Health care/insurance while living overseas

Germany:

Without getting into too much of the “nuts and bolts” and the intricacies of how the German health care system works, I will try and keep this as simple as possible and as specific as possible as how it relates to one’s VA disability compensation amount.

 

Health insurance in Germany became mandatory for everyone residing there as of 2007. Everyone must be able to show they are health insured either through the “Gesetzlichen  Krankenversicherung” (Statutory health insurance – abv. as “GKV”) or a “privat Krankenversicherung” (Private health insurance – abv. as “PKV”), or be able to prove similar coverage through other means such as TRICARE etc… Generally, anyone earning €5.362,- (gross) or less a month (yearly €64.350,- or less) -called “Jahresarbeitsentgeltgrenze”- must be insured through on of the many Statutory health insurances such as the AOK, IKK, BKK, Barmer, TK or the Mobile Krankenkasse etc… Anyone earning more than the above amount can seek health insurance through either a Statutory health insurance on a voluntary basis or a  private company.

The German health care system
200629_BMG_Das_deutsche_Gesundheitssyste[...]
PDF-Dokument [4.2 MB]

"Gesetzlichen Krankenversicherung" (GKV):

There are two types of Statutory health insurance: 1) the “Pflichtversicherung” (mandatory) and 2) the “Freiwilligeversicherung” (voluntary);

  • “Pflichtversicherung” or mandatory: Generally, if someone is employed, they MUST be health insured through one of the Statutory state-runed insurances. The employee does not have a choice in the matter unless their salary is above the €5.362,- monthly income limit (2022). If their salary is above this amount, they can choose whether to be insured through one of the Statutory state-runed insurances on a voluntary basis or a Private health insurance. When the employee’s income is below the above-mentioned threshold and MUST therefore be “Pflichtversichert” by one of the Statutory state-runed insurances, then a total of 14.6% (this percentage may vary between the different State-runed insurances) of the employee’s wages are withheld and paid into the health insurance; the employee and employer split this i.e. 7.3% is paid be each party.
  • “Freiwilligeversicherung” or voluntary: If the person has earnings above the income threshold, is self-employed or a Freelancer, a Student, is “retired” (and not covered by their retirement provider), a Soldier, or Civil servant, they may elect to be insured through one of the Statutory state-runed insurances on a VOLUNTARY basis or through a private health insurance. Here the monthly contribution amount of 14.6% is generally derived from ALL income sources and is then paid to the Statutory state-runed insurances. However, in this instance there is a cap on the monthly contribution, which is set at €4.837,50 a month (€58.050,- yearly), and is called the "Beitragsbemessungsgrenz." There is also a minimum set amount of income in which the 14.6% is set at as well, which is €1.096,67 a month and is called "Mindestbemessungsgrenze." So the minimum amount one would pay is about €160,-'s a month regardless if your income is below the €1.096,67, and the maximum amount would be roughly €767,- a month regardless if your countable income exceeds €4.837,50. 
    • “Familienversichert” or Family member insurance: Generally, if you’re insured through a Statutory state-runed health insurance either as mandatorily or voluntarily, you can have all additional family household members insured under you as “Familienversichert” (Family insured) at no additional cost! However, this is only if the family member themselves has no income or limited income of €520,- or less. If they have income that exceeds this limit, then they would have to be insured separately according to their own income.

"Privat Krankenversicherung" (PKV):

If someone has earned income of €5.362,- (gross) a month or more, is self-employed or a Freelancer, a Student, is retired (and not covered by their retirement provider), a Soldier, or a Civil servant, they may elect to be health insured through a private company. However, being insured through a private company is based on one’s health and not on one’s income. For someone receiving VA disability compensation, this will probably not be an option.

 

O.k. so now we come to how VA disability compensation plays into all of this;

  • If you’re still able to work and fall into the Private health insurance category, then your VA disability compensation amount has no effect on any monthly premiums. However, in the vast majority of cases they will deny insuring you completely due to your health issues, or they may stipulate that they will limit coverage to only anything that is not service-connected.
  • If you’re still able to work and fall into the “pflichtversicherung” category of the “GKV,” then your VA disability compensation amount has no effect on the amount you’ll have to pay on a monthly basis to the State-runed health insurance. The monthly amount is based solely from your earnings from your employer. Any other additional income is not factored in.
  • If you fall into the category of being able to be insured through a Statutory state-runed health insurer on a voluntary basis i.e. “Freiwilligerversicherung” because you’re unable to work or are able to sustain your means solely by your income sources (such as VA compensation, SSA, rental income etc…), or are able to work and choose to become insured on a voluntary basis through the Statutory state-runed health insurance due to your income exceeding the maxiumum amount, then this is where your VA disability compensation will cause problems! As stated above, generally the Statutory state-runed insurances will take into account all income sources to determine one’s monthly contribution regardless of its source. However, if they do try and consider VA disability compensation as an income source, they are INCORRECT in doing so! VA disability compensation is one of the few income sources that are excluded from consideration, as it is considered income under the “Bundesversorgungsgesetz” (more specifically § 31 BVG). Therefore, if you fall into this category of health insurance and the Statutory state-runed health insurer is taking your VA disability compensation into account to determine the monthly premium (“Beitrag”), then you should file an appeal on the above-mentioned basis!

NOTE: If you’re under your Spouse’s Statutory state-runed health insurance as “Familienversichert” and your only income source is VA disability compensation, then you should still be retained as a family member at no additional costs. As stated above VA disability compensation is excluded from consideration due to being considered as income under the “Bundesversorgungsgesetz.” Generally, once a year the state-runed health insurance will send out a questionnaire requiring the family member to report all income sources. VA disability compensation should be reported on this questionnaire, but with reference to the "§31 BVG" and should not be used in their "Beitrag" calculations. If the "Krankenkasse" does use your VA disability compensation as income, then see below;

 

Below is a word.doc to use as an appeal ("Einspruch") or as an official Court complaint filing ("Klage") against one's "Krankenkasse" to dispute their use of VA disability compensation towards the calculation of one's monthly "Beitrag."

 

Also below is a Court case by the "LSG Berlin/Brandenburg" stating that VA disability compensation is considered as 'income' under the § 31 BVG. They also referenced the "Bundessozialgericht (BSG)" and how they see similar income. In addition, is a Court case from the "Bundessozialgericht" explaining how and why income considered under § 31 BVG is not countable income towards one's monthly "Beitrag."

 

If your "Krankenversicherung" is using your VA disability compensation to determine your monthly "Beitrag," then take these three documents to them so they can refigure your monthly amount without your VA disability compensation. If after showing your "Krankenversicherung" these documents and they still refuse to leave your VA disability compensation out of the equation, then you can file a "Klage" with your Court of jurisdiction using the same word.doc and it's arguments.

Appeal - Monthly premiums
Beitragsrechnung Einspruch.docx
Microsoft Word-Dokument [29.5 KB]
Barmer
Barmer.pdf
PDF-Dokument [647.2 KB]
LSG Berlin/Brandenburg Court case
LSG Berlin-Brand. 19-03-2015 - L 31 AS 2[...]
PDF-Dokument [116.7 KB]
BSG Urteil from 1-24-2007
BSG, Urteil vom 24.01.2007 - B 12 KR 28_[...]
PDF-Dokument [138.1 KB]

In addition to the above, if you’re not working or are unable to be insured under your Spouse’s Statutory state-runed health insurance as a family member due to your own countable income exceeding the €520,- limit, then they may outright deny health insurance coverage on the basis that you’re supposedly already health insured through the VA’s “Foreign Medical Program” and that is “analog” to coverage such as TRICARE. This is also incorrect too! Coverage from the Foreign Medical Program only encompasses service-connected disabilities and is generally not an “anderweitige Absicherung im Krankheitsfall,” and also should be appealed. Below is an appeal to a Statutory state-runed health insurance and can be used as a template.

AOK appeal
AOK Einspruch.pdf
PDF-Dokument [179.5 KB]
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