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Private health insurance for employees in Germany: Made easy for Expats to understand

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Every employee whose income is regularly above the so-called annual income limit (JAEG) can take out private health insurance (PKV). The JAEG currently has an annual gross salary of 64,350 euros (as of 2021). Independent of their income, self-employed persons, freelancers, civil servants and civil servant candidates can also take out private insurance.

A private health insurance enables the insured person to receive comprehensive and individualized medical care. Shorter waiting times at the doctor or treatment by qualified specialists are just two of the advantages that private health insurance offers in Germany.

Children can also always have private health insurance – even if both parents are legally insured. The advantage: Your child receives the higher quality insurance coverage of the private health insurance.

Also, students have to have at the beginning of their studies the opportunity to free themselves from compulsory insurance and private insurance. This decision applies to the entire period of study. Insurance companies offer special student rates that are particularly cheap.

Private health insurance for employees in Germany: Summary

  • For workers and employees , the compulsory insurance in the statutory health insurance (GKV) applies . 
  • Depending on your requirements  , you are either compulsorily insured or voluntarily insured under statutory health insurance. As a voluntarily insured person, you can alternatively switch to private health insurance (PKV).
  • In order to be able to take out private health insurance , your regular wage as a worker or employee must be above the annual wage limit  (64,350 euros in 2021). Your employer pays up to half of the contributions .
  • One advantage of private health insurance is the mostly better medical services  (e.g. for dentures, treatment by the head physician or free choice of doctor, depending on the tariff). 
Private health insurance

Information on private health insurance and Corona pandemic

Corona test: when does private health insurance pay?

Will my private health insurance pay for the corona test? Yes, your Private Health Insurance reimburses all tests for a coronavirus infection to the extent agreed in the tariff, provided that you have a medically certified need for the test or your family doctor has given it retrospectively. However, there are some requirements to be observed. 

Daily sickness benefit insurance & quarantine – prolonged absence in the event of illness

Do I receive a daily sickness allowance if I am in quarantine? Basically, first of all, visits to the doctor in the event of illnesses with flu symptoms or viral illnesses will be reimbursed by your Private Health Insurance as usual to the extent of the tariff, of course also in connection with the coronavirus. Second: If a quarantine is ordered by the authorities, there is a right to compensation for the loss of earnings due to illness. Third: If you actually fall ill with the coronavirus and you are unable to work, you are entitled to daily sickness allowance in accordance with the daily sickness allowance insurance you have taken out – after the agreed waiting period has expired. 

International health insurance: What benefits does my travel health insurance cover if I get Corona abroad and have to be fetched home?

Do I have health insurance abroad if I contract COVID-19? Yes, if you have taken out a travel health insurance, you will be fully protected on your trip abroad. What is the current status for return transports? What happens to my insurance coverage in private health insurance if I, as a traveller, are prevented from returning home due to the corona pandemic?

Private health insurance

Standard benefits of a Private health insurance in Germany

  • Outpatient services – For outpatient services, medicines and bandages, aids and remedies, 100 percent of the costs are covered.
  • Services at the dentist – Dental treatments are reimbursed 100 percent , inlays up to 100 percent , dentures & implants up to 80 percent.
  • Alternative practitioner, psychotherapy – For alternative practitioners’ services and psychotherapy (up to the 30th session) there is a reimbursement of up to 100 percent.
  • Best care – State-of-the-art medicine enables the best care and faster appointments.
  • Worldwide protection – Medical expenses and repatriation worldwide are taken.
  • Digital services – Most private health insurance providers allow you to conveniently submit invoices and prescriptions online. You can keep an eye on your finances with the bonus check.

What are the requirements for private health insurance for employees in Germany?

Income

If your income as an employee is above the annual income limit JAEG (also: compulsory insurance limit ), it is usually possible to switch to private full health insurance. For 2021 is the Compulsory insurance limit (also known as the income limit) at 64,350 euros. This is not to be confused with the contribution assessment ceiling, which determines the contribution amount.

Health examination

Your state of health counts for private health insurance. This is part of a Health examination rated. Here you will be asked specific questions about your health. You should answer these carefully. In the case of previous illnesses, there may be risk surcharges. In the case of serious illnesses, benefits may be excluded or rejected.

Age: the younger the better

Since the contribution of private health insurance is based, among other things, on the starting age (age at the time the contract was signed), it is always advisable to take out a contract at a younger age. At a young age are Pre-existing illness not that often either.

Very important regarding a termination!!
Please do not cancel your previous insurance until you have received a written confirmation of acceptance from the new insurance company!

How can I switch from GKV to PKV?

Employees whose annual wages in 2021 are above the Compulsory insurance limit (JAEG) of 64,350 euros can benefit from the Statutory Health Insurance switch to private health insurance. With an annual wage above this limit, you are exempt from insurance and can switch to private health insurance.

Private health insurance

What do I have to consider when switching to private health insurance?

As an already voluntary member of the GKV, the notice period is two months to the end of the month, unless there is an optional tariff.

If you exceed the annual income limit for the first time due to an increase in your gross income, a so-called status change takes place and your compulsory insurance expires. You can immediately switch.

Frequent questions about private health insurance in Germany

For whom is private health insurance useful?

switching to private health insurance . Unlike with statutory health insurance, the contributions are not calculated according to the amount of income, but according to the scope of benefits, age and state of health at the start of the contract.

In addition, private health insurers offer high-quality insurance protection.
Even self-employed and freelancers save with a PKV most money.
Civil servants and civil servants are entitled to the so-called allowance. This means that your employer pays a large part of the medical expenses. Private health insurance is a good option for the remaining costs.

It is then often referred to as subsidy or residual cost insurance . It is significantly cheaper than a statutory health insurance. In the GKV, however, the civil servant or civil servant candidate would have to pay the full contribution.

What are the advantages of private health insurance?

The insurance coverage of the private health insurance usually goes far beyond the scope of services of the statutory health insurance . In addition, private patients usually get a doctor’s appointment faster and do not have to wait that long in the practice.

Privately insured people with a high income can also save money . The same applies to civil servants as well as self-employed and freelancers.

Example:
If a childless employee earns 5,500 euros a month, he pays the maximum amount of around 439 euros a month for statutory health and long-term care insurance as well as the income-related additional contribution from the health insurance company. Since this is 1.3 percent on average and the employer pays half of it, it comes to a total contribution of around 5,645 euros per year (as of 2021).

If he is healthy and 30 years old, on the other hand, he can save up to 3,355 euros per year in a PKV tariff.

How can I switch from statutory to private health insurance?

If you meet the requirements for private health insurance, you can switch from statutory to private health insurance . The regular notice period in the GKV is two months to the end of the month . If your annual income is above the JAEG for the first time, you can change without notice.

If you have found a suitable tariff in the private health insurance scheme, you can submit an application to the company . In it you have to answer questions about your state of health. Our private health insurance experts will be happy to help you if you need support.

After a successful application, you will receive a confirmation of acceptance , which you must submit to your health insurance company within the notice period. Only then does the termination take effect . If, contrary to expectations, a change does not work, you will remain insured with your health insurance company.

Can I take out private health insurance with previous illnesses?

Before you can get private health insurance, you need to answer health questions . The requested periods vary depending on the company. Questions are often asked about medical treatment over the past five years or hospital stays over the past ten years.

If serious illnesses or allergies are stated, the insurers often charge risk surcharges on top of the tariff or exclude certain benefits from insurance cover. People who are severely underweight or overweight must also expect a surcharge.

If you are seriously ill , the insurer can reject your application entirely . If you have a pre-existing illness and would like to know whether you can still take out private insurance at low cost, our insurance experts will be happy to help. We advise you free of charge and without obligation.

Can I also insure my family in private health insurance?

Private health insurance does not offer family insurance. A separate contribution must be paid for each insured person.

However, this also makes it possible to cater to the individual needs of each family member when concluding the contract. In the case of a couple, for example, both partners can choose different services.

In addition, private health insurance for children is comparatively cheap , as no aging provisions are built up. High-performance tariffs are available from 100 euros a month. In the case of employees, the employer also pays a subsidy of 50 percent of the contribution for the children up to the statutory maximum.

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Expaturm aims to help educate Expats in Germany on key issues that they will have to deal with while living in Germany by providing everything you need to know about Banking, Healthcare, Lifestyle, and Housing in Germany
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