Contribution debts with your statutory health insurance fund (GKV)
How high is my statutory health insurance contribution?
The monthly insurance premium is calculated on the basis of the income of the insured person.
Who pays the contribution to my health insurance fund?
For employees who receive a salary or wage, half of the contribution is paid by the employer; it is automatically deducted from the gross salary or wage and paid to the health insurance fund.
Members who are voluntarily insured must pay all of the monthly contribution to their health insurance fund themselves.
What happens if I do not pay my contribution?
A late payment surcharge of 1 % of the overdue amount is payable for each month or part thereof in which you are in arrears.
If you are in arrears with two months‘ contributions and, despite a reminder, do not pay, your entitlement to health insurance benefits is suspended. This means that you will only receive health insurance benefits in cases of acute illness or pain as well as pregnancy and maternity benefits.
Co-insured family members, however, continue to have full insurance cover. You will receive all health insurance benefits again if
- you receive benefits on the basis of Book II or Book XII of the German Social Code (SGB II or XII).
- you have paid the arrears,
- you have agreed with the health insurance company to pay instalments or
- insolvency proceedings have been opened.
It is no longer possible to cancel a health insurance policy since it is obligatory to have a statutory health insurance!
The health insurance fund will try to collect the contributions by force (e.g. by garnishing wages or a bank account).
Health insurance funds may also offset their contribution claims against the insured person‘s claims or against other social benefits, such as a pension.
How can I pay off my contribution arrears?
Contribution claims are subject to the statute of limitations and expire 4 years after the end of the calendar year in which they became due. However, the suspension and recommencement of limitation periods must be observed.
If you agree to pay by instalments, you should agree or state with each payment that the payment is to be offset against the contribution and not against the late payment surcharges or other ancillary costs.
There are several options that can be negotiated with the health insurance companies. These include:
- Deferral
Prerequisite: The immediate collection of the contributions imposes considerable hardship on the member and entitlements are not jeopardised by the deferral.
The consequence: The due date of the contribution claims is postponed to a later date. - Remission
Prerequisite: If it is certain that the arrears cannot be recovered or if the costs of recovery are disproportionate to the amount of the claim.
The consequence: The health insurance fund will drop their claim. However, they may reassert the claim at any time. - Waiver/partial waiver
Prerequisite: If collection would impose a particular hardship in the individual case.
The consequence: The health insurance company waives the outstanding contribution claims. - Settlement
Prerequisite: The settlement must be financially and practically reasonable for the health insurance company.
The consequence: The health insurance fund and the member can reach an individual agreement on how to deal with the outstanding contributions.
Voluntarily insured persons also have the option of having their contribution classification corrected retroactively for up to 12 months. Proof of lower income, e.g. presentation of an income tax assessment notice, is sufficient for this.
Can contribution debts be eliminated through consumer insolvency proceedings?
Consumer insolvency proceedings and the associated residual debt discharge generally mean that contribution debts can be eliminated. However, it should be noted that the health insuran- ce funds can offset their claims even during insolvency proceedings.
Contribution debts with your private health insurance (PKV)
How high is my private health insurance contribution (premium)?
The premium amount is based on your individual risk, age and choice of tariff, regardless of your income.
The insurance relationship is concluded in a contract.
Who pays the premiums to my health insurance?
With a private health insurance contract, each member is responsible for paying the premium owed to the insurance company.
What happens if I do not pay my premiums?
A late payment surcharge of 1% of the premium arrears is incurred for each month or part thereof in which you are in arrears.
If you are in arrears with two months‘ premiums and the insurance company has sent you a reminder for the second time, you may be categorised in the so-called „emergency tariff“. This means that you can only make limited use of private health insurance benefits. The emergency tariff does not apply if all outstanding claims and late payment surcharges have been paid and/or you receive benefits based on Book II or Book XII of the German Social Code (SGB II or XII). In addition, the emergency tariff ends if you agree with the insurance company to pay instalments.
How can I pay off my contribution arrears?
You must reach an agreement with your insurance company about how to pay off your arrears. All intervention options, ranging from instalment payments to deferrals and remissions as well as a (partial) waiver can be considered here.
In some cases, it is worth switching to the standard or basic tariff offered by private health insurance companies.
The member‘s claims for reimbursement of costs cannot then be offset against premiums owed.
Contribution debts with private health insurance funds are generally eligible for residual debt discharge, meaning that consumer insolvency proceedings are also a way of getting rid of contribution debts.
