Who can be exempted from compulsory health insurance?
Anyone who should actually be insured in the pensioners’ health insurance scheme because they are drawing a statutory pension can be exempted from this obligation under certain conditions. This applies, for example, to people with private health insurance who are eligible. You can continue your private health insurance when you receive your pension. However, you must submit an application for exemption to a health insurance company within a period of 3 months.
An exemption should be well thought out. The decision against statutory health insurance is usually of a permanent nature. This means that a return to the pensioners’ health insurance is then hardly possible.
Which pensioners can voluntarily insure themselves with a fund?
Anyone who is legally insured but does not meet the minimum insurance period for the KVdR can in principle insure themselves as a voluntary member. In the past, certain pre-insurance periods were required for this. A law from 2013 is interpreted in such a way that people whose compulsory insurance (or family insurance) ends usually no longer have to have a previous insurance period for voluntary continued insurance.
For pensioners who do not get into the KVdR and only have low income, family insurance may be an option.
What is changing for the self-employed?
Anyone who works full-time as a self-employed person and applies for a statutory pension does not automatically become subject to health insurance. The previous insurance remains in place, it takes precedence in this case. This does not apply to pensioners who only work part-time as self-employed.
How high are the health insurance contributions?
In principle, contributions are to be paid on the statutory pension (under certain conditions also on pensions from abroad), pension payments and on income from work (profit from self-employment). The general contribution rate normally applies. Income up to a limit of EUR 4,837.50 per month is taken into account. The pension insurance institutions pay half of the health insurance contribution from the statutory pension. It is withheld directly from the pension and paid to the coffers. Pensioners with a pension or income from work have to pay the contributions on their own.
In the case of voluntarily insured persons, interest, rent and other income subject to contributions are also taken into account. Under certain conditions, the income of the privately insured spouse can also influence the contributions of the voluntarily insured. More details are regulated in the contribution procedure principles of the National Association of Statutory Health Insurance Funds.
Voluntary members pay the full contributions and, upon application, receive a subsidy for health insurance from the pension insurance agency, which is calculated as a percentage of the statutory pension.
Insurance companies have the option of levying individual, income-related additional contributions. Affected members have a special right of termination if health insurance companies charge or increase additional contributions. Pension insurance providers and pensioners each pay half of the additional contribution.
If the pension insurance provider or the paying agency pays the contributions to the health insurance company, the increase in the additional contribution only takes effect with a 2-month delay.
Background: The pension insurance institutions and the payment offices for pension payments were granted a transitional period for the system changeover.
What is the situation for privately insured people?
Similar to those who are voluntarily insured, the pension insurance institution pays a subsidy to the contributions of privately insured persons who are entitled to a statutory pension.
In the face of increased cost pressure, retirees can consider slimming down individual benefits with their insurer, increasing the deductible or, if available, choosing an equivalent tariff with lower contributions. In certain cases, however, the entitlement to change to the so-called standard tariff can be lost if the insurance cover is changed.
Although this has a very weak scope of services, it can mean a certain alleviation of the financial situation in the absence of sensible tariff alternatives due to its often low contribution.
Persons whose entitlement to benefits changes as a result of retirement can adjust their private insurance tariff within 6 months without a new health check.
Are contributions rightly charged on direct insurance?
Lump-sum benefits and settlements that serve to provide for old age and surviving dependents are subject to contributions in the statutory health and long-term care insurance. However, these must be related to professional life. Example: Private life insurance and pension insurance are not affected for pensioners who are subject to compulsory health insurance. The capital paid out is mathematically distributed over ten years and then the monthly contribution is determined. There is a tax-free allowance for income from company pension schemes: Only the value that exceeds a monthly limit of EUR 164.50 is taken into account for the calculation of contributions. According to the current legal situation, this regulation only affects health insurance fund members who are subject to compulsory insurance, i.e. those who are not voluntarily insured. In addition, the exempt amount only applies to health insurance, not to long-term care insurance (there the previous exemption limit regulations remain).
The Federal Constitutional Court (Az.: 1 BvR 1660/08) ruled in favor of (KVdR) pensioners who had initially invested further private contributions in a company pension scheme after leaving the employment relationship: at least the privately financed portion of the payment from direct insurance may not be subject to health and nursing care insurance contributions in old age. However, for the benefit to be classified as “private” during the payment period after leaving the company, the company pensioner must be entered in the insurance policy as the policyholder. Comparable are decisions on the health insurance contributions of pensioners who are subject to compulsory insurance and who continue to pay into pension fund contracts after the end of the operational phase (Az.: 1 BvR 100/15 and 1 BvR 249/15). However, the situation is different for voluntarily insured pensioners: since they also have to pay contributions on income of a private nature, they hardly benefit from the decisions mentioned.