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How does private health insurance work for civil servants?

In terms of handling, private health insurance for civil servants works completely differently than, for example, statutory health insurance or private health insurance for employees and the self-employed.

The special feature of private health insurance for civil servants is the entitlement to assistance. The allowance is granted by the employer and covers part of the medical expenses.

The amount of your entitlement to benefits is at least 50 percent and increases in most federal states if children are added (exception: civil servants who were civil servants in Baden-Württemberg after December 31, 2012).

So how does private health insurance work for civil servants?

Very simple. The first step is to determine your exact entitlement to assistance. If you are single or married with up to one child, your entitlement to benefits is 50 percent in most federal states and for federal civil servants (exception: Hesse and Bremen and on parental leave from the first child in Bavaria and for federal civil servants).

The remaining costs must be insured with private health insurance for civil servants, civil servant candidates or trainee teachers so that you have 100 percent health insurance protection. If you are entitled to a 50 percent subsidy, you must also take out 50 percent remaining cost protection via private insurance for civil servants.

As already described above, the allowance directly covers part of the medical expenses. If you receive a medical bill for, for example, 80 euros, the subsidy pays 40 euros of this medical bill, and your private health insurance pays the remaining 40 euros, so that the total bill is reimbursed in full (example with a 50 percent entitlement to subsidy).

Your employer provides the subsidy portion without demanding a monthly contribution from you. Although there are some flat-rate cost containment allowances for the aid, an annual personal contribution, this is of course not comparable with the actual costs that would be incurred, for example, for 50 percent health insurance cover for civil servants.

In most federal states, the subsidy rate even rises to 70 percent from the second child onwards. As a result, only 30 percent of the remaining costs are covered by private health insurance (exceptions: Hesse, Bremen and Baden-Württemberg – the subsidy rates are structured differently here). Due to the lower private  Active health insurance coverage, the monthly contribution to private insurance decreases from the second child onwards.

Thanks to the support from the federal states and the federal government, private health insurance is so financially attractive for civil servants, civil servant candidates and trainees. This fact is particularly interesting in the context of the contributions for civil servants who remain in a statutory health insurance company.

What is the difference between statutory health insurance and private health insurance for civil servants?

In most federal states and in the case of federal aid, civil servants who remain in the statutory health insurance scheme do not receive any subsidies (including no part from the employer). You must therefore pay the entire contribution to the statutory health insurance yourself. There are only exceptions in the federal states of Brandenburg, Thuringia, Berlin, Hamburg and Bremen. In these countries, the so-called flat- rate aid is granted.

You can see from this example how clear the financial difference is between statutory health insurance and private health insurance for civil servants:

A teacher with an A13 salary (experience level 6) receives a salary of 4,657.40 euros.

4,657.40 euros monthly salary x 15.3 percent average health insurance contribution (including additional contribution without daily sickness allowance) + compulsory nursing care insurance 3.3 percent = 866.28 euros per month.

Only in the federal states of Thuringia, Brandenburg, Berlin, Hamburg and Bremen would the civil servant receive a subsidy from the employer for this contribution through the flat-rate subsidy. However, the flat-rate aid does not pay 50 percent, but only a maximum of half up to the maximum rate of the statutory health insurance company. There is no subsidy for compulsory nursing care insurance.

The maximum rate of the GVK in 2021 is 703.31 euros. Thus, a civil servant can receive a maximum of 351.66 euros via the flat-rate aid (however, never more than half). In our example, the teacher would receive the flat-rate allowance of 351.66 euros on top of the total contribution to be paid by the GVK (866.26 euros). Your monthly contribution to the statutory health insurance and compulsory nursing care insurance would thus amount to 505.35 euros (GVK contribution limited to the maximum rate: 2 flat-rate allowances + compulsory nursing care insurance). However, this subsidy is only available in the countries mentioned above. In all other federal states and also federal civil servants have to pay the full contribution to the statutory health insurance.

The calculation of the private health insurance contributions is based on three main pillars, whereby the salary plays no role here. Instead, the following criteria are relevant:

  • your starting age
  • your state of health
  • your aid rate

Let’s stay with the example of the teacher above. Let’s assume you have been working in the state of North Rhine-Westphalia for 30 years with a subsidy rate of 50 percent. Private health insurance, including a single room with private medical care in the hospital can be taken out for a monthly fee of around 270 euros without a deductible (without previous illnesses).

This saves the teacher 596.28 euros per month when switching to private health insurance (GVK: 866.28 euros – private health insurance: 270 euros). 

Nevertheless, it is extremely important to evaluate each situation individually. Certain “pre-existing conditions” can lead to additional premiums for private health insurance.

With an independent health insurance comparison , you can determine what contributions you would have to pay from the various health insurance companies if you took out private health insurance.

Private health insurance and statutory health insurance also work differently when it comes to services and processing.

With private health insurance, you will receive an invoice from the doctor or therapist. Simply submit this to private insurance and assistance and you will be reimbursed according to the secured rates from your bank account. You make the transfer to the doctor, such as with a craftsman’s invoice.

Conclusion:

Private health insurance and statutory health insurance for civil servants differ significantly in terms of contribution, performance and processing.

Depending on the federal state, civil servants have to pay the full contribution if they remain in the statutory health insurance fund and are only entitled to a share from the employer in the form of assistance in securing private health insurance for civil servants. The flat-rate subsidy only applies in 5 federal states. Here you will also receive a subsidy to GVK if you remain in a statutory health insurance company.

 

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