Switch to statutory health insurance for private persons easier

Raising the compulsory insurance limit allows return to the statutory health insurance

13/01/2012

With the turn of the year, some health insurance conditions have changed. Significant deviations from the previous year are an increase in the compulsory insurance limit, the introduction of unisex tariffs and significant premium increases in some private health insurances.

By raising the compulsory insurance limit to 50,850, - Euro annual income from January 2012, many private insured the previously excluded return to the statutory health insurance (SHI) is possible. For example, some statutory health insurance funds recently reported a massive wave of changes from private health insurance to GKV. Given the contribution increases in several private health insurances, more people seem to be making use of the option of switching than originally expected by policy makers. However, the private health insurance association promptly denied the alleged wave of change in the direction of the GKV and stressed that private health insurance companies have been able to gain massive membership in recent years. This was also confirmed by Debeka and the German Insurance Association (GDV).

Return flow from private insured to the GKV
The veritable onslaught of "back-changers" is nevertheless not to be dismissed out of hand. For while the change in private health insurance was steadily eased by the black and yellow government in recent years and many well-earning employees moved in the direction of private health insurance, a return to statutory health insurance was simplified in early 2012 by raising the mandatory insurance limit. In conjunction with the sometimes substantial contribution increases in private health insurance, this has the consequence that industry experts reckon with a return to the GKV for 2012. Here also should play a role, that according to the news magazine "Der Spiegel" some private health insurance at the beginning of their contributions have increased their contributions by up to 50 percent, in particular, the elderly are often affected by drastic increases in contributions.

Raising the compulsory insurance limit facilitates the return to statutory health insurance
The increase in the compulsory insurance limit at the beginning of 2012 has enabled many private persons to return to the statutory health insurance. Since January 2012, there is a compulsory insurance in the GKV only for workers with an annual income up to 50,850, - € (monthly income of 4,237.50 euros). In 2011, this limit was still 49,500, - Euro (monthly income of 4,125, - Euro). If the insurance limit is exceeded, the person concerned is free to decide whether they would like to switch to private health insurance or if they want to be voluntarily insured in the SHI. However, as a result of the significant increase in the compulsory insurance ceiling, many employees who were above the income threshold last year are again covered by compulsory health insurance. Anyone who has already switched to private health insurance but earns less than € 50,850 per year can now return to SHI. An exception is insured persons who switched to private health insurance already before 2003. For them, a mandatory insurance limit of 45,900, - € annual income or 3,825, - € monthly income.

Exemption from compulsory insurance in the statutory health insurance
Private insured persons, who would again fall under the compulsory insurance of the GKV due to the low income, can, however, be exempted from compulsory insurance and continue to be privately insured. However, the exemption from the GKV insurance obligation can then no longer be revoked, according to the statement in the Social Code V (SGB V, § 8 paragraph 2). As a result, insured persons will generally remain bound by private health insurance - although some loopholes and exemptions may allow them to return. For example, while those affected remain excluded from repatriation as they work in a social insurance scheme (even as income continues to decline), as soon as they lose their job and receive unemployment benefit I, they return to compulsory health insurance. In such a case, the persons affected can cancel their private health insurance and seek a new statutory health insurance, according to the decision of the Federal Social Court of 25 May 2011 (Ref .: B 12 KR 9/09 R).

Possibilities to push the income below the compulsory insurance limit
Those who absolutely want to return to the statutory health insurance, but with their income in 2012 above the mandatory insurance limit, may have the opportunity to reduce their income by making contributions to a company pension plan below the critical income limit. Employees can save up to € 224 of their gross monthly income through a pension-related salary conversion and thus reduce their annual income by € 2,688. Another option for reducing the insured income is the creation of provisions from income components on a long-term or lifetime working account. If such measures reduce the annual income below the compulsory insurance limit, the private insured concerned have the option of returning to the GKV.

From the age of 55 no return to GKV possible
However, the age limit of 55 years always applies as a time ultimatum for a return to the GKV. Private insured persons, who are already 55 years or older, usually have no option to return to the GKV, according to the statement in § 6, para. 3a of the SGB V. According to this, "after the age of 55" the return in the GKV blocks if those affected have not been legally insured for the past five years. 55 years is usually also the age from which the contributions in private health insurance are experiencing a rapid increase. Thus, willing-to-change private insured should in any case prior to their 55th year of age endeavor to return to the SHI. According to the experts, this return may pay off especially for older insured persons with children. Because they have to fear in GKV no drastic increases in contributions with increasing age and can also accommodate their children and low earning spouse free of any contribution through the family insurance in the GKV.

Abuse of the solidarity community?
However, it should be mentioned that an escape from the solidarity community of the statutory health insurance with high income and good health at a young age, as well as a subsequent return in old age, with relatively poor health, certainly not in the sense of the legislature. Here, the solidarity principle of the GKV is being undermined, at the expense of those for whom no change in private health insurance is possible due to the low income. It is not without reason that there are numerous regulatory hurdles that make it difficult or impossible to return from private health insurance to GKV. Due to the increased use of loopholes and exceptions in conjunction with the current increase in the compulsory insurance limit, the intention of the legislature does not seem to be achievable here. The wave of change in the direction of SHI is therefore quite critical, even if the statutory health insurance, according to their own information on the influx of insured look forward. (Fp)

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