legal or not?

Expat health insurance in Germany

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First things first

There are many excellent expat health insurance available around the world and brand-names like  AETNA, ARPIL, AWW, BUPA, CIGNA or  IMG offer good coverage. 

In Germany a expat health insurance does not fulfill the legal requirements to be considered as a law-compliant substitute for the German public health insurances.
German public or private health insurances demand penalty-back charges from everyone who has been living in Germany and been insured „incorrectly “with an international health insurance in the past months or years.
Expat health insurance may be advisable if you are only staying in Germany for a short time or for the first few months after your arrival.

Expat health insurance

Patrick Ott
Patrick Oliver Ott
Expert for insurance and finance
3. April 2022
Differences for expats and tourists

Expat health insurances - legal or not? 

Before you read the following info, please make sure you have read this important information about the dubious legal status of international health insurances in Germany.

On international platforms or from insurance brokers / agents outside Germany we find that international health insurances are being offered and sold indiscriminately to everyone around the world, even if the client claims to have his or her residence in Germany. This derives from a poor knowledge or even no understanding of the particular health insurance laws in Germany which are very different from most countries around the world.

Doubtlessly there are many excellent expat health insurance available around the world and brand-names like AETNA, ARPIL, AWW, BUPA, CIGNA or IMG, to name just some of the best-known health insurances around the world, offer good basic coverage up to fully comprehensive premium insurance plans that can be used all around the world.

The problem is: in Germany not one of them fulfills the legal requirements to be considered as a law-compliant substitute for the German public health insurances. Which is what in German a private health insurance is supposed to be: a full substitute, an insurance coverage in lieu of the public insurance and not on top or besides the German public health insurances.

When does expat health insurance make sense?

Even though expatriate health insurance is generally not possible as an alternative to German health insurance, there are still situations in which this type of insurance makes sense:

  1. You have had your insurance for many years already and plan only on a very time-limited stay in Germany. In such a case – especially for EU-citizens not needing to struggle with Visa-requirements – it can be sensible to continue using your international health insurance so that you have an ongoing coverage to take with you when finally, you leave Germany again.
  2. You are seconded by your employer to Germany. Legally secondment means that you remain outside the German welfare system entirely and only pay taxes in Germany. Secondment can be arranged by employers within the EU but there are also secondment agreements with many countries around the world, for instance with the USA. Under secondment you won’t be able to enter the German health insurance system anyway and the use of an international health insurance may in effect be your only good choice after all.
  3. You’ll enter the German health insurance system out of necessity, but want to continue your good coverage from an international health insurance still because you like its great coverage and have used it for many years successfully already.  In such a case you can basically use it as a supplement to the German public health insurance (either as an employee you are compulsorily insured in the German public system or for other reasons you are a member of it).

As experts for expats we know these insurance plans very well that many non-specialized insurance broker or agents do not know because more often than not these plans are not suitable for Germans or German residents who need to rely entirely and solely on such insurance plans.

We can offer you an international health insurance from well-rated insurance companies as named above if we find together that this is a good solution in your special individual circumstances or of course if you insist after having been informed by us about the legal compliance-issues in Germany and still decide so in full knowledge of the facts.

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Switch from international to German insurance

What if you have used such an international insurance for many years and now find yourself in a position needing German health insurance instead? Since we are advising Expats in Germany neigh on two decades by now, we have encountered very often Expats who lived happily and well-insured with international health insurance plans for years, even decades in Germany.

And suddenly find themselves in a situation where they’ll need to switch into the German health insurance system (due to changes of residence status, changes of plans to stay in Germany for longer or even indefinitely, marriage and family planning often also on top of the list of events changing the need for health insurance coverage).

We can help to get around the worst problems and penalties for Expats

First you need to understand that if you have lived for many years in Germany based on an international health insurance, you usually have lost all chances to access the German public health insurance system. If you are still under the age of 55 years, you might get into the German public health insurance of your choice by means of lawful employment with a gross salary below the legal threshold due to compulsory membership for employees.

We created this video for all expats looking to understand the healthcare system and secure their health:
Health insurance for expats in Germany
Or, if you spouse is a member of public health insurance in Germany and you are at least for some time without your own source of income, you can join as a dependent family member and continue after some time due to the “Obligatorische Anschlussversicherung” in your own right even when re-starting your business etc.

But this is a legal minefield and you’ll need to hire an expert consultant in order to set this up in a secure way so that it won’t backfire later if audited.

In consequence usually only, a switch into a German private health insurance is legally feasible. This, though, comes with some other problems: Both the BAFIN (federal insurance authority) and the head association of German private health insurance have decreed that they deem international health insurance plans not to be legally compliant as substitutive health insurance under German laws.

Therefore, they will universally demand penalty-back charges from everyone who has been living in Germany and been insured „incorrectly “with an international health insurance in the past months or years if at a later point in time you want or need to switch to a German health insurance.

Which can often happen if you have a chance for employment (because international insurances don’t work in employment in Germany at all for lack of tax recognition for employers). Or, just as often, because the immigration office (Ausländeramt) demands after the first or second residence permit suddenly now full German health insurance.

How high will my back-charges be if I used international health insurance in error?

The back charges are computed like this: 6 full monthly premiums (assuming that you have been insured longer than 6 months with the international health insurance while residing in Germany), and after that for each consecutive months of failing to have compliant coverage with 1/6ths of the monthly premiums.

Example: you’ll sign up with a German private health insurance for a monthly premium of 500 EUR. You have used your international health insurance for 3 years in Germany. You’ll be back-charged 3.000 EUR for the first 6 months plus another 2.500 EUR for the following 30 months.

Solution: no back-charges while still getting back into the German health insurance system

For such cases we here at Chambervelt, Rooselain & Cie. have worked out together with the ASEIG (Association of self-employed Expats in Germany) a special group-plan that is offered by a bona-fide German health insurance company of good reputation (HALLESCHE) which complies with both § 193 Abs 3 VVG and § 257 Abs 4 SGB V and is thus a fully compliant substitutive German health insurance.

And only with this particular group insurance plan the German insurance company does waive any back-charges which otherwise they are legally beholden to collect from clients.

It is a plan with excellent benefits and can be run for max. 5 years. After 2 years you’ll have the right to switch to any other insurance plans of the HALLESCHE without further health checks, i.e. ( we can already work out quotes for you so that you can see which plans will he available at what monthly costs and with what benefits now as part of the selection process)

And all other German private health insurance companies will also accept this insurance as law-compliant previous insurance coverage and thus you avoid facing these back-charges.

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