Return to statutory health insurance

Return to the legal - not easily possible: Who decides to switch to private health insurance (PKV), often enters a "covenant for life" - it is at least intended by law. Although the conditions for a change to private health insurance were made easier in 2011, at the same time the return from private to statutory health insurance (GKV) was made more difficult.

Health insurance: Why is the change difficult?

The reason for this is that many young and healthy people benefit from the benefits of private health insurance by paying a much lower contribution than the statutory health insurance fund and, in addition, getting even better benefits.

With increasing age, however, the contribution rates increase, so that the statutory health insurance now represents a cost savings for them - for the statutory health insurance, the changers would be a financial burden, as they have not paid into this, but in the PKV, which ultimately as big winners would emerge.

PKV: change to the statutory health insurance

Joining the private health insurance should be considered carefully, because if circumstances change or the costs increase beyond expectations, a return to the statutory health insurance is only possible in certain cases. A prerequisite for this is that a person becomes reinsured. Such a case could occur if the private insured falls below the income threshold for at least one year, for example because the insured person earns less than previously.

In addition, the contribution assessment limit is recalculated every year, so that it may be that the previous annual salary is no longer sufficient. For 2011, a gross annual income of € 49, 500 was set as the contribution assessment limit. Unlike in the past, it will no longer be possible to automatically return to compulsory health insurance if you are unemployed. Due to the new regulation, the job center for the contributions of private health insurance now has to step in. As a rule, the insured will in this case be downgraded to the basic rate.

Change to the legal as self-employed

Self-employed and freelancers are often among the members of the private health insurance. But self-employed can not return to the statutory health insurance as such. As an option, they only have to give up self-employment and enter into an employment relationship with earnings below the annual earnings ceiling. Those who do not receive their own income after giving up their self-employment have the option of changing into the family insurance of their spouse or their parents.

However, the prerequisites for a change from private health insurance to statutory health insurance mentioned here can also be null and void: If the case arises that a private health insurance has to be abolished because the statutory insurance obligation applies, a private insured person can file an objection. If he is released from the statutory compulsory insurance in this case, he can under no circumstances return to the statutory health insurance.

A similar problem often has students who were privately insured when they started their studies: With the waiver of the statutory compulsory insurance, they can no longer make the transition to the statutory health insurance for the duration of their studies - even in the case of interruption, change of subject or second degree.

Change to the SHI over 55

As already mentioned, older people in particular often think about returning from private to statutory health insurance. Due to increased health problems, the contribution rates continue to rise, while most retirees only have a significantly lower income. It is also possible that certain benefits were excluded when entering the private health insurance system, which are now urgently needed. Therefore, the Social Code provides for a change from private insured over 55 years to GKV only in very rare exceptional cases.

Anyone considering a return to the private health insurance fund should ensure at least twelve months before the age of 55, for example by reducing working hours, that their salary falls below the annual earnings ceiling. When returning to the statutory health insurance, those affected usually lose their old age allowance, which would also not save a change to another PKV.

In order to prevent pensioners from being able to afford their private health insurance at some point, the legislator introduced the basic tariff in 2009. This roughly covers the benefits of the statutory health insurance and may not exceed their monthly maximum tariff (which in the year 2011 amounts to 575.44 euros). In addition, there is usually the possibility of having the benefits of private health insurance adapted to the new individual requirements. Interested parties should obtain detailed information from their insurance carrier.

Share with friends

Leave your comment