Carefree single life: No matter whether career or leisure, consumption or investment – who lives alone, does not have to take any consideration for a partner. This also applies to health insurance: If the income is above the compulsory insurance limit (2017: 57,600 euros), there is nothing to prevent the change to private health insurance. On the other hand, whoever is married, has to pay for two – or even more -: The optimal insurance protection for couples therefore depends heavily on the further life planning.
Family question: private or legal?
In Germany, the term “family insurance” refers to the option for persons insured under the law to co-insure family members free of charge. The family members include, among others, their own children, spouses or registered partners. In §10 of the Fifth Book of the Social Code (SGB V) the family insurance is regulated by law.
In addition to the statutory family insurance, there is also the option for privately insured persons to use a family plan. However, the contribution amount is not fixed and depends on the individual hedging wishes.
In addition, spouses or children are not insured without a contribution, but usually enjoy only a discounted rate. The private family insurance is open to all those who could voluntarily insure themselves by law, so their annual gross income exceeds about 51,000 euros.
Basically, it makes more sense for families, if it is possible to use the family insurance of the statutory health insurance. The costs may already be lower for the co-insurance of a child than for the private family insurance.
In addition, the insurance premium is set by law, while private rates are expected to increase with the age of the main insured person.
In order for family members to be co-insured, certain conditions must be met.
- Children are usually always insured until their 18th birthday. If the child is not gainfully employed or earns less than 450 euros a month, it can stay in the family insurance up to the age of 23.
- If the child is studying or training, co-insurance is valid until the age of 25 years.
- If study or training is interrupted by the military, volunteer or civil service, the family insurance is extended by up to 12 months.
- The same applies to work as a development worker.
- For disabled children who can not take care of themselves, the contributory co-insurance is unlimited.
The insurance coverage of the statutory family insurance can also be used for grandchildren or stepchildren. For them, the same conditions apply as for children.
As is common practice with statutory insurance, co-insured children within the EU and some other countries are also insured abroad. However, these are usually only acute care and benefits covered by the tariff.
Anyone wishing to take advantage of additional services, such as repatriation, must take out travel or international health insurance.
In these cases, however, it is not possible for children to be co-insured:
- If one of the two spouses is privately insured, their income exceeds one-twelfth of the annual earnings limit, and he regularly earns more than his or her legally insured spouse or legally insured spouse, children can not be included in family benefits. In 2016, the income limit will be set at € 4,687.50 gross.
- If the mother was not insured at the beginning of the maternity leave, family insurance with the child is not possible.
Own health insurance of the child tax deductible
If children can not be covered by a family insurance scheme, the additional costs for the child’s own health insurance can be deducted as special expenses from the tax.
For spouses and partners in a registered partnership, the following requirements apply to family insurance:
- You must be a resident of Germany
- You may not be insured yourself
- You have to earn more than 405 euros per month (with mini-job 450 euros).
In addition, the family member may not be a civil servant or self-employed person or earn so much that a statutory insurance is not possible. Self-employed are all policyholders who work independently for more than 18 hours per week.
A family insurance with the spouse is also not possible if he receives unemployment benefits. In this case he is already compulsorily insured through the employment office.
Unmarried couples can not benefit from co-insurance through the family insurance. Here a private family insurance would be a possible alternative, as the private health insurance usually takes the partnership definition a little wider.
When a family health insurance is not possible
A family health insurance in the true sense can only be claimed by legally insured persons. If a spouse is privately insured, his gross monthly income may not exceed € 4,687.50.
If the income is higher, a free co-insurance of the children is not possible. He also can not be insured.
The self-employed can not benefit from statutory family insurance unless they work less than 18 hours per week as part of their self-employment.
For children who are insured free of charge, they can not earn more than 405 or 450 euros with a mini-job. This income limit also applies to spouses or partners of a registered civil partnership. If he or she earns more, there is no possibility of contributory co-insurance.
Further exclusion criteria:
- A spouse does not live in Germany
- A spouse is a civil servant
The way to the new family health insurance
Whether a family insurance is worthwhile and whether it is even possible, such insurance should be checked before any consideration. The following steps are useful:
First, consider possible alternatives. You may want to take advantage of more comprehensive insurance or the benefits of private health insurance. But even with statutory health insurance, there are differences.
Here it is above all the additional benefits that are of interest to policyholders. Some SHI also offer attractive premium refunds when certain health programs are used.
The amount of the additional contribution is also important for determining the monthly costs.
Request information on interesting offers
Therefore, before filing the application, obtain all the information about rates and insurance models you are considering.
On the homepages of insurers, there are usually sufficient details about the respective insurance tariff. With the PKV you can also send specific offers.
Once you have decided on a tariff, submit your insurance application. In the case of statutory family insurance, children can be insured for both the father and the mother without any contribution if both parents are employed and are subject to compulsory insurance.
The application must be completed by a detailed questionnaire. Based on this information, the insurance company checks whether the right to family insurance exists.
Check your insurance companies at regular intervals to see if family insurance is still lawful.
Cancel old insurance
If you have opted for an insurer, you should remember to cancel the old insurance. Some insurance companies also take over this service for you.
In order for your employer to pay his share of the insurance correctly, you must also inform him about your new insurance.
Simultaneous family insurance not possible
It is not possible to co-insure children with their father or mother. Concurrent family insurance is not supported by most SHI.