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WEDNESDAY, MAY 12, 2021 | Jessica L.

Health insurance

Health insurance

Health insurance is a compulsory insurance in USA. Compulsory health insurance was introduced on January 1, 2009, after it had already applied to many people with statutory health insurance in 2007. By introducing compulsory insurance, the state ensures that its citizens are covered in the event of illness and that they do not have to bear the costs of treatment themselves. Health insurance is thus a fundamental social safeguard and an important component of the US social security system. Is it even possible to live in USA without health insurance?

According to projections by the US government, more than 77,500 people in USA lived without health insurance in 2015. However, the number may be higher. In many cases, people who used to have private insurance are not covered by health insurance today. For example, low-earning self-employed people in particular often cannot afford the cost of private health insurance, as private health insurance can often be more expensive for the self-employed, and therefore choose not to take out insurance. Prior to 2009, the self-employed also had the option of remaining uninsured.

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Another group of the uninsured consists of homeless people who have no financial means for health insurance. In addition, there are also foreigners and illegal immigrants who are not registered and therefore cannot take out insurance.

Step by step back into health insurance

  • Return to health insurance as soon as possible
  • The sooner you are back on health insurance, the less premium arrears or premium surcharges you will have to pay.
  • Select health insurance

Use the PKV or the GKV insurance comparison to compare insurances and rates. Keep in mind whether you need private or statutory health insurance!

Contact and advice

Contact the selected health insurance company and describe your situation. Take advantage of possible consulting offers.

  • Apply for a discount

Apply for a discount on premiums or negotiate with the private health insurance company for possible discounts on premium surcharges. You can also arrange to pay the premium arrears or premium surcharges in installments if you do not have the money immediately available.

Conclude insurance

As soon as all modalities have been clarified, you can conclude the insurance contract. You will then have comprehensive health insurance again.

Which insurance will I get back into?

If you had private health insurance before your insurance-free period, you must take out private health insurance again. Those who have a non-self-employed job can take out statutory health insurance through their employer. For those who were previously covered by statutory health insurance, they must take out statutory health insurance again.

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The subsequent obligation to pay contributions

Anyone who has lived without health insurance after the introduction of compulsory health insurance and re-insures is obliged to pay any unpaid premiums in arrears. In addition, late payment penalties may be assessed.

The payment is calculated for each day on which statutorily insured persons have been uninsured since April 1, 2007, and all insured persons have been uninsured since January 1, 2009. If a formerly uninsured person is unable to pay the contribution debt directly, a reduction of the outstanding contributions and any applicable late payment surcharges is possible.

Contribution debt for statutory health insurance

For returnees to the Statutory Health Insurance, there is a uniform regulation adopted by the Central Association of the SHI on the basis of the Contribution Debt Act of 2013. Those who had re-registered with the statutory health insurance by December 31, 2013 did not have to pay any additional contributions and the contribution debt was automatically settled.

Since January 1, 2014, there is no chance of a complete waiver of the contribution debt. However, under certain conditions, the outstanding contributions do not have to be paid in full. Likewise, late payment penalties do not apply.

Requirements for the reduction in the subsequent payment

In order to be eligible for a reduction in arrears, policyholders must have been exempt from insurance for at least three months. In addition, they must not have claimed any insurance benefits during the insurance-free period. If this was nevertheless the case, they must pay for the medical services themselves and cannot expect the health insurance fund to cover the costs retrospectively. Co-insured family members are excluded from this regulation.

Calculation of the supplementary payment

The additional payments to the statutory health insurance funds are calculated on the basis of ten percent of the income subject to contributions.

If a person subject to contributions has not had health insurance for ten months and has earned 2,000 dollar per month during this period, the basis for calculation is 200 dollar. The general contribution rate of the statutory health insurance is 14.6 percent. Per month, the contribution debt would therefore amount to 29.20 dollar. In the case of ten months without insurance, the insured person would have to pay 292 dollar in arrears.

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Contribution debt private health insurance

Privately insured persons must also make additional payments for the insurance-free period. The payments are a so-called “premium surcharge”. The amount of this payment is based on the amount of the premium in the new insurance tariff.

Calculation of the premium surcharge

For each month in which persons were not insured, the private insurance company charges a premium surcharge in the amount of a full monthly premium. This amount is maintained until the sixth month of the uninsured period. Thereafter, one-sixth of the full monthly premium is payable for each uninsured month.

If an uninsured person takes out private health insurance again and has been without health insurance for twelve months, he or she must pay six times the full premium of his or her current rate and once the full rate.

Since private health insurers offer very different rates at different conditions, it is worthwhile to compare different insurance offers. With similar performance, there are often significant price differences after an insurance comparison.

The longer the period of non-insurance, the more noticeable rate differences are in the premium surcharge. Policyholders should also try to negotiate with the new insurance company. Insurers often grant further discounts on the payment of the premium surcharge.

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