Employees from a certain gross annual income have the opportunity to be exempted from compulsory insurance. This means that you can choose between voluntary health insurance and private health insurance. Which insurance you ultimately choose depends on the services offered by private health insurance, your living conditions, the costs and a comparison of different tariffs. In this article, you will learn everything important and get practical tips on private health insurance for employees.
When can an employee choose to have private health insurance?
Employees generally have the option of private insurance if they exceed the mandatory insurance limit, also known as the annual earnings limit (JAEG). This limit is recalculated for each year and is based on general wage development. JAEG has been growing steadily since 2011. It is 2019 at 60,750 euros. If your annual gross income exceeds this sum, you can switch to private health insurance as an employee.
If your salary exceeds the compulsory insurance limit, you will normally receive the message from your statutory health insurance fund that you are a voluntary member of the GKV and that you can freely choose your health insurance. After receiving this information, you can stay in the GKV or switch to private health insurance.
If your employee salary is above the statutory insurance limit, you should think twice about whether statutory health insurance or private health insurance makes sense for you.
Contribution assessment limit and compulsory insurance limits 2019:
Contribution assessment limit: This value indicates up to what amount of your salary social security contributions are calculated maximum. The salary component above this limit is no longer taken into account for determining the contribution amount.
Insurance limit (annual income limit): This value is also called the annual income threshold and determines the salary level, from which there is no compulsory insurance for statutory health insurance and insured can choose between SHI and PKV. If the earnings are below this limit, the GKV is mandatory and there is no choice.
When does a change in the PKV make sense to employees?
Anyone who stands as an employee before switching to private health insurance should think carefully. Basically, if you join the PKV early, you can benefit from low-cost contributions with high employee benefits.
At the same time, however, you should take into account that a return to the GKV after the decision for private health insurance is not so easy.
- Older employees with pre-existing conditions: For this group, a stay in the GKV is usually the better choice. In this way, potential exclusions and risk premiums in private health insurance can be avoided.
- Employees with children: Children of GKV members receive a non-contributory co-insurance until the age of 21 or, if the children do not have their own income, also until the age of 25 years. In this case, statutory health insurance can make more sense, because otherwise would have to be completed separately for each child, private health insurance, which would drive the monthly costs significantly in the air.
- Employees without children, without serious pre-existing conditions, with high incomes: This group could benefit significantly from a change to private health insurance. On the one hand, the contributions can decrease with higher performance. Or more comfortable private health insurance tariffs can be chosen without increasing the contributions enormously, as the employer also has to take a share.
- Employees with higher benefit: Those who would like to benefit from shorter waiting times at the specialist, the free choice of doctor and private medical services as an employee can think about a change to private health insurance if he exceeds the compulsory insurance with his salary.
Benefits of PKV for workers
Those who opt for private health insurance as employees can benefit from various advantages. Which includes:
- individually adjustable insurance protection
- Insurance contributions are not income-dependent
- A possibility of free choice of specialist treatment
- high reimbursements for dentures possible
- Insurance benefits usually conform to medical progress
- Premium refunds when benefits have not been used
- Higher benefits in-hospital treatments possible
- higher hospital accommodation possible
- higher reimbursement for visual aids possible
Employees in the SHI can provide with private supplementary insurance such as dental insurance for extended insurance coverage. However, then it is questionable whether the combination of statutory health insurance and supplementary insurance is cheaper than private comprehensive health insurance.
Use of premium refunds
Especially young employees can benefit from the premium refund of private health insurance. If no health insurance benefits are used within one insurance year, insured persons can be reimbursed up to six monthly contributions, depending on the chosen tariff. The advantage for employees: They receive both the employer’s contribution and their own contribution. However, employees must also consider possible tax reductions for premium refunds.
Employees should pay attention to the PKV
If employees opt for private health insurance, they should definitely choose a solid insurance company. As a rule, a change in private health insurance rarely happens when insurance has been chosen once.
Therefore, future policyholders should compare not only tariffs but also insurance companies before applying for insurance.
When choosing the tariff, the following factors have to be taken into account in the policy and the costs:
- the insurance rate itself and the options contained therein
- the state of health of the policyholder as well as his previous illnesses
- the age of the policyholder
The voluntary employer grant from private health insurance
Employers provide a subsidy not only to the GKV but also for the PKV of their employees. Ultimately, the good health of employees also benefits the company.
The distribution of the health insurance contribution is usually also for private health insurance in equal parts for employees and employers.
The employer’s contribution to private health insurance can be up to 50 percent of the monthly contribution for employees. The monthly employer’s allowance is based on the subsidy, which would also be payable for the SHI and is at a maximum of 7.3 percent of the income ceiling.
A condition for the receipt of the subsidy is that the achievements of the PKV at least correspond to the achievements of the GKV. The employer’s allowance is not charged directly to the insurance company, as in the case of the GKV, but transferred to the employee’s account together with the salary.
Development: Employer grant for private health insurance (PKV) from 2010 to 2018
Anyone who earns around 4,000 euros can receive a health insurance subsidy from the employer for his private health insurance of up to 300 euros. The maximum possible employer grant is € 323.03. At the same time, the cap will enter into force for a maximum of 50 percent of the monthly PKV contribution.
If an employee does not make full use of the employer’s allowance because of a very favorable private health insurance plan, he or she can use the difference to the maximum amount of the insurance contributions of his family members. This may be the spouse or children up to the age of 18 years. The unused employer allowance can also be shared among the children up to the age of 23 if they do not have their own income. Fully exempted from the age limit, the employer’s allowance is for children who suffer from a disability that prevents them from providing for their own livelihood.
Employees insured in private health insurance are entitled to an employer grant even if their income is low.
Further requirements for a grant from the employer to the PKV
The amount of the employer’s subsidy can be calculated on the basis of the so-called “employer’s certificate”. This certificate is privately insured by their insurance company for presentation to the employer.
The Social Code V (SGB V) provides the following conditions for the payment of a PKV-employer grant:
- Private health insurance must be conducted in the manner of life insurance and make provisions.
- The PKV must offer a base rate.
- The majority of the insurance premiums must be used for the benefit of the insured person.
- The PKV must waive a period of notice within the scope of the normal termination right.
- The private health insurance company may not operate its insurance with other insurance partners.
Service module sickness allowance of PKV for employees
Employees have the advantage over self-employed that their salary in case of illness up to six weeks in the full amount paid by the employer. Those who have statutory health insurance can receive sickness benefits from the GKV after this time.
For privately insured employees, this rule does not apply. You have to look for sickness insurance yourself.
For this reason, it is recommended that the insurance coverage for employees in the PKV also includes daily sickness insurance. She should work incapacitated from the seventh week. Recommended is a daily allowance, which corresponds to the 30th part of the monthly wage. The amount of the daily allowance can be set individually in the PKV.
Can employees transfer from private health insurance to the GKV again?
Many PKV employees assume that they can no longer switch to SHI. That is not completely correct. Although it is difficult to switch from private health insurance to compulsory health insurance, it is possible under certain conditions.
As long as the insured person’s income is above the compulsory insurance limit, a return to statutory health insurance is not possible. However, if the salary decreases, for example, due to a career change or a change of employer and the limit is reached, a change is possible.
Likewise, the loss of employment when receiving unemployment benefits can allow a return to SHI.
Almost impossible is the return to the GKV for employees over 55 years. Whether the change back to the statutory health insurance is possible, individual cases would have to decide. If you want to avoid the high costs of PKV in old age, you may want to try to get the base rate.
If you have any questions about this topic and need advice on PKV for employees, our experts are happy to help.
Private health insurance for public employees
Anyone employed in the public sector is paid according to the Public Service Tariff (TVöD) or the Länder Tariff Code (TV-L). Employees can usually use their salaries and respective regulations to easily determine whether private health insurance is available in the public sector or not. For here too, the annual earnings limit (JAEG) of 60,750 euros applies (status: 2019). However, as this limit is based on the development of annual incomes, it can also decrease if the general salary trend is negative. In this case, better-paid employees in public service have the opportunity to switch to private health insurance earlier.