(2) For trainees who are liable to pay contributions in the statutory health insurance – except in the cases of paragraph 1 sentence 3 – as a voluntary member or according to § 5 paragraph 1 number 13 of the Fifth Book of the German Social Code, the demand for the health insurance contributions has to be increased, but at most 155 euros. 2 For their insurance contribution as a compulsory member in the social nursing care insurance pursuant to § 20 (1) (12) or (3) of the Eleventh Book of Social Law – except in the cases referred to in the first sentence of paragraph 1 – the need for the proven long-term care insurance contributions increases, but not more than 34 euros monthly.
(3) For apprentices who exclusively
1. are liable for contributions to a private health insurance company which meets the conditions set out in the first sentence of Paragraph 257 (2a) of the Fifth Book of the Social Code, and
2. to be entitled to benefits from this insurance that are similar in nature to the benefits of the Fifth Book of the Social Code, with the exception of sickness and maternity benefits,
the demand increases by 84 euros per month. 2 If the benefits referred to in sentence 1 (2) are limited to a certain proportion of the eligible costs, the requirement shall instead increase by the proven marginal insurance contributions, but not by the amount specified in the first sentence. 3 For apprentices who are insured for contributions under § 23 of the Eleventh Book of Social Security by a private insurance company that meets the requirements of § 61 (5) of the Eleventh Book of Social Security, the need increases by another 25 euros per month. 4 By way of derogation from sentences 1 to 3, for apprentices who exceed the age or semester limit of § 5 (1) (9) of the Fifth Book of the Social Security Code, paragraph 2 shall apply mutatis mutandis.
Administrative provision to § 13a BaföG
to paragraph 1
13 a.1.1 The health insurance surcharge increases the demand. It is granted if the apprentice is covered by health insurance. It is not granted if the trainee is insured free of charge by a family insurance. This also applies if there is also a premium-liable private insurance.
If the contribution-liable health insurance ratio begins and / or ends during the approval period, the notification must be amended in accordance with § 53 sentence 1.
13 a.1.2 In the case of apprentices who are contributors to a statutory health insurance, the need increases without further examination by the amount referred to in the first sentence of paragraph 1, since the statutory health insurance is always a full insurance.
For privately insured apprentices subject to contributions, the following must be considered: Does the insurance company fulfill the requirements of § 257 (2) a and 2 b SGB V? Can the insured claim benefits that correspond in kind to the benefits of SGB V with the exception of health and maternity benefits (not just supplementary health insurance)? Is it a full or partial insurance? Full insurance is to be assumed if the contract provides for reimbursement rates of up to 100%. A deductible in some areas, eg. As in dental treatment or dentures, the assumption of a full insurance does not exclude. Partial insurance is to be assumed if the contract provides for reimbursement rates of less than 100% (eg 20% tariff for eligible children of federal civil servants). In the case of full insurance, the demand increases without further examination by the amount referred to in the first sentence of paragraph 1. In the case of partial insurance, it is still necessary to check the total monthly health insurance costs at the time the application was made and whether the contractual services also include separately calculable accommodation (ie accommodation in single and double rooms) and optional services for inpatient hospital treatment (ie head physician treatment). If a part insurance contract covers these special services, a lump-sum discount of one tenth of the proven health insurance costs will be charged. The upper limit for the refund shall be the amount referred to in the first sentence of paragraph 1.
The trainee must prove that the conditions for the health insurance supplement have been met by presenting a certificate from the responsible health insurance fund or private insurance company. In the case of a partial insurance, the health insurance costs must also be proven and whether the contractual services also include separately calculable accommodation and optional services for inpatient hospital treatment. If the certificate of the health insurance company or the private insurance company does not show all the necessary requirements, the apprentice can prove it by further proof (eg insurance policy, bill of health insurance).
Decisive are the health insurance costs at the time of application. However, a cost statement specific to the time of application is only required if the content of the health certificate to be presented gives reason to believe that the amount of the contribution has changed since the certificate was issued. Amendments to the amount of the contribution that occur after the date of the application will be disregarded for the duration of the approval period.
13 a.1.3 Section 13 a.1.1 and Section 13 a.1.2 apply to the health insurance subsidy according to § 5 AuslandswalagsV if trained abroad, provided that no special requirements are placed on the insurance undertaking and the nature of the insurance benefits. If there is a contributory full insurance, the subsidy is paid independently of the insurance costs. A reduction is only possible if a partial insurance exists.
The laws and regulations provided on this site are for informational purposes only and are not official. For the correctness and topicality therefore no guarantee can be taken over.
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