someone. Apologies if it was. I'm guessing there are many unwritten rules that I will unknowingly break since I'm new to posting here. 

You're a breath of fresh air. Believe me. ;)

 

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Update: I went to TK, and they were very nice but said they were unable to insure me because I work for a Canadian company. I asked if it would make a difference if I were a freelancer, and they said no. 

 

They also said I should be ok for now with my travel insurance and Canadian health insurance (I'm still registered and paying in Canada). Not sure if that is true - just passing it on. 

 

I am still trying to track down my parent's old insurance, but no luck so far. 

 

So... Plan B. Not sure what that is yet, but I'm working on it. It may be that I need to find a job here for a while to get things started. 

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@FreelanceFamily

 

Don't ever assume that health insurers will give you the right information. They often don't because:

 

1. The rules are so complicated the KK employees don't understand them themselves

 

2. They lie because they don't want you as a member, which is what seems to be the case here.

 

You might want to hire John G. or Starshollow to write them a letter quoting the law that PandaMunich has so helpfully spelled out.

 

 

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On 11/10/2017, 8:01:39, Smaug said:

@FreelanceFamily

 

Don't ever assume that health insurers will give you the right information. They often don't because:

 

1. The rules are so complicated the KK employees don't understand them themselves

 

2. They lie because they don't want you as a member, which is what seems to be the case here.

 

You might want to hire John G. or Starshollow to write them a letter quoting the law that PandaMunich has so helpfully spelled out.

 

 

Thank you! Good advice!

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