Insured in the statutory health insurance without minimum premium payment

Self-employed persons with a very low income can apply to pay less than the so-called minimum contribution to the statutory health insurance (GKV). But Dr. Johannes Fiala and Dipl.-Math. Peter A. Schramm think that you have to come up with this on your own, because hardly anyone will tell you voluntarily.

What the tariff change broker never reveals and rarely knows

The current study by a lobby organisation not mentioned here in detail proposes making statutory health insurance (SHI) more attractive for lower earning self-employed persons. This was reported by a newspaper from Southern Germany.

For self-employed persons there would be a minimum contribution of 342 euros per month. It is astonishing what representatives of the press take over here without being checked. Especially when the deception is then taken to the extreme by the journalist joining the call for a change in the law. The journalist’s opinion: self-employed people should be paid according to their income. That this has long been common practice is not mentioned at all.

This leads to the question: Is this just pure lobbying, actual ignorance – or even intention?


SHI-insured persons can also pay less than the minimum contribution – on request

No SHI system voluntarily points out that self-employed persons can apply to pay a lower contribution than the so-called minimum contribution if they have a lower income. You have to figure it out for yourself. Or get advice from the statutory health insurance, for example. And if the advice provided is incomplete, a public liability lawsuit for damages against the SHI can be brought later.

The legal “trick” is to contradict the premium classification with the minimum premium. The reasons for this are kept open by the proof of income to be submitted later, such as the tax assessment notice.

Some unfriendly SHI administrators do not express “reservations”, thus unnecessarily provoking an objection procedure. They accept that naive self-employed persons with a monthly profit of about 342 Euros may also hand over this money to the GKV one to one. Otto, the average consumer, does not learn such vulgarities at school.


Minimum contribution is not equal to lowest contribution

However, the term “minimum contribution” does not mean that this is the minimum contribution the self-employed person must actually pay. This is similar to a minimum penalty according to the StGB, as this can also be lower due to § 49 StGB. Not to mention the fact that early release is possible retrospectively – or a pardon by the Federal President, for example in view of winning the European Football Championship.

It was done the other way round in former times: there were dungeon punishments that were changed into death penalties (wheels, quarters and hanging between the goalposts). And only because of the lack of space in the dungeon for the losing team. Except for the goalkeeper, because he was already shot from the penalty spot.


Ongoing false advice from insurance brokers

Of the approximately 9 million people fully insured in private health insurance (PKV), only about 1.4 million are self-employed. Plus the approximately 400,000 family members.

The above-mentioned lobby organisation, actually a proper foundation, promotes the unnecessary departure from the SHI system by spreading half-knowledge. At the same time, it is partly to blame for the poverty of many self-employed people in later life due to the high private health insurance contributions.

This need not always be the case. Often, staying in private health insurance is the more sensible option. A case-by-case assessment is therefore always advisable.

Even if the lower contributions for some self-employed persons are hardly known to the insurance brokers, this is clearly incorrect advice. Because ignorance does not protect from punishment. The self-employed person can sue for damages in the amount of the premium to be paid in the private health insurance, less the premium to be paid in the statutory health insurance (after application). Added to this are the costs of services that the private health insurance does not pay for, but which the statutory health insurance would have paid for. In court, this is enforced first as a declaratory action and then as an action for payment. The amount of the loss is determined by an actuarial expert opinion.


More favourable SHI contributions through the establishment of a GmbH

In 2016, the actual minimum contribution for self-employed persons will be 137.57 euros plus the additional contribution of the individual insurance company plus nursing care insurance. And if this is still too expensive for you, you can also sell, lease or rent out your company. Or left to the next generation via an anticipated succession – or alternatively to a good friend. If you are only an employee there as a former self-employed person, you may pay even less – and quite legally. At least if everything is designed correctly and actually carried out in the same way, i.e. not just for the sake of appearances.


Even over 55 years of age, a change to statutory health insurance is possible and attractive

Anyone who has not returned to statutory health insurance until shortly after the middle of their working life is no longer compulsorily insured in the health insurance for pensioners (KVdR) at about half the usual contribution.

You must therefore take out voluntary insurance beforehand, including the contribution of capital and rental income.

It can be different, however, if well designed compulsory insurance exists for other reasons. The optimised design can save a six-figure sum here, even if you have already reached the age of 55 and can no longer switch to statutory health insurance so easily. Regularly, one can hardly expect help or advice from the SHI on how the change will work. And the own PKV insurance broker has no increased interest in this either.

The privilege of the KVdR, i.e. the reduction of contributions at retirement age, refers to the time of the start of retirement with the Deutsche Rentenversicherung Bund (DRV), regardless of whether full or partial pension is paid. If necessary, you have to postpone the start of your pension there – and in return you get a bonus in the pension amount. Moreover, one must not have entered the SHI system at the age of 55 or later.


One day in the statutory health insurance system is enough – the practice can be different

One day in the statutory health insurance – no matter how you got in – is enough to have to stay in it, if you do not prove that you are covered otherwise.

Another question is how to subsequently structure income and assets so that an appropriate classification of contributions is achieved.

Both are first of all different questions, with possibly different criteria.


Change of profession and/or stay abroad as well as change of status lead to SHI

The self-employed veterinarian can be employed at the animal shelter, for example, to be compulsorily insured until the age of 55. If you are disappointed after some time because your expectations have not been met and you change your mind in the course of doing so, this does not reverse the date of entry into the compulsory insurance. The distribution of income and wealth within the family, with regard to the assessment of contributions, seems to be the secondary problem.

Alternatively, a stay abroad with compulsory insurance is an option, or the – often not necessary – change to a private health insurance company abroad. After that, it is easy to (re-)establish the insurance obligation, the age is irrelevant. Relatives and family members abroad can even make the return to the SHI system noticeably easier.


Twice as expensive advice from the tariff change broker?

Courts have repeatedly found that the tariff change broker in the PKV provides prohibited legal advice. Some of them pay several thousand euros in advance, but only take action afterwards. And the supposedly cheap tariff often leads to much higher premiums a few years later than in the original tariff.

However, such illicit legal advice not only leads to no fee being owed, but also to increased liability.


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


by courtesy of (published on 06.12.2016)



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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.
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