Family insurance in the health insurance company: Whoever comes in for free

 Family insurance: In order to bring up their children, many parents step back from work and give up part of their income, at least temporarily. This also changes the health insurance contributions.

The essentials in brief:

• Family insurance: In the statutory health insurance, spouses and children can be insured under certain circumstances. You then do not have to pay your own contributions to the health insurance company.
• In many cases, statutory compulsory insurance is cheaper than voluntary insurance.
• Maternity benefit and parental benefit are non-contributory to statutory health insurance.
• It is possible to return to statutory health insurance during parental leave.

Family insurance - also insured free of charge

Statutory health insurance is attractive for families because, under certain conditions, family members can be included in family insurance without making a contribution. The insured member only has to register the relative with their health insurance company. The family member receives their own health insurance card and can thus claim the services of the statutory health insurance company.

There is no family insurance in private health insurance. In this case, family members must be insured themselves.

What are the requirements for family insurance?

• The family member to be insured must have their usual place of residence in Germany .
• There must be no other health insurance that excludes family insurance, e.g. B. compulsory insurance as an employee or pensioner.
• As a member with family insurance, you can only have low monthly income of a maximum of 470 euros.
• TIP: You can exceed these limits up to twice a year . In addition, the parental allowance does not count as income for health insurance, so that you still remain covered by family insurance if the income limits are only exceeded because of the parental allowance.
• Full -time self-employment excludes family insurance.
• You may not be exempted from the statutory health insurance requirement upon application (exemption from the compulsory insurance).
• In addition, people from certain professional groups such as civil servants, judges, soldiers or clergy cannot be included in family insurance.

Who can get family insurance?

If you meet the above conditions, spouses or life partners can be insured free of charge in the statutory health insurance of their relatives in accordance with the Civil Partnership Act.

Until the divorce decree is final, both spouses can remain in the family insurance - even if they live separately.

As a rule, children can be insured under family insurance up to the age of 18. This also applies to stepchildren and grandchildren if the member mainly maintains them, and to foster children in the same household. The time is even extended up to the age of 23 if the child is not employed, e.g. B. because of going to school and up to the age of 25 if it is in training or studying.

If the training is interrupted by military service, voluntary service or work as a development worker, an extension of another twelve months is possible. Children who are unable to look after themselves due to a disability remain family insured indefinitely.

Termination of voluntary statutory health insurance

In addition, no voluntary statutory health insurance may exist. Existing voluntary insurance can be terminated in favor of family insurance if all other requirements are met. In this case, the twelve-month commitment period does not apply. The health insurance company regulates in its statutes when exactly the family insurance begins – whether with the termination or when the requirements are met. It is best to ask your health insurance company. You can also find the statute on the internet.

Termination of private health insurance

Even those who previously had private health insurance and meet the requirements for family insurance can switch. However, private health insurance does not end automatically, but must be canceled retrospectively by the insured person within three months of the start of family insurance. If those affected miss the deadline, termination is only possible at the end of the respective month, with the result that two insurance policies exist at the same time and double premiums are due. Insured persons must also submit a membership certificate from the new health insurance company to their private health insurance company within two months, stating the reason for the statutory insurance.

When can children not be insured under family insurance?

If one parent is privately insured and the other legally insured, family insurance is excluded if:

• the privately insured parent earns more than the statutory insured and
• the monthly total income of the privately insured parent regularly exceeds one twelfth of the annual income limit (JAEG) (2021: monthly 5362.50 euros).

example

Ms. Müller is an employee and earns 2,700 euros gross per month. She is compulsorily insured in the statutory health insurance.

Her husband is an executive in a company. His income is well above the annual income limit (2021: 5362.50 euros per month). He has private health insurance.

The couple's two underage children cannot be covered by Ms. Müller's statutory health insurance.

Children must then either also be insured in private health insurance or become a voluntary member of statutory health insurance. The costs for voluntary membership in statutory health insurance are similar (approx. 200 euros) or slightly higher than private health insurance for children.

The exclusion from family insurance only applies if all three conditions are actually met. For example, if the father is privately insured and the mother is legally insured, but she earns more than her husband, the children can still be covered by family insurance.

However, the overall consideration of both parents only takes place if both are married or connected according to the Civil Partnership Act. If both parents are not married, the child can be insured either through the privately or through the legally insured parent.

Continued insurance after the end of the family insurance

After the end of family insurance, those affected automatically continue to have statutory health insurance on a voluntary basis, provided no other compulsory insurance applies. However, insured persons can declare their withdrawal within two weeks of being informed by the health insurance company, provided they can prove that they have other insurance in the event of illness - for example private health insurance.

This is how contributions are calculated for those who are compulsorily insured and those who are voluntarily insured

Statutory compulsory insurance must pay a percentage of 14.6 percent of their wages to the health insurance company. The employer pays half of this. In addition, there is the insurance-specific additional contribution, which is 1.3 percent on average, but can vary depending on the health insurance company. Parents pay 3.05 percent and childless 3.3 percent for compulsory nursing care insurance. Here, too, the employer pays half, but does not contribute to the extra surcharge for the childless.

In the case of voluntarily insured persons, on the other hand, not only the earnings from employment or self-employment are used for the contributions, but the entire economic capacity. This also includes pensions, pension benefits and all other income and funds from renting and leasing as well as capital income.

The maximum income to be taken into account is the same for those who are compulsorily insured and those who are voluntarily insured. The income of the insured is used up to a maximum of 4837.50 euros per month to calculate the contributions.

However, there are differences in the minimum income. Those who are compulsorily insured pay their percentage of their wages, no matter how low it is. However, a minimum income of 1096.67 euros applies to voluntarily insured persons, even if lower income is actually achieved.

Different contributions depending on family constellations

If both parents are legally insured - regardless of whether they are compulsorily insured or voluntarily insured - they only pay the contributions from their own income.

In the case of voluntarily insured persons whose spouses or life partners have private health insurance (according to the Civil Partnership Act), the income of spouses or life partners will be added to their own income and used to calculate the contributions.

First of all, the voluntarily insured partner's own income (if any) is taken into account and then half of the spouse's or life partner's income, up to a maximum of half the contribution assessment limit. In 2021, this limit is 2418.75 euros.

However, this is not the case under certain conditions. The main reasons are:

• The voluntary member himself earns more than half the contribution assessment limit or more than the spouse or life partner.
• For spouses who are permanently separated. For this, among other things, the maintenance payments are subsidized.

example

The privately insured husband has monthly gross income of 5000 euros. The wife has no income of her own. Half of the gross income of 2500 euros is credited to the wife as income. However, the amount is more than half the contribution assessment limit of 2418.75 euros. Therefore, the contribution rate of 15.9 percent, including the additional contribution, is offset against the maximum limit of 2418.75 euros. The wife therefore pays a monthly contribution rate of EUR 384.58 plus a contribution to long-term care insurance of EUR 79.82 (3.3 percent in this example).

Allowances for children when taking into account the spouse’s/life partner’s income

Spouses or life partners can claim allowances for children if the income of the privately insured partner is taken into account for the contribution calculation of the voluntarily legally insured partner. For children who do not have family insurance, there is an allowance of one third of the monthly reference amount, which is 1096.67 euros in 2021 (old federal states) or 1038.33 euros (new federal states). For children with family insurance, one fifth of the monthly reference amount is deductible, 2021 658 euros (old federal states) or 623 euros (new federal states). The amount is deducted from the gross income of the privately insured spouse or partner, the remaining income is halved and then credited to the income of the voluntarily insured spouse or partner.

Maternity allowance and parental allowance free of charge

Statutory insured persons do not have to pay any contributions for maternity benefit and parental benefit. If you only had income from employment subject to compulsory insurance before receiving these benefits, you will have health insurance free of charge during this time.

Even with voluntary membership in statutory health insurance, these wage replacement benefits are non-contributory. However, that does not mean that health insurance costs nothing overall.

Because voluntarily insured persons pay contributions on all income. And even those who do not receive any money during maternity leave and parental leave have to pay contributions. Because for those who are voluntarily insured, the health insurance company sets a minimum income, in 2021 that is 1096.67 euros per month, on which the usual health insurance contributions have to be paid.

If the spouse or life partner is also legally insured, family insurance may be an option. However, this is not possible if the income is too high (more than 470 euros in 2021) or the voluntarily insured person is self-employed full-time.

If one of the two parents is privately insured and the other is voluntarily insured by law, the income of the spouse is also counted as income, up to a maximum of half the contribution assessment limit. That is 2418.75 euros in 2021.

Privately insured mothers and fathers usually also have to continue to pay insurance premiums if they receive parental benefit. Neither the receipt of parental allowance nor the start of parental leave justify an obligation to be insured in the statutory health insurance system. Family insurance is also excluded, even if the other person is legally insured. You will then continue to have private health insurance. The following point is an exception.

Working despite parental allowance

The time of starting a family is also an opportunity to set the course for health insurance. Because mothers and fathers are allowed to work up to 30 hours a week on the side in addition to the parental allowance. Therefore, during family time, there is the possibility of pursuing an activity that is subject to compulsory insurance. If you were previously privately insured, you have the chance to switch back to the statutory health insurance system if you work part-time and earn less than the compulsory insurance limit. However, anyone who is self-employed full-time would have to give up their main job and would only be able to work part-time.

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