Family insurance or private child health insurance?

Children are covered by the free family co-insurance in a parent’s statutory health insurance. It does not matter which parent the child is insured with, because there are no extra contributions. However, children can also be privately insured if one or both parents are private patients. In some cases, parents can choose between private and statutory health insurance for their child.

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Families have to choose between GKV and PKV.

Children can also be insured in the SHI.

In the PKV, children are insured in their own tariffs.

Both models have some advantages and disadvantages.

Families with children

Statutory or private – children in health insurance

In the case of employees subject to compulsory insurance, children are usually insured free of charge in the family insurance and receive within the statutory insurance basic protection. In the private health insurance will be one for each child own contribution collected, the amount of which varies depending on the performance. In order for a child to be privately insured, at least one parent must also be privately insured. If both parents are privately insured, there is no possibility of insuring the child in the statutory health insurance.

If one partner is insured in private health insurance and the other in statutory health insurance, the question arises of how the child should be insured. It is generally the case that the child is not entitled to family insurance if the privately insured partner has an income above the annual wage limit (5,212.5 euros gross per month) has and regularly receives a higher income than the legally insured. However, if the legally insured partner earns more or the income of the privately insured falls below the annual wage limit, the child can be re-included in the family insurance. Otherwise it is possible to insure the child with either statutory or private health insurance.

How does family insurance work??

In the Statutory Health Insurance the child’s co-insurance is fundamental no problem. The child is family-insured through a parent and thus has all rights to the statutory benefits plus any additional benefits from the respective health insurance company. If the child receives their own income that is more than 445 euros per month (as of 2019), they are no longer entitled to family insurance. The only exception form the so-called mini jobs. Here the income can be up to 450 euros per month.

In principle, family insurance is valid up to the age of 18. If the child is not in gainful employment and earns more than 450 euros per month, this extends to the age of 23. As part of an apprenticeship, a course of study, voluntary military service or a voluntary ecological or social year, family insurance can continue until the age of 25.

In addition, family insurance is only possible if the child is disabled in the sense of the ninth book of the Social Code and is unable to take care of himself.

Also spouses can be covered by family health insurance if their income does not exceed the above values. If the spouse is self-employed, the activity carried out may not be carried out as a full-time job, i.e. it may comprise more than 18 hours a week. Here, however, the health insurance company judges to what extent the requirements for non-contributory family co-insurance are met.

Private health insurance for children

In the private health insurance, every family member, regardless of whether spouse or child, must be insured independently. With several children in particular, the insurance premiums can quickly become a financial burden, while the GKV’s family insurance does not require an additional premium. However, there is a more extensive range of services at the PKV. In most tariffs, for example, alternative practitioner benefits are reimbursed, which is a decisive argument for more and more parents when choosing the type of insurance. Insured persons also usually get an appointment with a specialist more quickly if they are a member of private health insurance. Working parents, who also have to plan doctor’s appointments with the child exactly, have a decisive advantage.

The parent’s private health insurer must accept the child if requested to do so within two months of birth. This has the advantage that there is no health check and no risk premiums are due – even if the child suffers from congenital diseases.

However, the child may not be insured at a higher rate than the insured parent. For example, if the mother is insured in the basic tariff, the child may not be classified in the standard tariff. However, if you choose a different tariff from another provider, for example, the provider may insist on a health check and, if necessary, risk supplements.

It is not necessary to insure the child with your own provider. Sometimes it has advantages to look for a different provider, for example if the insurance premiums in a different tariff are much cheaper. Here, however, private insured persons should make sure that there is a corresponding range of services despite a low price. In addition, they should rethink which deductible is really worthwhile when the child is insured. Because children get sick more often and this creates costs that have to be paid through the deductible. In addition, when choosing a different provider, a health check is usually required. If illnesses are found, the insurance premiums can increase very quickly through risk premiums. It is worth considering this carefully and, if necessary, taking the advice of an independent insurance expert.

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