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You may be considering switching to the private health insurance (PKV) system. There are good reasons for this. However, a change is not only associated with advantages over the statutory health insurance. The construction of the PKV also results in some restrictions that you should know before taking out private health insurance.
No family insurance
Relatives of statutory health insurers (GKV) who do not generate their own income (e.g. non-working spouses, children) can in many cases also be insured free of charge. Private health insurance does not know this. Here a separate contribution is made for each person. Especially for families with many children, the contribution in the PKV is usually much higher than in the GKV. Each child costs around € 150-200 per month. For this reason, we recommend that you also consider the premium of your (future) children when comparing contributions.
Deductible and advance payment
The PKV billing system differs fundamentally from that of the GKV. As a private patient, you first pay your treatment and medication bills yourself. Submit them to your insurer for reimbursement. However, since almost all private health insurance tariffs provide for a deductible and reimbursement of contributions in the event of non-payment, invoices are usually only submitted at the beginning of the following year if the submission is worthwhile. So some of them go into advance for a year. With the conclusion of private health insurance, liquidity provision should therefore always be built up, which corresponds at least to the agreed excess.
No child sickness benefit
Salaried parents who, like their children, have statutory health insurance are generally entitled to the so-called child sickness benefit, i.e. your salary will continue to be paid even if the child is ill. Each parent can stay at home for a maximum of 10 days per year (max. 25 days for all children together), for single parents it is 20 days per child (max. 50 days for all children together).
Private health insurers are usually not entitled to child sickness benefits. There is only the option of being released from work for a limited period of time (usually up to 5 days).
Health insurance for pensioners/strong>
Long-term health insured persons can use the pensioners’ health insurance (KVdR) in retirement. In this, only statutory pensions, pension payments and earned income are used to calculate the contribution. The contribution rate is greatly reduced and roughly corresponds to that of an employee with an employer grant.
Private health insurers largely continue to pay their previous contribution in the pension. Employees do not receive the employer’s allowance, which is why their contribution initially doubles. However, the statutory surcharge (10% of the main tariffs) and daily sickness allowance no longer apply. With your statutory pension, you can also apply for a subsidy to your private health insurance, which corresponds to the subsidy of a legally insured pensioner. However, since the subsidy is based on your pension amount, it can be quite small under certain circumstances. Therefore, assume that as a privately insured pensioner you will pay a higher contribution than a statutory health insurer.
In order to reduce the premium in old age, it is often advisable to take out a premium relief tariff. You pay an additional contribution for this, but this reduces your financial burden in old age.
Maternity and parental leave
During parental leave, statutory health insurers are generally insured free of charge. With private insured persons, however, the contribution must continue to be paid. In addition, the employer subsidy ceases during this period, which usually doubles the contribution. Some private health insurance plans offer financial relief during parental leave, but in private health insurance you definitely bear a considerable additional burden.
The usually three-week parent-child cures (these mothers generally take advantage of them) are currently a compulsory benefit of the statutory health insurance, so that these costs are borne. However, the PKV is a voluntary service. Insurance is only available for parent-child cures if your tariff expressly provides for this.
Please keep in mind that it is not usually possible to switch back to statutory health insurance. So the decision for the PKV is a lifetime. Therefore, please carefully consider whether the benefits of private health insurance outweigh the restrictions listed for you personally.
Economic motivation of the consultant
In the past, many brokers and distributors have been very active in pushing customers from statutory health insurance to private health insurance. The reason for this was the partially absurdly high commission of up to 20 monthly contributions (i.e. with € 500 monthly contribution there was up to € 10,000). Although the commission system was changed in the interests of the customers, the private health insurance with an average of 7.5 monthly contributions is still dramatically more attractive than the statutory health insurance, which usually pays an allowance of around € 70. We can assure our customers that the amount of commission does not matter in our advice. For example, we have advised many customers in the past against products that we would have earned a lot from, but which, in our view, would have led to permanent disadvantages for our customers. Nevertheless, it is important to us that you know the economic differences when deciding for or against the private health insurance system. Please also note here our blog article on compensation.
Are you interested in switching to private health insurance? Then we look forward to hearing from you!
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