This ruling hits privately insured people hard

Current verdict

Return to the GKV: Court remains tough

Returning to statutory health insurance is difficult. Even a low salary is not always the ticket, as a ruling by the Federal Social Court shows.

Taking up private health insurance should be carefully considered. The low contributions at the beginning are a bad argument, because the contributions usually increase significantly with age. However, returning to statutory health insurance is not an option: changing after the age of 55 is almost impossible; the federal government closed several loopholes at the beginning of the year.

The current limit for compulsory insurance is 77,400 euros per year. However, for those who have been insured for a long time (with private health insurance since 2002), the limit is lower with a gross annual salary of 69,750 euros.

The present case involved an employee with private health insurance whose salary had been above the compulsory insurance limit for years. The man then suffered a stroke in 2013. From 2015 to 2016, he completed a gradual reintegration with his employer, during which his gross salary of 2,440 euros per month was below the compulsory insurance limit.

A few days before his 55th birthday, the man applied to switch to statutory health insurance. His argument: Since he could only work part-time, a new employment relationship was created. Due to the lower remuneration, he is now required to have insurance again and can switch to statutory health insurance. But the health insurance company rejected the application.

The man was also unsuccessful with his argument in court. The plaintiff’s existing employment relationship did not change with the reintegration. This also did not result in a new employment relationship. “The occurrence and continued existence of incapacity to work generally does not affect the insurance obligation or freedom from insurance associated with employment,” the Kassel judges found.

In order to assess the compulsory insurance limit, only an income should be taken into account that is expected to be received by the employee for one year under normal circumstances. However, this is not the case in the present case because it is not apparent that the plaintiff will permanently work less and therefore earn less. The man is therefore prevented from switching back to statutory health insurance.