Return of self-employed to the GKV

Self-employed and return to the GKV

New guidelines for the return of the self-employed make the way to statutory health insurance even more difficult, but the rules are becoming clearer.

Self-employed and freelancers are often privately insured for cost reasons. But if the revenue breaks away, the health insurance in a statutory health insurance (SHI) is often quite cheaper. Simply change the health insurance again, but not, and so many affected in the past, the detour over an insurable (second) employment gone to accommodate again in the GKV. The Association of Statutory Health Insurance Funds has now adopted new guidelines.

Self-employed can not return to the GKV
Anyone who has left the GKV as a self-employed person for whom a return is possible only under much more difficult conditions. And also the way to a job requiring insurance is faced with high hurdles. Persons who are self-employed full-time are generally excluded from compulsory health insurance, despite possible employment as an employee. Prior to admission to the SHI, the applicant's main joblessness would be checked by the funds through a questionnaire, explained Andre Fasel of the miners' union. In addition to the salary from dependent employment, the questionnaire also examines income from other areas, such as self-employment. In particular, the expenditure of time and the income from self-employment are a particularly important evaluation criterion for insurers with regard to compulsory insurance.

New rule reduces discretion
The freedom of interpretation in the assessment of self-employment by the respective SHI, but so far allowed a considerable margin of discretion, which was sometimes interpreted in favor and sometimes to the detriment of the applicant. To reduce the amount of work involved in applying for a job, the rule of thumb has always been the rule of many insurance companies: the main occupation is always employment as an employee, if this is not exactly a mini-job. However, this generous interpretation will no longer be possible in the future. Because a new guideline of the GKV-Spitzenverbandes now creates clarity about the classification „full-time self-employment“. Applicants will henceforth be considered as full-time self-employed if they spend more than 20 hours a week on self-employment and / or receive the bulk of their income from it. The new directives also state that a self-employed activity is always full-time employment if at least one employee is employed by the applicant with a non-negligible employment.

From the age of 55 the application is mostly rejected
If the applicants earn the majority of their income as dependent employees and spend most of their time here, a return to the statutory health insurance is possible in the future. Although the new directives give more stringent guidance than has been the case so far, in principle the examination of the main job is still a one-off decision, explained Andre Fasel. However, from the age of 55, the decision is usually to the detriment of the applicants. Older persons who were previously privately insured as self-employed persons are usually not re-admitted to the GKV even when they take out employment subject to compulsory insurance.

Detour via the voluntary unemployment insurance
Self-employed persons who voluntarily contribute to unemployment insurance, as the Federal Employment Agency has been offering for business start-ups since 2006, are far better off with declining incomes and a corresponding wish to return to SHI. If they give up their self-employment and fall into unemployment, they are automatically reinsured in the GKV and can remain in the GKV even if they resume work. Thus, the return to the GKV is also possible for the self-employed through the detour of the voluntary unemployment insurance.

Stricter guidelines should save costs
With the stricter guidelines, the SHI want to save costs in the first place, because the decision whether someone full-time or part-time self-employed, has a significant impact on the finances of the insurance. For example, self-employed persons who are self-employed can no longer be insured in the free family insurance via the parents or the partner, are exempt from the statutory health insurance obligation in an optional part-time job and have to pay a minimum contribution of currently € 274.02 as a voluntarily insured person in the statutory health insurance (from the 1st January 2011 increase to 285.52 €) pay. In addition, the umbrella association of the SHI hopes the new directive, questionable constructions in which, for example, the wife of a good-earning man, the free family insurance claims, but at the same time in the tax losses from self-employment claims to withdraw the basis. According to the experts, most self-employed persons will only be marginally affected by the new directive, although on the one hand they may have to accept somewhat stricter rules, but on the other hand they will benefit from the clearly comprehensible basis for decision-making. (fp, 16.12.2010)

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Picture: Rainer Sturm