Healthcare Switching health insurance fund

If you are covered by statutory health insurance, you have the right to choose your health insurance fund. This means that you are entitled to freely choose your health insurance fund and switch to a different statutory health insurance fund. This applies to everyone with statutory health insurance as of their 16th birthday.

You can choose any of the about 100 health insurance funds in Germany providing they are not associated with a specific place of residence or work, or employment in a specific company.  

If you are a member of the health insurance fund for farmers, you do not have the right to choose as this is a compulsory insurance for this profession.

A list of all health insurance funds together with their areas of coverage and supplemental contribution rates can be obtained from the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband).

The selected health insurance fund is obliged to accept you – regardless of your age, gender or health. It is also prohibited from preventing or hindering the membership by providing false or incomplete advice.

It is only possible to switch between private and statutory health insurance under certain circumstances. Decisive factors include the insured person’s social security status, salary and age.

All statutory health insurance funds largely cover the same benefits. They are legally obliged to do this. These include medically justified services such as doctor’s appointments and hospital stays, for example.

However, there are differences between the providers with regard to:

• Supplemental contribution rate: health insurance funds charge a supplemental contribution on top of the base contribution rate for statutory health insurance. This supplemental contribution is used to seal any gaps in finance not covered by the general contribution rate. The health insurance funds individually set the contribution rate and can adjust it at any time. 
• Voluntary benefits: some health insurance funds voluntarily cover the cost of certain benefits – such as special therapies, alternative treatments and travel vaccinations – or subsidize health courses. The specific benefits are detailed in the health insurance funds’ statutes.
• Service features: health insurance funds differ in terms of how easy their offices are to reach, their contact options and digital tools that they provide their members.
• Bonus programs: some health insurance funds offer programs aimed to promote health-conscious behavior, for example. These are often associated with incentives such as financial bonuses or bonuses in kind.
• Optional tariffs: health insurance funds offer different optional tariffs that provide cover for individual needs or are associated with premiums. They can be opted for voluntarily and have a term of one or three years. 
Certain healthcare services such as the general practitioner tariff (“Hausarzttarif”) are offered by all health insurance funds. With a general practitioner tariff, people undertake to contact their family practice as the first port of call in the event of medical problems. The family practice then coordinates their ongoing care. Many health insurance funds also offer a deductible tariff. With this, people pay a fixed amount themselves in the event of illness and in return pay a lower premium.

How can I find the right health insurance fund for me?

If you want to switch health insurance fund, you should consider what is important to you when it comes to healthcare.

If you want to save money, choose a provider with a low supplementary contribution. However, it can be worth noting the precise service package and any interesting benefits.

Important questions include:

• How would you like to contact your health insurance fund? If you prefer to deal with things in person, a widespread network of offices with long opening hours can be important. If you prefer to deal with everything from home and want to go paperless, apps and digital contact options can make sense.
• Who offers the best advice?
• Which benefits and services are important to you? 
If you are interested in optional tariffs, additional benefits or bonus and treatment programs, it is worth taking a closer look at what is right for your needs.
• Do these services justify the health insurance fund potentially having a higher supplementary contribution rate? Does a cheaper health insurance fund offer the same benefits and service?

Stiftung Warentest regularly publishes a comparison of health insurance fund services and benefits on its website.

After switching health insurance fund, the following benefits must be reapplied for:

• Medical treatments: certain treatments must be approved by the health insurance fund before they start. If a benefit has been approved by the old provider but not yet started, you have to submit a new application to the new provider. You must notify the health insurance fund of any ongoing treatments. The new health insurance fund will usually cover the costs.
• Resources: any loaned resources often have to be returned to the previous health insurance fund or medical store and be reapplied for with the new fund. The insured person will generally receive an equivalent replacement.
• Medication: it is also possible that different but equivalent medication will be reimbursed after switching provider.

Switching is easy: simply send a membership application to the health insurance fund of your choice. You do not need to provide a written notice of termination. The health insurance funds will deal with all the formalities between themselves without you having to do anything. Some exceptions apply however: You have to provide notice if you are leaving the statutory health insurance system, for example to switch to a private health insurance provider or because you are permanently moving abroad.

The notice period is two months to the end of any month. The period is not based on the date of your membership application but when the new health insurance fund reports your application to your current fund.

For example: your new health insurance fund notifies your current fund on March 17 that you have submitted a membership application. You will become a member of the newly selected health insurance fund on June 1 of the same year. 

Commitment periods

Once you have chosen a health insurance fund, you are bound to it for at least 12 months. This is known as the “commitment period”. You can only switch provider once this period has expired.

Example: you send the new provider a membership application on March 17. If the commitment period with your current health insurance fund applies until July 31 of the same year, you can switch to the new fund as of August 1.

If you have also agreed on an optional tariff, additional commitment periods apply.

Commitment periods with optional tariffs:

• no commitment period: optional tariffs for special types of care, for example general practitioner models or treatment programs for people with chronic health conditions
• 1-year minimum commitment period: tariffs involving premium payments and the reimbursement of costs
• 3-year minimum commitment period: tariffs with a deductible and sickness benefit tariffs for the self-employed

If you do not terminate a tariff in a timely manner, it will usually extend automatically. Detailed information can be found in your health insurance fund’s statutes.

There are certain circumstances in which you can switch health insurance fund even if the commitment periods have not yet ended:

• right to extraordinary termination
• end of the membership “by law” 

Right to extraordinary termination

You have a right to extraordinary termination if the health insurance fund

• charges a supplementary contribution for the first time or
• increases the supplementary contribution rate

In these cases, no commitment periods apply. However, the two-month notice period still applies.

You must exercise your right to extraordinary termination by the end of the month from which the new or increased supplementary contribution applies. You must pay the increased rate until your switch to the new fund is complete.

Example: your health insurance fund increases the supplementary contribution as of May 1. You can therefore “cancel” by no later than May 31 of the same year. Under consideration of the two-month notice period, you can switch to the new provider on August 1.

The decisive factor for timely termination is when the new health insurance fund notifies your current fund about the switch – not the date of your membership application. If you wish to make use of your right to extraordinary termination, you should therefore submit your membership application to the new health insurance fund as soon as possible.

Your health insurance fund is obliged to notify you in writing about the change of supplementary contribution one month in advance. The written notification must contain information about the amount of the average supplementary contribution of all health insurance funds and about the possibility of switching to a cheaper fund. It must also indicate the right to extraordinary termination. If this happens late, later cancellation is also possible: this will then be treated as though it had happened in a timely manner.

Termination “by law”

It is also possible to prematurely switch to a different health insurance fund if the membership is terminated “by law”. This is the case if you change employer or your legal insurance status changes, for example because:

• you switch from receiving unemployment benefit I or II to being employed
• you switch from being employed to receiving unemployment benefit I or II
• your regular income at the end of the year rises or falls above or below the annual income threshold (“Jahresarbeitsentgeltgrenze” – JAEG). People whose annual income is higher than the annual income threshold are no longer subject to compulsory health insurance and can obtain statutory or private insurance as a voluntary member. 

In these situations, you do not need to observe minimum commitment periods or the general notice period.

If you change employer and are subject to compulsory health insurance, it is only possible to switch health insurance fund in the first 14 days after starting your new job. If you are voluntarily insured, you can switch provider within the first three months. 

Further information about the annual and current income thresholds can be obtained from the Federal Ministry of Health (Bundesgesundheitsministerium).

Only people who are not subject to compulsory statutory health insurance can obtain private health insurance. These include civil servants, the self-employed and people whose annual income exceeds a certain threshold known as the annual income threshold.  

On the other hand, statutory health insurance is compulsory for employed persons whose income is below this threshold. Students and pensioners are also usually subject to compulsory statutory health insurance. 

It is only possible to switch between private and statutory health insurance if this compulsory insurance status changes. As contributions and contractual terms can also differ greatly, it is advisable to be well-informed prior to any switch.

Switching from private health insurance to a statutory health insurance fund

To switch from a private health insurance company to a statutory health insurance fund, you must be subject to compulsory insurance.

This applies:

• if you work in a role where your income is below the current annual income threshold
• you give up self-employment entirely or only continue to do it as a second job

Furthermore, switching is only possible if you are 55 or under.

If you are considering switching to statutory health insurance, you should first consider the following questions:

• Which benefits do you rely on? Does statutory insurance cover these benefits to a comparable extent?
• If your private insurance contributions are too high: is there a lower rate that you can switch to?

Further information and opportunities to switch from private to statutory health insurance can be found on the consumer advice center website.

In general, switching to a different private health insurance provider is not advisable as you may lose any accruals and other discounts or bonuses that you have acquired over the years when you switch. Your health will usually be re-examined.

Switching to a private health insurance provider

People who are not subject to compulsory statutory insurance can choose whether they want to take out statutory or private health insurance.

Private health insurance sometimes offers certain advantages. For example, it often covers more benefits than statutory health insurance, no co-payments are required and waiting times for doctor’s appointments tend to be shorter. The precise conditions offered by private health insurance providers are specified in the insurance contract.

If you are considering private insurance, it is useful to think about several aspects:

• Contribution and premium conditions: with private health insurance, the contribution amount is based on factors such as age and pre-existing health conditions, not income. The contributions generally increase with age.
• Coverage differences: the benefits covered are regulated in the insurance contract.
• Contractual freedom: private health insurance companies are not obliged to accept people as members. You may therefore find that a company rejects your membership application.
• Health check: the applicant’s health will be checked and the contribution amount determined based on the result.
• Family insurance: a separate contract must be concluded for every family member to be covered.
• Long-term care insurance: private long-term care insurance has to be taken out in addition to the health insurance.
• Switching to statutory health insurance: This is only possible under the aforementioned conditions. An age limit of 55 years also applies, after which it is no longer possible to switch.

If you wish to switch to a private health insurance company, you must give the statutory health insurance fund two months’ notice. In this case, the 12-month commitment period shall not apply.

Further information on switching to private health insurance can be found on the website of the Federal Ministry of Health (Bundesgesundheitsministerium). 

The Independent Patient Advice Service for Germany (UPD) and consumer advice centers provide advice on topics such as switching health insurance fund.

The database provided by the Federal Association of Insurance Advisors (Bundesverband der Versicherungsberater e.V.) makes it possible to search for independent insurance advisors.