Compulsory safety insurance

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The mandatory supplementary insurance was introduced to ensure comprehensive health insurance coverage for all citizens living in Germany.

Groups of people

According to Section 5, Paragraph 1, No. 13, Fifth Book of the Social Code (SGB V) (possibly with Section 2, Paragraph 1, No. 7 of the KVLG 1989 for agricultural health insurance ), the mandatory supplementary insurance covers those persons who have no other entitlement to coverage in the event of illness have and

  • were last covered by statutory health insurance or
  • not yet legally or had private health insurance, not full-time self-employed and not on the basis of § 5 para. 1 to 12 SGB V insurance or on the basis of § 6 para. 1, 2 SGB V exempt from insurance are.

According to § 9 SGB ​​V, voluntarily insured members, self-employed and family- insured members according to § 10 SGB ​​V are excluded from mandatory insurance. The mandatory safety insurance covers the same groups of people as the voluntary health insurance . A termination of the voluntary insurance according to § 191 No. 3 SGB V leads to the mandatory insurance .

If you are entitled to coverage in the event of illness outside of the statutory health insurance and private health insurance through certain special systems - the EU's joint health care system, the NATO troop statute or the insurance system of an international organization with a corresponding intergovernmental agreement between the two states - there is no subordinate insurance obligation according to Section 5, Paragraph 1, No. 13 of the Social Code V. As soon as this protection ends, when examining the facts of the case “last insured” in the sense of Section 5 (1) No. 13 SGB V, the insurance system affiliation before the protection in the special system is used.

Assessment of contributions

The assessment of contributions for mandatory safety insurance is identical to the regulations for voluntary health insurance . In this regard, Section 227 of the Book V of the Social Code, which applies to the determination of the income subject to contributions, refers solely to Section 240 of the Book V of the Social Code, which must be applied accordingly without restriction .

As in voluntary insurance, the contribution assessment is uniformly regulated by the contribution procedure principles for self-payers (BVSzGs) of the National Association of Statutory Health Insurance Funds , authorized by Section 240 (1) sentence 1 SGB V. The BSG has decided on the permissibility of the BVSzGs.

The BVSzGs specify Section 240, Paragraph 1, Clause 2, Paragraph 2, Clause 1 of the Book V of the Social Code, according to which it must be ensured that the contribution burden takes into account the member's entire economic capacity, including at least the member's income from a comparable employee who is subject to compulsory insurance are to be taken as a basis . Section 3 (1) of the BVSzG specifies which monthly cash inflows are used to determine economic performance .

The minimum assessment basis applies as the lowest limit for the contribution burden. If the income is lower, the contribution calculated from the minimum assessment base must be paid. This results from the minimum contribution or general minimum income regulation of Section 240 Paragraph 1 Clause 1 SGB V. According to this, at least the 90th part of the monthly reference figure applies as income subject to contributions for the calendar day . For the month, which is to be measured at 30 days in accordance with Section 223, Paragraph 2, Sentence 2, SGB V, 30/90 = 1/3 of the monthly reference figure is therefore the minimum income. The reference figure is currently (as of 2018) EUR 3,045.00. The minimum assessment basis is therefore also in the mandatory safety insurance at 1015.00 euros.

The regular health insurance contribution rate is 14.6 percent according to § 241 SGB ​​V, which leads to a contribution of 148.19 euros (as of 2018). If you are not entitled to sick pay, the reduced contribution rate of 14 percent applies in accordance with Section 243 SGB ​​V. According to this reduced rate, at least 142.10 euros are currently payable as health insurance contributions.

Bearer of the contributions

Just like voluntary members, those for whom the mandatory safety insurance is carried out bear their contributions alone in accordance with Section 250 (3) SGB V and pay them directly to the health insurance company, Section 252 (1) sentence 1 SGB V.

According to Section 20, Paragraph 1, No. 12 of Book XI of the Social Code, they are also compulsorily insured in social long-term care insurance . The same applies to voluntary members in accordance with Section 20 (3) SGB XI. The contributions to be borne by you according to § 59 Abs. 1 Satz 1 SGB XI are collected by the health insurance together with the health insurance contribution.

Students withdraw from the KVdS according to § 5 Abs. 1 Nr. 9 SGB V.

  • when on the 14th semester study also
  • when they have reached the age of 30. Regardless of the length of study, the age of 30 is usually the limit that prevents the completion of the KVdS, even if a study was only started after this age limit was reached.

Section 240 (4) sentence 7 SGB V refers to Section 236 and Section 245 SGB ​​V applicable to students in the KVdS as an exception for those who study abroad voluntarily .

Individual evidence

  1. ↑ On the term: Karl Peters in: Kasseler Commentary on Social Insurance Law . 2010, § 240, Rn. 1.
  2. ↑ See Karl Peters in: Kassel Commentary on Social Insurance Law . 2010, § 191, Rn. 3, 7).
  3. ↑ Basic information on mandatory insurance under Section 5 (1) No. 13 SGB V of December 14, 2018. National Association of Statutory Health Insurance Funds, accessed on August 1, 2019 . . Section “A.2.4.4 Entitlement to coverage in the event of illness outside the statutory health insurance and private health insurance”, subsection “A.2.4.4.1 General”, pp. 34–37.
  4. ↑ assessment of contributions . National Association of Statutory Health Insurance Funds. Retrieved January 14, 2019.
  5. ↑ See schedule of the BSG No. 68/12, B 12 KR 20/11.
  6. ↑ In addition: Karl Peters in: Kasseler Commentary on Social Insurance Law . 2010, § 240 Rn. 3.
  7. ↑ In addition: Karl Peters in: Kasseler Commentary on Social Insurance Law . 2010, § 240 Rn. 49 f.