Return to the GKV for insured persons of the private health insurance (PKV) still with age 85

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).



European law helps insured who can no longer afford private health insurance

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 GKV in old age or earlier will save expenses of up to more than € 250,000 for the rest of their lives;

and, moreover, often a patient’s will, because nonsensical life-prolonging measures are omitted. If you want to know whether your contact person at the GKV is competent, please ask for an explanation of the EC Regulation No.1408/71

dated 14.06.1971. This may be unsuccessful all the way up to the head of the SHI office, even though he or she may be

is remunerated with up to more than € 12 per month, plus a company car and company pension scheme. And who

If you want to know more, 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.



Is your PKV also too expensive?

Hundreds of thousands of people insured under private health insurance turn to their private health insurer because they cannot afford to pay for the increasingly expensive

contributions can no longer afford or no longer want to make. Comprehensive advice on changing tariffs should be given,

because there is a legal entitlement to this if a need is identified, §§ 6, 204 VVG – including liability of the PKV 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!



You are 85 years young and want to get out of the PKV: No problem!

The ways out of private health insurance are manifold and possible at almost any age. For example, a residence in the

Help abroad, with compulsory insurance 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.



Change of profession and status

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 (Issue 11/2015)

and (Strategy Paper 33/2015, page 2-4)

and (Submission Gazette dated 10/19/2015)

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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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