Facilitated return to the statutory health insurance system

The new “Law for the elimination of social excessive demands in case of contribution debts in the health insurance” regulates a new obligatory follow-up insurance as an automatic voluntary continued insurance even after only one day of previous insurance, Sounds complicated, but it is actually quite simple.


Anyone who legally leaves the previous compulsory insurance (§ 5 SGB V) or family insurance (§ 10 SGB V) without being seamlessly followed by another compulsory insurance, will automatically continue to be insured in the statutory health insurance (GKV) according to this new provision. This obligatory follow-up insurance does not require a longer pre-insurance period of 12 months, as was previously the case; instead, just one day of compulsory or family insurance is sufficient. A written declaration of membership within the prescribed period is also no longer necessary.


No age limit for permanent membership of the SHI system

However, over 55-year-olds can no longer return to the GKV via compulsory insurance for at least 1 day, but as a rule only via family insurance, or by taking a detour via a foreign country.


No person already insured should be able to become uninsured

Even before the amendment, insured persons, even if they were only in the SHI system for a very short time, were subsequently caught up again via § 5 (1) No. 13 SGB V, and would therefore have been compulsorily insured. Only voluntarily insured members and members with compulsory insurance who wanted to change their health insurance fund could terminate their insurance under § 175 (4) SGB V only if they provided evidence of subsequent insurance, otherwise the termination did not take effect at all.

If, on the other hand, the family insurance or the compulsory insurance ended altogether, the insurance used to end without the person concerned having to give notice. However, it would have been possible to follow up on this in the past, with regard to § 5 (1) No. 13 SGB V. However, the persons concerned have not yet been contacted and information has not been requested. Thus, many former GKV members remained uninsured for a long time, and in many cases deliberately stopped paying contributions. Since they would have had to pay this back with interest, the return thus became successively more and more expensive.


More difficult exit from voluntary statutory health insurance

However, anyone who would have registered with the health insurance fund as an uninsured person after the end of compulsory or family insurance, possibly only for a short period, would of course have been accepted as a compulsory member immediately in accordance with § 5 (1) no. 13 SGB V. What is new now is that he is automatically in the fund for the time being, as a “voluntarily” insured person, whether he wants to be or not.

By providing proof of subsequent insurance (in PKV or GKV), you can leave your GKV, as well as, for example, if you do not reside in Germany.


A single day of compulsory GKV insurance is sufficient for withdrawal

Being compulsorily insured in GKV for one day: then one has to remain there “voluntarily” on a regular basis due to § 5 (1) No. 13 SGB V. This also worked before, only the GKV did not force this, i.e. one had to poke them with the nose at it – now it takes place automatically.


Return for older workers

For many over 55 year olds with premiums that have risen with age in private health insurance (PKV), family insurance would be an option – for this, however, income must not exceed EUR 385 per month, or EUR 450 in the case of a mini-job (as of 2013). This goal can be achieved by briefly reducing professional activity with an income up to this respective limit.

Particularly in the case of termination of employment, family insurance (which also exists in the case of registered civil partnerships) offers the possibility of returning to the GKV by applying for a pension at a later date.


Return option via family insurance for pensioners

If a higher statutory pension is already drawn, there is also a way back into the GKV via short-term family insurance:
Every old-age pension – including the standard old-age pension from the age of 65 – can also be paid after the age of 65 as a so-called partial pension in accordance with § 42 SGB VI. The partial pension amounts to one third, one half or two thirds of the full pension achieved. This means that a full pension of up to EUR 1,155 per month that has already been drawn can also be used. be reduced to such an extent that entitlement to family insurance in the GKV exists if no other income is added.


Return for younger

For employees under 55 years of age, it is sufficient to fall below the annual income threshold (JAEG) even without family insurance. If an employee’s income in the current calendar year falls below the JAEG in the future, the obligation to insure comes into effect immediately. For those already insured under private health insurance on 31.12.2002, this will be at a monthly rate of EUR 1,000 per month in 2013. EUR 3,937.50, for all others EUR 4,350. In the case of an earlier exemption from compulsory insurance due to falling below the JAEG, however, this path is initially blocked – in this case, termination of the employment contract and conclusion of a new one with income initially below the JAEG will help. This also applies to younger self-employed persons, whereby the part-time continuation of self-employment is harmless.


Change in the private health insurance often cheaper

However, there are good reasons to remain in the PKV. Thus the PKV-insured is not dependent on the waiting list for organ donations, but can also let an organ transplantation take place abroad if medically necessary, outside the allocation rules of Eurotransplant with the chance to have to accept years of health disadvantages on the waiting list or to die before. Often the premium can be reduced to less than half by changing the tariff according to § 204 VVG – “unaffordable” premiums in old age do not have to be.


by Dr. Johannes Fiala and Dipl.-Math. Peter A. Schramm

by courtesy of


(Issue 10/2014)


published in www.med-dent-Magazin.de (July 2015 issue)

Link: http://www.med-dent-magazin.de/docs/archiv/mdm-Juli%202015.pdf (pages 8 and 9)



Our office in Munich

You will find our office at Fasolt-Strasse 7 in Munich, very close to Schloss Nymphenburg. Our team consists of highly motivated attorneys who are available for all the needs of our clients. In special cases, our law firm cooperates with selected experts to represent your interests in the best possible way.

About the author

Dr. Johannes Fiala Dr. Johannes Fiala

Dr. Johannes Fiala has been working for more than 25 years as a lawyer and attorney with his own law firm in Munich. He is intensively involved in real estate, financial law, tax and insurance law. The numerous stages of his professional career enable him to provide his clients with comprehensive advice and to act as a lawyer in the event of disputes.
»More about Dr. Johannes Fiala

On these pages, Dr. Fiala provides information on current legal and economic topics as well as on current political changes that are of social and/or corporate relevance.

Arrange your personal appointment with us.

Make an appointment / call back service

You are already receiving legal advice and would like a second opinion? In this case please contact Dr. Fiala directly via the following link.

Obtain a second legal opinion

(The first phone call is a free get-to-know-you conversation; without consulting. You will learn what we can do for you & what we need from you in terms of information, documents for a qualified consultation.)