Return to statutory health insurance possible in old age

In Germany the “compulsory insurance for all” was introduced by law almost 10 years ago. Anyone wishing to change their health insurance (KV) has a difficult time, because without new insurance cover, the cancellation will not be effective with the previous KV. This applies especially to people who are 55 years old or older, who often find it impossible to return to the statutory health insurance (GKV). If one turns to a GKV, then this would have to advise – office obligation-adverse one finds rarely competent interlocutors and would have to complain later for compensation (OLG Munich, judgement of 01.06.2006, Az. 1 U 2388/02).

It is not uncommon for the amount of the private health insurance contribution to exceed the pension income in old age. The increase in private health insurance contributions by about 7.5 % p.a. in old age as an empirical value is legally determined by the calculation regulation (KalV) on the basis of formulas – this is therefore also called the actuarial old-age problem of private health insurance. Those who return to the SHI system in old age or earlier will save up to more than €250,000 in expenses for the rest of their lives; and in addition, they will often have to make a patient’s last will and testament because they will not take any senseless life-prolonging measures. If you want to know whether your contact person at the SHI is competent, please ask for an explanation of EC Regulation No. 1408/71 of 14 June 1971. This can be unsuccessful right up to the head of the SHI office, even if he or she may be remunerated with up to more than €12 per month, plus company car and company pension scheme. And if you want to know more about it, you might ask the state and federal authorities – possibly with success. However, according to settled case law, a legal claim to advice exists only on the part of the social insurance institutions.

Hundreds of thousands of people with private health insurance turn to their private health insurance because they can no longer afford or are no longer willing to pay the premiums that become more expensive with increasing age. Comprehensive advice on the change of tariff should be given, because there is a legal right to it if the need is recognised, §§ 6, 204 VVG – including liability of the private health insurance for incorrect advice. This advice is free of charge, sometimes in vain. Then he may come to the “tariff change broker” who will pay for his advice, with up to more than one annual premium saving. Afterwards, perhaps years later, the insured often finds that the initially “cheaper” tariff has become so expensive that it once again seems unaffordable. And then there are providers with the promise “even at 55 years of age and over” we will get you back into the SHI system – with the help of EU law. A company in Switzerland acts as a provider and advertises with letters of thanks to 80-year-olds who within 12 weeks found their way back from private to statutory health insurance: EU law makes it possible!

The ways out of private health insurance are manifold and possible at almost any age. For example, a residence abroad can help, with statutory insurance requirements there. However, this has a few side effects, such as when the centre of life changes, the risk of double taxation arises.

Alternatively, the pensioner can pro forma take up employment abroad for a certain period of time as a Leihopa for 10 € per hour, which in some EU countries can lead to compulsory insurance in the local statutory health insurance system and subsequently also in Germany. This also requires concrete design advice, as a tailor-made suit in individual cases. And this is certainly associated with consultancy costs, which can be considerable – but they are negligible in comparison to the savings in contributions to the KV. Any failure to obtain advice from the SHI system should be carefully documented, and advice should be sought in advance to ensure that the prospects of later reimbursement by way of recourse are secured.

For example, anyone who is self-employed and wishes to remain so will not return to the SHI system in Germany even if he or she is 55 years old, even if he or she takes up paid employment on the side.

He can nevertheless become liable to social insurance in a foreign SHI system by taking up a part-time dependent employment there for some time or by transferring his residence.

Subsequently, he will be admitted to the German statutory health insurance system – even at retirement age. Knowing how and where, the self-employed person, the high-income employee and the over 55 year old will also become liable to statutory health insurance simply by taking on a short-term second job, even without changing their place of residence or reducing their main occupation, and this quite legally according to the existing legal regulations in Germany or in other EU countries. Helpers experienced in EU law can be found to organise the formalities for smooth implementation.


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


by courtesy of (The Dentist Week, edition 08/2016)

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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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