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Statutory health insurance: Compulsory follow-up insurance after membership ends

S.
January 10, 2017, 1:20 pm

Dear Mr. Köper,

In September my health insurance company received the notification from the job center that my application had been received (which, incidentally, was made in April). Thereupon my KK informed me that from now on the KV will be taken over by the job center. The health insurance paid back my contributions that I had paid in from April. Now I have received a letter from the KK that my application was rejected in November and that they therefore want the contributions back. My question is whether it is that easy because I have no income, live with my parents and are supported by them and now have to pay 1700 euros. Why have the contributions been paid back to me even though the application has not yet been approved? Where is the communication problem between the KK and the job center and why do I have to pay for their mistakes now or do I even have to? Many thanks for your help.

RA twill
January 10, 2017, 1:28 pm

Dear S.,

Whether you have to transfer the premium reimbursement to your health insurance company depends on your insurance relationship. If your application for 'Hartz 4' benefits has been legitimately rejected, you are not compulsorily insured through the job center. If you do not have family insurance through your parents either, you are most likely voluntarily insured through the so-called "compulsory follow-up insurance". After that, after the end of a previous insurance, you will by law 'automatically' become a voluntary member of the statutory health insurance, if you do not declare your withdrawal within two weeks of being informed by the health insurance company about the possibility of leaving and you have another claim to coverage in the event of illness (e.g. through a private Health insurance). However, since the statutory insurance regulations are relatively complex, I recommend that you seek legal advice from a local colleague for social law if you have any doubts. You are also welcome to take an initial consultation with me, which is subject to a fee, so I would have to look at your documents. For the initial consultation, please note my cost information.

M.
01/24/2017, 9:37 am

Good Morning! Due to illness, I am drawing a disability pension of € 1,228 (€ 1,200 was insured). This was done privately when I was still employed. Now the job center does not want to pay me the health insurance, but I do not have to pay any KKV contributions from my BU pension (as it is not insured by the employer and not self-employed). At the moment I still have private assets over € 5,500, which I am only allowed to have at the age of 32. Do I have to pay the health insurance myself now? I hear from all sides that I don't have to because I was always compulsorily insured. However, the job center refused my application. I'm desperate! I would be more than happy to receive an answer!
With best regards

RA twill
01/24/2017, 9:50 am

Dear M.,

In principle, the same applies to you as in my previous answer, i.e. it depends on whether your application for 'Hartz 4' or SGB II benefits has been legitimately rejected by the job center or not. If the rejection was correct (which could be the case with an income of € 1,228 per month), you are not insured via the job center, but your previously existing compulsory insurance in the statutory health insurance will be after it has ended 'automatically' converted into a voluntary membership with the same health insurance company ("compulsory follow-up insurance"). For this voluntary membership fees are unfortunately due, which you then have to pay yourself. However, it may be that the job center's rejection of benefits is unlawful if you have not calculated correctly there. In your so-called "requirement calculation" (see Excel calculation aids via Google search) the job center must also include your voluntary contributions to the health insurance, ie of your income of 1,228 €, in addition to the "standard rate" and reasonable accommodation costs, the voluntary contributions would also have to be included will be deducted, the amount of which the health insurance company will inform you of. Then there is a special legal regulation in

Section 26, Paragraph 2 of the Social Security Code 2: For persons who are subject to compulsory or voluntary insurance in statutory health insurance or who are privately insured under the conditions of Paragraph 1 Clause 1 first half-sentence and who in need of help simply by paying the contribution would, a contribution is made to the amount that is necessary to avoid the need for assistance.

In plain language: If you slip just below the 'Hartz 4 limit' because of the high voluntary health insurance contributions, the job center has to pay you a subsidy towards the contributions. You should then expressly apply for this at the job center.

M.
02.02.2017, 01:08 pm

Dear Mr. Köper,

my Insurance coverage ended after receiving unemployment benefits on December 30th, 2016, I do not receive ALG 2 ('Hartz IV'). Only now did I receive an application for "voluntary membership". In an interview (before receipt of the application) with the health insurance company I was told that I have to pay the contribution - which has yet to be calculated - retrospectively (for January) - although there was no insurance cover during this period - even if I cancel within the 2 week period. That is a contradiction! By the way: The state calls the "compulsory follow-up insurance" an automatic voluntary membership. How can something be voluntary if I have to pay for it and can only be exempted from it if, in turn, I enter another health insurance company, where I have to pay again? For me this is an automatic compulsory insurance.

Yours sincerely

MD

RA twill
06.02.2017, 12:08 pm

Dear Mr. D.,

As the name "compulsory" follow-up insurance suggests, this insurance cannot be avoided. In the case of membership as a "voluntary member", one might think that one can dispose of insurance and the obligation to pay contributions, but this is not the case. In this respect, the terminology has failed somewhat. The legislature wanted to close insurance gaps with the regulation in Section 188 (4) of the Social Code. In Germany, it is politically undesirable for someone not to have health insurance. In my opinion, this is also correct in terms of social policy, since illness is a basic risk that everyone should be protected against. If you fail to do so, bankruptcy occurs very quickly in the event of a serious illness, with the result that the taxpayer has to pay for the medical costs through social assistance. In addition, otherwise a large number of people with low incomes would be without insurance cover (see problem in the USA - "Obamacare"). That is why the legislature wants, firstly, that everyone is insured and, secondly, that everyone pays contributions. Your Ask whether the compulsory follow-up insurance also applies to the period prior to receipt of the written notification from the health insurance company about the possibility of leaving (Admittedly with evidence of a different insurance), is currently not legally clarified in court, but ultimately also irrelevant for the question of the obligation to pay contributions, since in the event that the compulsory follow-up insurance does not apply, the so-called "Compulsory fall insurance"enters into § 5 Abs. 1 Nr. 13 of the Social Security Code and the contribution calculation in the mandatory insurance and the compulsory follow-up insurance follows exactly the same rules (§§ 223, 240 SGB V). As the last GKV insured, you cannot escape the statutory health insurance and have to pay contributions one way or the other. With private health insurance policyholders recently, things look a little different, despite the legal obligation to take out private insurance, de facto non-insurance can still result (if you simply do not meet the obligation or, for example, the application documents Comfort yourself with the thought that you were also insured in the GKV in the past, ie from January continuously by law, even if you did not actually have to claim any benefits during this time. The pure "insurance protection" alone is worth contributions ("If you had got cancer, you would have been covered"). If you had medical expenses during this period, ask your health insurance company for reimbursement. Send your last one to your health insurance company as soon as possible Income tax assessment - or if not yet available - proof of your income in the last calendar year and your Unemployment benefit notificationso that the contribution can be set as low as possible. The most important thing is the last income tax assessment, try to get it as soon as possible and fax it to your health insurance company. "Doing nothing" can quickly become expensive in contribution matters; the maximum contribution is then set. Finally, the current wording of the

Section 188 (4) of the Social Security Code 5: (4) For persons whose compulsory insurance or family insurance ends, the insurance continues as a voluntary membership on the day after leaving the compulsory insurance or on the day after the end of family insurance, unless the member declares within two weeks after notification of the health insurance about the exit possibilities his exit. The resignation is only effective if the member proves the existence of a different entitlement to coverage in the event of illness. Sentence 1 does not apply to persons whose compulsory insurance ends when the other requirements for family insurance are met or there is a claim to benefits under Section 19 (2), provided that there is evidence of another claim to cover in the event of illness.

AAD
04/09/2017, 3:17 pm

It would also be interesting if the insured person does not receive a notice from his health insurance until more than a year later that he is in the compulsory follow-up insurance. If no other insurance can be proven for this year - is the old "mandatory insurance" still valid for this period due to the failure of health insurance? If so, could this result in a reduction within the meaning of the Contribution Debt Act for this one year? Thanks.

W.
06/05/2017, 8:26 pm

I was born in April until June 30th. blocked by the job center. As a result, health insurance with the AOK was no longer paid. Now I received that from the AOK Questionnaire on compulsory follow-up insurance. Recently, however, I have had a few mini-jobs that are subject to insurance, in which I have always indicated the AOK as KV. From July 1, 2017, the insurance through the job center will also apply again. Does this have an impact on the compulsory follow-up insurance? Kind regards, W.

RA twill
06.06.2017, 10:38 am

Dear W.,

employment above the € 450.00 limit leads to a Compulsory insurance in the statutory health insurance, which replaces the voluntary membership over the compulsory follow-up insurance. But we only speak of "mini jobs" if the wage does not exceed € 450.00. These are insurance-free in the statutory health insurance. It is therefore not entirely clear what you mean by "insurable mini-jobs". In any case, the health insurance companies receive machine reports from the employers about the amount of the wages and the length of employment, so that the AOK checks and you can request information about from when to when you are employed subject to compulsory insurance and for which periods you do not have to pay any voluntary contributions. Ask the AOK to send you your insurance history in the last X months.

B.
06/19/2017, 11:57 am

Dear Mr. Lawyer, when will I be the lawyer? health insurance in the event of unemployment, I registered as unemployed on June 14th, 2017, I gave notice from my employer until Friday, June 30th, 2017, but have to see an ophthalmologist on Monday July 3rd, 2017 for an eye examination (cataracts). I can no longer do my job as a truck driver like this, it was already established in March of this year, so my employer gave me notice. Now my question: Am I already insured for health, if I may not yet receive any benefits from the employment office, maybe the one ALG application not yet processed is. I would be very happy to receive good advice from you and thank you for your efforts.

RA twill
06/19/2017, 12:11 pm

Dear Mr. B.,

i don't think there is any trouble with your health insurance. If you have submitted all application documents in full and your employer also quickly completes the so-called employment certificate and sends it to the employment office (you can ask your employer about this and push something), your application for unemployment benefit should be approved by the end of the month. If unemployment benefits are granted, a will then be issued EDP ​​notification from the employment office to your health insurance company (also possible retrospectively) and you are insured there according to Section 5, Paragraph 1, No. 2 of the Social Security Code 5. If, contrary to expectations, there are difficulties with the grant of unemployment benefit and the employment office does not report to the health insurance company because of this, but instead only receives the EDP notification from your employer, the health insurance company's IT system may provide you with income forms for voluntary health insurance sent ("compulsory follow-up insurance"). In this case, to be on the safe side, you should fill out the forms and send them back, even if you ultimately do not have voluntary insurance, in order to avoid setting the maximum contribution as a precautionary measure. You can then write to the health insurance company that you are assuming that you have compulsory insurance (tip: if in doubt, don't call health insurance companies, but rather write and always with proof of access). As I said, I assume you have ALG approval and there should be no problems. In any case, you will remain legally insured, see above.

H.
11/22/2017, 10:47 pm

Dear lawyer Köper,

In what form does the health insurance company notify you about the two-week withdrawal period? I signed up for the 01.10. became self-employed and communicated this to the statutory health insurance company in advance in September. I then received a letter from the private customer service there, in which they thanked me for my interest in voluntary insurance and asked me to fill out a declaration of membership and return it. Attached was an information sheet on voluntary membership with general information such as start, end, contribution amount, due date, etc. In addition to many other deadlines, the withdrawal period is also mentioned. Is this letter sufficient or rather unusual as a reference within the meaning of Section 188 (4) SGB V? I have not received another letter about the end of my compulsory insurance or the like. Thanks in advance.

RA twill
11/23/2017, 11:13 am

The wording of the law only states that a "notification from the health insurance company about the exit options" has to be given; this does not even have to be in writing. Therefore, I cannot infer anything from your descriptions that would speak against proper notification by the health insurance company, i.e. the withdrawal period is probably set in motion with the receipt of the letter with the information sheet.

S.
January 9th, 2018, 1:02 pm

Dear Mr. Köper,

I am voluntarily insured, not gainfully employed and apart from my savings I have rental income of € 180 per month. I changed health insurance on 01.01.18. Until my termination it was never a problem that I could not provide a decision from the tax office. Now my old KK requires proof of income since 2014 (2013 last income tax assessment). After I am no longer a member and have paid all contributions correctly to date, do I assume that the old KK can no longer make any claims on me? Or in the end? Many Thanks

RA twill
January 9th, 2018, 2:44 pm

Dear Ms. S.,

If you were insured with a statutory health insurance company up to December 31, 2017, it can also request proof of income up to this point in order to check whether the contributions have been correctly calculated and collected by then. In the event of incorrect calculations, e.g. due to missing proof of income, health insurance contributions can usually be levied for the last 4 years. If you do not submit an income tax assessment in response to the request, the maximum contribution can be set for voluntary members - so here you should comply with the request as much as possible.

S.
January 9th, 2018, 8:54 pm

Many thanks for the quick response. So I still have to provide proof of income to the health fund (I have been voluntarily insured there since 2014), although an income request and a bank statement were sufficient until 2016? I have notices from all years that my contributions are correct after checking the documents.And that is now doubted after the termination. The letter also refers to Section 240 (4) SGB V. However, I am and have never been self-employed and this is also known to the health insurance fund. All of this contradicts my sense of justice, hence the demand. And since I am not obliged to submit an income tax assessment, I have not had any evidence from the tax office since 2014, which I should present by January 17, 2018. regards

RA twill
January 10, 2018, 10:21 am

Dear Ms. S.,

if you were not assessed for income tax or were not obliged to submit tax returns for certain years, have this certified by the responsible tax office. The insured persons of the statutory health insurance are obliged according to § 206 of the Social Code 5, "upon request, to provide information immediately about all the facts necessary for the determination of the insurance and contribution obligation and for the implementation of the tasks assigned to the health insurance company". If you do not comply with this as a voluntary member, the maximum contribution can be set, as I said. In addition, a fine can be set in accordance with Section 307 of the Social Security Code (is rarely used by the health insurances in practice because of the administrative effort). It is therefore idle to get excited about the obligation to cooperate - just send it over, done.

N.
April 23, 2018, 6:10 p.m.

Dear Mr Köper, I have been voluntarily insured with the AOK for almost 10 years because I was self-employed. Now I deregistered my business on January 7th, 2018 because I switched back to an employment subject to social insurance. My income tax assessment for 2016 was issued on January 23rd, 2018 and I immediately sent it to the AOK, with the request that the contribution for 2016, which was set on the basis of the 2015 income tax assessment, be retrospectively recalculated and the overpayment in Amount of € 3,880.35 to be reimbursed. The AOK refused, the notification was issued after the business was deregistered, or would only be used for a new premium calculation for 2018, but since the business had been deregistered, this would not be done. In fact, I paid far too high contributions for 2016 and 2017 because they were calculated on the basis of the profit from 2015. Is this right? Kind regards

RA twill
April 24, 2018, 4:44 pm

Dear Mr. N.,

the legal situation has unfortunately changed only from 2018 Amended in Section 240 (4a) of the Social Security Code 5 to the effect that the contribution assessment based on the last available income tax assessment is initially only provisional and then - after the new income tax assessment has been submitted later - is finally determined. Your case is still subject to the old regulationaccording to which a change in contributions only took place from the month following the submission of an income tax assessment, and in principle only for the future, not for the past. This could have positive consequences (long period with low contributions based on an old tax assessment notice - but with correspondingly low sickness benefit entitlement) and negative (long period with excessively high contributions due to an old tax assessment notice) for the insured. Your constellation, or your contribution setting, unfortunately belongs to the latter cases and was probably based on the old legal situation that was in effect at the time. The legal situation at the time the decision is issued is always decisive.

R.
06/22/2018, 1:54 p.m.

Dear Mr. Köper, until March 15th, 2017 there was a membership in the GKV according to §192. As of March 16, 2017, a voluntary continued insurance was applied for in writing because no other coverage was available. As of April 4th, 2017, an employment subject to compulsory insurance was resumed. Do you have to pay voluntary contributions to the GKV for the period from March 16, 2017 to April 3, 2017 or does the subsequent benefit claim according to § 19 apply here? Many thanks for your help.

L.
02.09.2018, 11:43 am

Dear lawyer,

I have been sanctioned by the job center. 100% reduction in ALG II benefits. AOK sent me a questionnaire that I was only able to fill out with the help of my brother-in-law. I have explained to the AOK that I have no income whatsoever. Also pointed out that, for this reason, I cannot pay the required contributions. Even if I can receive benefits again, my income should probably not be attachable. Despite an objection, the AOK insists on payment of monthly. 178.64 € and defines an income of 1,015 euros, which was set as the minimum assessment basis. Which ALGII recipient receives so much money? The legal regulation is botch. The aim of the law is being missed. Why the homeless are better off is very questionable. These receive 1/30 of the monthly fee per day. Rule set. Is there a possibility that the social welfare office covers the costs for the health insurance?

RA twill
03.09.2018, 12:35 pm

Dear Mr. L.,

While receiving unemployment benefit II, the job center pays the contributions. If you do not receive such benefits, for example because of a full sanction in your case, the job center will no longer pay the contributions and you will then be voluntarily insured. According to Section 240 of the Social Security Code 5, the health insurance company cannot set a lower contribution than the minimum contribution. The question of how you can pay for this does not legally matter. See whether you can legally successfully proceed against the sanction with an objection, a lawsuit or, if necessary, an urgent social court procedure. If the sanction was lawful, the contribution debt is unfortunately 'your default' and an unpleasant but legal side effect of it.

G.
October 17, 2018, 3:53 pm

Until July 31, 2018 voluntary insurance as an employee above the contribution assessment limit and from September 1, 2018 compulsory insurance as an employee: Does the mandatory follow-up insurance apply for the interim period between August 1, 2018 and August 31, 2018 - despite the end of non-insurable employment?

RA twill
March 25, 2019, 7:26 pm

The Bavarian State Social Court has made an important decision on the voluntary statutory health insurance of civil servants entitled to subsidies and has determined that the regulations of the compulsory follow-up insurance also apply to civil servants.

Bavarian State Social Court, judgment of August 9, 2018 - L 4 KR 435/17: Finally, the legislative goal pursued with its introduction speaks for the validity of Section 188 (4) SGB V also for persons entitled to aid, Complete insurance cover against illness for as many people living in Germany as possible to ensure. Before the introduction of Section 188 (4) SGB V, persons entitled to aid were obliged under Section 193 (3) VVG to take out private health insurance with regard to the costs not covered by the aid. However, there was still the option of doing without it and taking the risk yourself. Anyone who did not meet the obligation under Section 193 (3) VVG was only sanctioned by the fact that a premium surcharge had to be paid in accordance with Section 193 (4) VVG. However, this sanction only came into effect if private insurance was applied for at a later date. If this did not happen, there was neither a sanction nor an insurance by virtue of the law. The sanction standardized in Section 193 (4) VVG was therefore unsuitable for persuading people who did not wish to have health insurance to supplement the allowance for a longer period of time to conclude a corresponding contract. It could even have an increasingly deterrent effect because of the rising premium surcharge. In order to achieve the above-mentioned legislative goal as comprehensively as possible, a change in the legal situation was therefore necessary, particularly with regard to persons entitled to aid.

However, it is currently under the file number B 12 KR 20/18 R on this legal issue Appeal proceedings pending at the Federal Social CourtSo it remains to be seen whether the BSG shares this view and thus opens the GKV for civil servants, which is socio-politically desirable because the Removal of civil servants from the GKV system as a whole as disadvantageous, inconsistent and no longer in keeping with the times has proven.

L.
April 1st, 2019, 5:52 pm

Dear Mr. Köper, As a housewife, I had family insurance through my husband. When I received a one-off payment (direct insurance) from a previous employment relationship, the health insurance company transferred this to 120 months and informed me that I was (just) above the income limit for family insurance (otherwise I have no income). I'm not getting a DRV pension yet. I mean, the family insurance continues because it is not a regular payment, but a one-off payment. My objection to the rejection of further family insurance is in progress. I have also filed an objection to the notification of voluntary insurance. Now the health insurance company writes to me that I should withdraw the objection because, according to their statutes, the voluntary health insurance can be terminated retrospectively if I actually continue to have family insurance. If I upheld the objection, I would not be covered in the event of illness. Is that correct? Am I currently without health insurance? Why doesn't the health insurance company just decide now about my family insurance? I am suspicious of the health insurance company.

RA twill
April 2nd, 2019, 12:45 p.m.

Dear Ms. L., the compulsory follow-up insurance only does not apply if you have declared your departure within two weeks of being informed by the health insurance company about the exit options and if you can prove to the health insurance company that you have any other entitlement to coverage in the event of illness.

M.
April 9th, 2019, 6:52 am

Dear Mr. Köper, I got the a few months ago You stopped receiving unemployment benefits and started working as a self-employed person. Now I have received mail from the KK: Since I have not declared my departure in writing, I have apparently been voluntarily insured for almost 4 months now. According to an income assessment of 4,537.50 euros (which does not correspond to my income). I am now asked to return the enclosed questionnaire, in which I do not have the opportunity to state that I have less income. My fear is now that I should pay the 4 months retrospectively, which would be almost 3600 euros. To what extent does this apply or do I have the option of avoiding it or at least having the contribution calculated based on my actual income?

RA twill
April 9th, 2019, 10:39 am

Dear M., Thank you very much for your contribution. In fact, you are under the above "Compulsory follow-up insurance" after the end of the compulsory insurance because of receipt of unemployment benefit if the withdrawal declaration has not been made 'automatically' become a voluntary member of the health insurance company. In these cases, the health insurances must send questionnaires about income in order to be able to calculate the contribution. Voluntary members of the statutory health insurances can only be urgently advised to send these questionnaires back to the health insurer as soon as possible (and with proof of receipt, e.g. by registered mail or fax with delivery report). If you do not provide any income information, the maximum contribution can be set. If the questionnaire (surprisingly) does not offer the possibility of specifying a lower income, simply write on it by hand "My income as a self-employed person is approx. [...] per month from [...] onwards, see attachment" and add one Proof of income at, In the case of a recently started self-employed activity, e.g. current business evaluations, profit calculations or a copy of the sales and profitability forecast. In any case, you should answer the health insurance company quickly. MfG RA Köper


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