Frequently asked questions and answers about private health insurance for civil servants

In this article you will find answers to the most important questions about statutory and private health insurance for civil servants, civil servant candidates and trainee teachers.

Do I have to have private health insurance as a civil servant or civil servant candidate?

No. You have no obligation to choose private health insurance as a civil servant or civil servant candidate. 

These result from the special status of civil servants under social security law who are not obligated to take out health insurance in the statutory health insurance fund (such as employees with an income below the mandatory insurance limit), but always have the freedom to choose between statutory and private health insurance, regardless of salary.

In the majority of the federal states and for federal civil servants, however, the statutory health insurance company has the disadvantage that civil servants have to pay the full statutory Active health insurance contribution . This means that if you remain in the statutory health insurance, the employer does not contribute to the costs of the statutory health insurance. These must be carried by the officer completely out of his own pocket. There are currently only exceptions in The subsidy is granted by your employer and is exclusively responsible for the reimbursement of health costs for civil servants and their families. The entitlement to aid is at least 50 percent, but can increase to a maximum of 70 percent for the civil servant, depending on the state or federal aid ordinance. Only the remaining part has to be insured via a private health insurance for civil servants.

This usually results in a clear financial advantage compared to coverage in a statutory health insurance company, as this requires the full contribution. But even in the five federal states with the flat-rate allowance (50 percent subsidy by the employer also above the statutory health insurance) the contribution of a private health insurance for civil servants can be cheaper than that of the statutory health insurance. This depends very much on the amount of the salary.

However, a blanket statement as to whether statutory or private health insurance is better for a civil servant can never be made without assessing the individual situation. 

How much does private health insurance cost for civil servants?

This question cannot be answered in general, but depends on various factors. The main ones are your starting age , your state of health and your benefit rate . In addition, there are the different contributions of the different providers. Civil servant candidates also receive reduced candidate conditions with most private insurance companies. The salary, on the other hand, generally has no influence on the amount of the private health insurance contribution.

Here are two examples of private health insurance premiums for civil servants:

A 29-year-old teacher (official on probation) opts for private health insurance (salary A13 in the state of Baden-Württemberg). Including the optional inpatient services (single room with chief physician) and supplementary allowance tariff, it is possible to take out private health insurance from around 295 euros per month (with a 50 percent allowance rate – no “pre-existing conditions”).

A 40-year-old civil servant with two children and an A11 salary receives private health insurance from a monthly contribution of 260 euros per month (70 percent subsidy, no “pre-existing conditions”, including a single room and private medical care in the hospital and supplementary subsidy tariff).

Would you like to know how much private health insurance for civil servants will cost you?

How much does statutory health insurance cost for civil servants?

As explained above, there are differences in the costs of statutory health insurance for civil servants. In Thuringia, Brandenburg, Berlin, Hamburg and Bremen there is what is known as a flat- rate subsidy . In these federal states, the employer pays 50 percent of the costs of the statutory health insurance (the civil servant has to pay all of the compulsory nursing care insurance himself). In all other federal states and in the case of federal civil servants, however, the full contribution to health and long-term care insurance is due for the civil servant if they remain in the statutory health insurance system.

Example:

Our teacher from Baden-Württemberg is paid A13 (level 5) and receives 4,587.09 euros per month. The contribution to statutory health insurance is a total of 15.2 percent (incl. additional contribution 1.2 percent / Techniker Krankenkasse) plus compulsory nursing care insurance at 3.3 percent. This results in a monthly contribution to the statutory health insurance fund of EUR 848.61 per month. Entry into private health insurance is possible from 295 euros per month. This means that the teacher saves around 550 euros a month when she decides to take out private health insurance.

Our federal civil servant with two children with the A11 salary (Level 3) receives 3,990.79 a month. The health and nursing care insurance contribution to the GKV for this civil servant is therefore 738.30 euros per month. Civil servants can take out private health insurance from 260 euros, saving around 478 euros compared to statutory health insurance.

From these examples you can see that the contribution to statutory health insurance for civil servants in federal states without a flat-rate allowance is enormously high. Private health insurance for civil servants is significantly more attractive than statutory health insurance for a large proportion of civil servants in terms of contribution and benefits due to the individual support they provide. Nevertheless, it is always important to evaluate each situation individually. Therefore, an individual private health insurance comparison is always recommended for civil servants before deciding for or against private health insurance.

What does lump sum aid mean?

In five federal states, in addition to the offer of assistance in connection with private health insurance, there is the so-called flat- rate assistance (as of 12/2021). Brandenburg, Thuringia, Berlin, Bremen and Hamburg offer civil servants the opportunity to receive a 50 percent share of the costs even if they remain in the statutory health insurance system. However, only the costs up to the maximum limit of the statutory health insurance are covered and the employer does not contribute to the costs of the compulsory nursing care insurance.

Example of statutory health insurance with a flat-rate subsidy:

A teacher with an A13 full-time position (Level 4) receives a salary of 4,826 euros per month in Hamburg. The total health insurance contribution to be paid would amount to 733.55 euros. Since this contribution is below the maximum rate of the statutory health insurance, the civil servant in our example is entitled to the full 50 percent cost sharing via the flat-rate subsidy from the employer. This contributes around 366 euros to the GKV costs. In addition, there is the full contribution to compulsory nursing care insurance of around EUR 159 (3.3% of salary). In our example, the teacher has to pay around 525 euros a month for the flat-rate allowance .

Comparison to private health insurance:

Let’s assume that the teacher in our example is 28 years old. In a private health insurance for civil servants, coverage from about 290 euros per month would be possible (50 percent subsidy, without “pre-existing conditions” – with a single room and private medical treatment in the hospital). Despite the flat-rate subsidy, the civil servant saves 235 euros a month when choosing a private health insurance for civil servants. In addition, the optional services (single room with chief physician) in the hospital are insured within the scope of private health insurance. If the civil servant attaches importance to this service, there would be additional costs to the statutory health insurance company for a corresponding additional insurance.

If the teacher has two children, his or her entitlement to benefits is as high as 70 percent. In this case, coverage with private insurance would be possible under the same conditions as mentioned in the example above, even from 225 euros. However, the contribution to the statutory health insurance does not change, since the maximum rate of the flat-rate subsidy is 50 percent. This increases the savings by 300 euros when choosing private health insurance for civil servants.

Attention: If you opt for the flat-rate subsidy, you should consider that this entitlement will be forfeited if you ever change your office and become a civil servant in a federal state that does not grant a flat-rate subsidy. In this case, the full contribution to the statutory health insurance scheme is due without the employer’s contribution.

What is the amount of the subsidy entitlement based on?

The subsidy rate always depends on your family situation. Single civil servants without children are entitled to 50 percent in all federal states and in the case of federal aid. This increases to 70 percent from the second child and at retirement age in most federal states and in the case of federal aid. However, there are also exceptions. In Hesse and Bremen, for example, there is only an increase in the benefit rate of 5 percent per child. Here, for example, the subsidy rate for civil servants with two children is 60 percent. The maximum subsidy rate in Hesse and Bremen is also 70 percent for civil servants (e.g. a civil servant with 4 children). In these two federal states, there is also a 60 percent entitlement to benefits at retirement age (regardless of the number of children).Important: You do not have to insure your children privately in order to be entitled to the increased benefit rate. The decisive factor is the receipt of the child allowance.

In Baden-Württemberg, on the other hand, civil servants who became civil servants after December 31, 2012 are entitled to a flat rate of 50 percent (regardless of the number of children). This does not increase at retirement age either, but remains unchanged at 50 percent.

Spouses may also be entitled to an allowance. However, this depends on income. These income limits vary from federal state to federal state and are specified in the respective aid regulations. A spouse’s entitlement to benefits is not to be equated with the possibility of taking out private health insurance. For example, the spouse may be entitled to assistance, but at the same time be required to be insured with a statutory health insurance company. If, for example, the spouse is employed for more than 450 euros per month, there is an obligation to be insured in the statutory health insurance system, but the annual income can be within the entitlement to state or federal state aid.

At this moment, the spouse cannot take out their own private health insurance due to the obligation to be insured with the statutory health insurance company, but can still claim medical expenses from the allowance. If the spouse has no income of his own or income from self-employed or freelance work below the income limits of the respective allowance, it is possible to take out private health insurance for civil servants for the spouse.

Children are entitled to 80 percent of the benefits in most federal states and in the case of federal subsidies. Exceptions are the federal states of Hesse and Bremen. In this case, the child’s allowance rate corresponds to that of the civil servant himself (if the civil servant has two children and is therefore entitled to 60 percent of the allowance, the allowance rate per child is also 60 percent).

What health information is important when taking out private health insurance for civil servants?

An essential point when taking out private health insurance for civil servants is basically the state of health. Due to possible “pre-existing conditions”, the companies can demand additional contributions in the form of risk surcharges .

It is therefore very important to correctly answer the health information in the health insurance application. In this context, the pre-contractual disclosure obligation is very important. When you apply, you agree to provide all health information that is noted in the medical files. It may therefore be advisable to request an excerpt from all treatments billed or an excerpt from the medical file from your previous health insurance company or from the individual doctors. Such an excerpt gives you the security that all points are taken into account when submitting the application.

The most important questions about health from the health insurance companies mostly relate to the medical diagnoses made in the last three years in the outpatient area (with general practitioners or specialists, naturopaths, physiotherapists, etc.), and inpatient hospital stays over a period of the last five years are also generally reported years queried. Likewise, the health insurance companies are interested in chronic diseases and recommended treatments that have not yet been carried out. This is just a brief sampling of some of the major health issues facing societies. It is always important that you answer all questions correctly according to the diagnoses in the medical records.

Tip: Since the contributions to the tariffs can increase due to certain diagnoses, it makes sense to ask the private health insurance companies about the amount of possible risk surcharges before taking out a private health insurance contract. This is possible in the course of an independent health insurance comparison. You can request such a comparison here free of charge. This allows you to compare the real contributions of the different tariffs in advance. Such a procedure makes it much easier for you to find the right health insurance for you and you will not have any nasty surprises in the form of additional premiums after you have taken out the insurance.

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