As soon as family planning is an issue, many expectant parents ask themselves how or through whom their offspring will be covered by health insurance. In principle, children also have the option of taking out private health insurance. However, there is a big difference between this system and the statutory health insurance system, which provides free family insurance for children (and spouses). There is no such option in private health insurance: here, a separate contract must be concluded for each family member, whereby numerous simplifications have been introduced for newborns. As a general rule, the ‘co-insurance’ of children depends on where the parents are insured and which parent earns the higher income. Adults can of course always take out statutory health insurance (compulsory or voluntary). As self-employed, freelancers and civil servants, they can switch to private health insurance at any time. As employees, their salaries must exceed the so-called annual salary limit (in 2015 it will be 54,900 euros gross annually).
What parents can read about children’s health insurance in this article
Typical questions such as ‘Does my child have to be covered by statutory or private health insurance’ or ‘What does health insurance for children cost’ should be answered as compactly as possible in this article. In addition to general information on compulsory health insurance, this article describes various scenarios that reflect different life situations. Thus, it should be possible for everyone to answer his or her questions. In the end, the most important factors are summarized again.
The law regulates the general insurance obligation
In general, health insurance is compulsory in almost all country, which of course also applies to children. The parents’ desire for optimal health care is understandable, but not decisive for the final decision. As a rule, children are insured with the partner who earns a higher income. The child is then ‘automatically’ insured by this parent. If the father or mother is legally insured, so will the child. In private health insurance, however, a separate contract becomes due, with corresponding additional costs, which also depend on the concrete tariff or the scope of insurance. Parents who wish to offer their offspring optimum protection in the statutory health insurance system may consider taking out private supplementary insurance.
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Registration of the new generation in the PKV and/or GKV
It is generally recommended that parents register their children with their father’s or mother’s private insurance company no later than 2 months after birth. If the parent responsible is insured there for at least 3 months, the baby will be insured retroactively from birth. This means that there is never a gap in insurance at any time. In addition, the admission conditions have been simplified to the effect that no health exam is required for newborns. However, this only applies if the offspring is registered with the same insurance company. As a rule, the scope of the child policy corresponds to the parent tariff, whereby specific adjustments are possible. Due to the flexible tariff structure, it is possible in later life years to adjust the scope of insurance to specific needs. If the child is/is to be accepted by the statutory health insurance fund, a corresponding application for free co-insurance must be submitted in good time or shortly after birth. Later it will be customary for the statutory health insurance fund to review the requirements for family insurance on a regular basis.
The following conditions must be fulfilled for the free family insurance in the statutory health insurance fund:
the family member to be insured lives in the origin country
the family member must not be subject to compulsory insurance or earn more than 405 euros per month (the monthly limit for a mini-job is 450 euros)
the family member to be insured must not be exempt from insurance, i.e. must not be a civil servant or an employee above the annual income limit
full-time self-employment with more than 18 working hours per week is also not permitted
Scenarios that provide orientation: Where the child can be insured with a view to the situation of father and mother
In the following, typical scenarios are described in which most parents will find themselves. In this way, it will be possible to determine where and under what conditions a child can be covered by health insurance.
Scenario 1: Mother not employed, father compulsorily insured in the SHI system (or vice versa)
If the father is the sole breadwinner in the SHI, his wife who is not working and the child are insured free of contribution. In such a constellation, it is not possible to take out private health insurance for the child. For children, the family insurance generally applies until the age of 23, whereby extensions are also possible under certain conditions.
Scenario 2: Father and mother covered by compulsory statutory insurance
If both parents have statutory health insurance, the child is also insured free of charge by one parent. In this constellation, it is not possible to register the child in private health insurance.
Scenario 3: Mother compulsorily insured in SHI, father voluntarily insured in private health insurance
In this case, the father’s income exceeds the compulsory insurance limit. If the income is higher than that of the mother, the child can be insured in private health insurance for a fee. If the private health insurance fund would refuse admission due to illness or ongoing treatment (which is possible in principle), it would also be conceivable to insure the child in the SHI system via the mother. If the father is self-employed or his income is below the annual limit, free family insurance via the mother is possible.
Scenario 4: Mother privately insured, father voluntarily legally insured (the father achieves the higher income).
In this case, the child is insured free of charge in the father’s statutory health insurance because the father has the higher income. If the father’s income exceeds the annual income limit of 54,900 euros (2015), he could also take out private health insurance, so that his offspring could also take out private health insurance.
Scenario 5: Mother with private health insurance, the father with voluntary statutory health insurance (the mother achieves the higher income)
In this constellation, the child can be insured either privately (with costs) via the mother/father or free of charge legally via one parent. This rare scenario can take effect if a parent is privately insured, although too little income is earned. If an application is made for exemption from compulsory health insurance, children can be insured free of charge in the father’s or mother’s statutory health insurance. So there are also scenarios in which there is a certain choice, namely when both parents earn very well but are accommodated in different forms of insurance. In individual cases, however, the individual prerequisites must always be checked carefully!
Result: The choice of the health insurance of the parents has an influence on the children
The scenarios in this article have shown that health insurance and ultimately the concrete income situation of the parents are decisive. In most cases, the child is attributed to the parent with the higher income, whereby additional costs only arise in private health insurance. Thus it is not possible to exploit both system advantages at the same time. If the father earns well and has private health insurance, but the wife is a part-time employee in the SHI system, the child must be insured for a fee by the father. As a general rule, privately insured persons have to reckon with additional costs for their children’s health insurance, in return for which they receive access to first-class health care. Therefore, if possible, the choice of a form of health insurance should be considered in the long term. The SHI system does not address any cost issues, as the family insurance option is possible for children and spouses under the conditions mentioned here.
Health insurance for children: important information in the compact summary
👉The choice of health insurance for the child depends on the insurance and income situation of the parents
👉As a rule, the child is attributed to the parent with the higher income (the parent’s form of insurance then also applies to the child).
👉children up to the age of 23 or even longer are insured free of charge with the statutory health insurance fund.
👉statutory health insurance funds regularly check whether the conditions for free family insurance are still met
👉in private health insurance, a contribution of one’s own is due from birth, the amount of which can, however, be actively influenced
👉In private health insurance, easier admission conditions apply to newborns (no health examination).
👉the legislator wants to prevent the advantages of both systems from being exploited by the aforementioned regulations (privately insured 👉persons with a high income are therefore usually denied the opportunity of free family insurance for children)
👉How do I insure my child? The scenarios listed above provide concrete answers with regard to different life situations
👉With private supplementary insurance, parents can specifically improve the range of services offered by the statutory health insurance for their child.