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Applying for exemption from compulsory statutory health insurance

Service Description

In Germany, health insurance is compulsory. The law stipulates who is compulsorily insured in the statutory health insurance scheme and who is exempt.

In exceptional cases, you can be exempted from compulsory statutory health insurance. The exceptions mainly apply to people who were previously exempt from compulsory insurance and become subject to compulsory insurance under the statutory provisions.

Exemption from compulsory insurance means that you must take out voluntary statutory health insurance or conclude a contract with a private health insurance company. To be exempt from compulsory insurance in the statutory health insurance scheme, you must prove that you are covered in the event of illness.

You apply to the statutory health insurance fund for exemption from compulsory insurance.

As a rule, you cannot reverse the exemption. Switching from private to statutory health insurance, for example, is only possible under certain conditions.

Process flow

  • You can apply for exemption from compulsory insurance by post or - in the case of many statutory health insurance funds - in person at the office.
  • Send the application to the statutory health insurance fund with which you are insured or - if you are not covered by statutory health insurance - to a statutory health insurance fund that is open to insured persons at your place of residence or employment.
  • Fill in the application form of the statutory health insurance fund and submit it to the health insurance fund together with the required documents. There are usually different forms depending on the reason for exemption.
  • The health insurance fund will check whether you can be exempted from compulsory insurance and inform you of the result.

Requirements

The prerequisite for exemption from compulsory insurance is that you are entitled to cover in the event of illness, for example

  • have private health insurance.
  • You must also continue to receive an allowance or free military welfare and your salary in the event of illness. This is the case for civil servants, police officers and members of the armed forces, among others.

You can apply for exemption from compulsory insurance if

  • the statutory annual income limit for compulsory insurance is increased. You have become subject to compulsory insurance because your annual income is now below the annual income limit.
  • You receive unemployment benefit and have not had statutory health insurance in the past 5 years.
  • You reduce your weekly working hours by at least 50 percent and you have been exempt from insurance for at least 5 years.
  • You reduce your weekly working hours due to care or family care leave.
  • you work part-time for a maximum of 30 hours per week during parental leave.
  • you take up part-time employment after parental, nursing or family care leave, you have also been exempt from insurance for at least 5 years and your income would be above the annual income limit if you worked full-time.
  • you become subject to compulsory insurance because you are drawing a pension
  • you take part in a measure, for example pension insurance, to help you participate in working life.
  • you start a course of study.
  • you are doing unpaid work experience, for example an internship.
  • you are employed as a person with a disability in a facility, for example a recognized workshop for people with disabilities.

Which documents are required?

  • Proof of your entitlement to cover in the event of illness, for example a confirmation from your private health insurance company.
  • Depending on the special case, further documents may be required. Please contact your statutory health insurance provider for more information.

What are the fees?

You do not have to pay anything for the application.

What deadlines do I have to pay attention to?

  • You must submit the application within 3 months of the start of the compulsory insurance. The exemption from compulsory insurance then starts on the 1st day of the following calendar month.
  • You will be exempted retroactively if you or co-insured family members have not yet made use of statutory health insurance benefits. For example, you must not have received any medical examinations or prescription medication from the pharmacy.
  • The exemption from compulsory insurance applies for as long as the reason for exemption exists.

Processing duration

Processing normally takes around 3 to 4 working days.

In order to process and decide quickly, your health insurance fund must have the necessary information and any required documents in a complete and meaningful form. The health insurance company decides on applications promptly.

Please note that the processing time stated is an average value for all health insurance companies. It may vary in individual cases. The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent to you or your health insurance company by post.

Legal basis

Applications / forms

  • Objection
  • Action before the social court

Appeal

  • Forms: yes
  • Written form required: no
  • Informal application possible: yes
  • Personal appearance necessary: no
  • Online service available: no

Further Information

Author

Forwarding service: Deep link to the original portal

Spitzenverband Bund der Krankenkassen (GKV-Spitzenverband)

The text was automatically translated based on the German content.

Technically approved by

Federal Ministry of Health (BMG)

Professionally released on

19.01.2023

Source: Zuständigkeitsfinder Thüringen (Linie6PLus)

Competent Authority

Liste der Krankenkassen auf der Seite des GKV-Spitzenverbands (Spitzenverband Bund der Krankenkassen)

WWW
List of health insurance funds on the website of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)