Voluntary health insurance

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The voluntary health insurance according to § 9 Fifth Social Code Book (SGB V) allows in Germany workers who are not in the statutory health insurance (GKV) insurance are to be insured in the statutory health insurance. So have z. B. Employees with an annual income subject to contributions above the annual income limit (2020: € 62,550) can choose to take out voluntary insurance with a health insurance company or a private health insurer .

Insurance eligibility

Voluntary health insurance is particularly effective when either a previous health insurance policy ends or for people who are to be given access to statutory health insurance because they are not covered by compulsory insurance or another insurance policy. The legislature uses the term “insurance entitlement” ( Fifth Book of the Social Code , second section).

According to Section 9 (1) SGB V, all persons who have withdrawn from compulsory insurance as members and who have completed a certain period of previous insurance can join the insurance voluntarily. It is irrelevant for what reason the compulsory membership existed. Furthermore, people who are no longer entitled to family insurance can take out voluntary insurance if they have completed the previous insurance period.

While compulsory insurance comes about regardless of the will of the person concerned, the will is of decisive importance for voluntary insurance. Insurance can only be taken out if the person concerned declares his intention in writing. The exception is the regulation on employees who are exempt from insurance due to exceeding the annual income limit. If, after notification by the health insurance company, the employees concerned do not declare their departure within two weeks, the previously existing insurance continues as voluntary health insurance ( Section 188 (4) SGB V).

Groups of people

  • Members whose compulsory insurance ends.
  • Family insured persons whose entitlement expires or for whom family insurance is excluded.
  • Doctoral students in general, as well as students who are no longer subject to compulsory health insurance for students .
  • Children for whom family insurance is excluded because the requirements according to § 10 SGB ​​V are not met.
  • Severely handicapped persons (here the health insurance companies can have different regulations because they make regulations in the statutes).
  • All persons who take up employment in Germany for the first time and who are exempt from insurance under Section 6 (1) No. 1 SGB V, d. H. whose regular annual wages as blue-collar or salaried employees exceed the annual wage limit; Employment before or during vocational training is not taken into account ( Section 9 (3) SGB V). Employees and workers should be given the chance of GKV membership at least once in their working life, regardless of their income, even if they were previously privately insured and did not meet the previous insurance periods.
  • Self-employed persons who apply in writing to voluntarily join the GKV no later than 3 months after the start of self-employment (preclusive period). The required previous insurance period must be fulfilled.
  • Employees who have returned from abroad and (since June 29, 2011) employees who stop working for an intergovernmental or supranational organization if they return to Germany within two months of their return to Germany or after their work with the intergovernmental or supranational organization take up employment. The prerequisite is that their membership in the statutory health insurance was terminated solely because of their employment abroad or with the intergovernmental or supranational organization.
  • Recipients of a pension from the statutory pension insurance, who became compulsory for insurance after March 31, 2002 according to § 5 paragraph 1 No. 11 SGB V, but who had not fulfilled the previous insurance period in the version valid since January 1, 1993 and therefore until 31 March 2002 March 2002 were voluntary members.
  • Spätaussiedler as well as their spouses entitled to benefits and descendants according to § 7 paragraph 2 sentence 1 BVFG within six months after moving their permanent place of residence to Germany or within three months after receiving unemployment benefit II , if they were covered by statutory health insurance abroad.
  • People who have received current subsistence benefits in the past under the Federal Social Welfare Act and have never been insured in statutory health insurance or private health insurance before (within six months from the beginning of 2005).
  • a person who retired from service as a temporary soldier on or after December 31, 2018 ( Section 9 (1) No. 8 SGB V).

Entry deadline, start and end

Membership must be declared within three months and must be in writing. Voluntary insurance begins on the day following the end of compulsory insurance or family insurance; if there was no such prior insurance, the voluntary insurance begins instead on the day of joining. It ends with written notice of termination, the conclusion of compulsory insurance (priority insurance) or death.

A termination of a voluntary health insurance is only possible with proof of another, subsequent health insurance or with a deregistration from Germany z. B. due to emigration or long-term stay abroad. The term “voluntary” health insurance is therefore misleading. Only entry is voluntary.

Contribution

General principles

Until January 1, 2009, each health insurance company set the contributions to the voluntary insurance individually. Since then, the uniform procedural principles issued by the National Association of Statutory Health Insurance Funds apply to the assessment of contributions for voluntary members. They are regularly checked and adjusted by the National Association of Statutory Health Insurance Funds. The local health insurance companies are responsible for advising the insured on their interpretation and application. The contribution procedure principles were controversial in the prevailing doctrine, but the Federal Social Court has confirmed the fundamental legality of the contribution procedure principles in a judgment. Only the regulation on the amount of contributions for residents of a fully inpatient home, according to which 3.6 times the standard requirement of standard requirement level 1 was deemed to be income, was considered illegal because it would also levy contributions on income that does not serve general subsistence but is earmarked to ensure the care of the home resident. This regulation has now been changed so that 3.2 times the standard requirement of standard requirement level 3 is now considered income as income.

Current status since the Statutory Health Insurance Insurance Act (from January 1, 2019)

On October 18, 2018, the German Bundestag and on November 23, 2018 the Bundesrat passed the Statutory Health Insurance Insurance Relief Act ( BGBl. 2018 I p. 2387 ). Most of the law came into force on January 1, 2019. It relieves those who are voluntarily insured.

Among other things, a uniform minimum assessment base for voluntarily insured and self-employed persons of € 1,038.33 has been in effect since 2019 (for 2019, instead of, for example, € 2,283.75 for full-time self-employed or € 1,522.50 for start-up grants , entry fees or hardship cases).

Regulation until December 31, 2018

The contribution to the voluntary health insurance is measured according to § 240 SGB ​​V according to the total economic capacity of the voluntary member. In principle, all income that serves general subsistence needs to be taken into account, i.e. not only earned income, but also z. B. Interest, rental income, the amount of the pension paid, pensions and similar income.

The law passed until December 31, 2018 a. a. Specifically, set the following framework conditions, which were binding for the determination of the premium (since January 1, 2019, slightly different assessment limits apply):

  • Income is to be taken into account in the same amount as would be taken into account for a comparable person with compulsory insurance. However, the minimum amount is around 5 times higher than for those with compulsory insurance. The minimum contribution is calculated from the contribution rate (as for the compulsorily insured) of the assessment limit, which is € 2,283.75 for voluntary insurance (as of 2018) and € 450 for employees.
  • The contribution also has a maximum income threshold . (Section 240 (2) sentence 1 SGB V).
  • Gradations according to marital status or number of children are not permitted. (Section 240 (2) sentence 2 SGB V).
  • Care allowance may not be taken into account as income, as may the start- up grant up to an amount of 300 euros. (Section 240 (2) sentence 3 and sentence 4 SGB V).
  • The minimum monthly income, even if the member actually has little or no income, is a third of the monthly reference amount (in 2018 this is € 1,015.00). Applying the reduced contribution rate (i.e. without entitlement to sickness benefits) of 14 percent, this results in a minimum contribution of € 142.10; In addition, there may be an additional contribution levied by the health insurance company . (Section 240 (4) sentence 1 SGB V).
  • For full-time self-employed persons, the minimum monthly income is three quarters of the monthly reference figure (in 2018 this was € 2,287.75); involve them Gründungszuschuss or Einstiegsgeld or is a hardship before, half is regarded as minimum income per month of the reference value (in 2018 include the € 1,522.50); this results in a minimum contribution of € 319.73 or € 213.15. (Section 240 (4) sentences 2, 3 and 4 SGB V); In addition, there may also be an additional contribution levied by the health insurance company . (Section 240 (4) sentence 1 SGB V).
  • In principle, the spouse's income may be taken into account, but if the spouse is privately insured and the family insurance of the children is therefore excluded, an exemption amounting to one third of the monthly reference amount (in 2018 € 1,015.00) must be granted for each affected child. If family insurance is possible, an exemption amounting to one fifth of the monthly reference amount applies (€ 609 in 2018). (Section 240 (5) SGB V)
  • If the income is not stated on request to the health insurance company, an income in the amount of the contribution assessment ceiling is assumed. (Section 240 Paragraph 1 Sentence 2 Clause 2 SGB V).
  • Changes in income can only be taken into account on the first of the month following notification to the health insurance company. (Section 240 (4) sentence 6 SGB V).
  • If a person receives a pension from the statutory pension insurance in addition to their own income, the contribution must be calculated separately for income and pension. If this would lead to a contribution burden above the contribution assessment ceiling, only the subsidy according to § 106 SGB ​​VI has to be paid to the health insurance fund. (Section 240 (3) SGB V).
  • Pension applicants who are not compulsorily insured according to Section 5, Paragraph 1, Clause 1, Item 11 of the Social Code Book V simply because they are exempt from statutory health insurance, pay the same contribution as comparable compulsorily insured pension applicants. The minimum income does not apply here. (Section 240 (4) sentence 8 SGB V)
  • Deviating from the above regulations, foreign students, pupils from a technical school or vocational school as well as traveling journeymen pay a reduced contribution, which results from a corresponding application of the student health insurance (KVdS). (Section 240 (4) sentence 7 SGB V).
  • Also deviating from the above regulations, the income of certain groups of people is based on a tenth of the monthly reference figure, which is € 304.50 in 2018. The reduced contribution rate does not apply here, but the general contribution rate, even if there is no entitlement to sickness benefit, which results in a contribution of € 44.46. (§ 240 Abs. 4a SGB V) These groups of people are:
    • Persons whose entitlement to benefits is suspended due to a work-related stay abroad
    • Officials with the right to free medical care (e.g. police officers),
    • Development workers,
    • other cases in which the entitlement to benefits has been suspended for more than three months (e.g. due to the execution of a prison sentence or completion of military service),
    • People who work in an international organization.

Individual evidence

  1. ↑ Federal Government: New calculation parameters from 2020. December 23, 2019, accessed on January 23, 2020 .
  2. ↑ Note: Compared to the version of the law that was in force before April 1, 2007, the addition “inland” was added. The justification for the law made it clear: “This addition serves to provide legal certainty when applying the original regulation. In this regulation, the addition “in Germany” was missing and there were different legal opinions in the practice of the health insurance companies and the supervisory authorities as to whether persons who were already employed abroad should be employed for the first time when taking up employment in Germany within the meaning of the regulation apply. “ BT-Drs. 17/3040 p. 22.
  3. ^ Advice on health insurance, 15th updated edition: as of November. Federal Ministry of Health, 2017, accessed on July 11, 2019 . Chapter 1, Section “1.1.3 Voluntarily Insured”, pp. 25–26.
  4. ^ Amendment of § 9 SGB V of June 29, 2011 , buzer.de
  5. ↑ Uniform principles for the assessment of contributions for voluntary members of the statutory health insurance and other member groups as well as for the payment and due dates of the contributions to be paid by members themselves (contribution procedure principles for self-payers) from October 27, 2008, last changed on November 28, 2018
  6. ↑ assessment of contributions. National Association of Statutory Health Insurance Funds, January 7, 2019, accessed on July 31, 2019 .
  7. ↑ BSG, December 19, 2012, Az. B 12 KR 20/11 R , BSGE 113, 1
  8. ↑ Health insurance: billions in relief for health insurance contributions happened Federal Council. Retrieved December 29, 2018 .
  9. ↑ a b GKV Insurance Relief Act (GKV-VEG). Retrieved November 7, 2018 .
  10. ↑ Contributions for voluntarily insured persons. (PDF) Retrieved on December 11, 2017 (basis for 2017 and 2018).
  11. ↑ General and reduced contribution rate - GKV topics - statutory health insurance - kkdirekt.de. Retrieved November 15, 2018 .