Return of the self-employed to the SHI

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Self-employed and return to the SHI

New guidelines for the return of the self-employed make the path to statutory health insurance even more difficult, but the regulations are clearer.

The self-employed and freelancers are often privately insured for cost reasons. But if the income breaks down, health protection in a statutory health insurance (GKV) is often quite cheaper. Simply changing health insurance again does not work, and so many of those affected have in the past taken the detour via (compulsory) employment that is subject to compulsory insurance in order to get back into the SHI. The Association of Statutory Health Insurance Companies has now adopted new guidelines.

Full-time self-employed cannot return to the SHI If you have once turned your back on the SHI as a self-employed person, a return is only possible under considerably more difficult conditions. And the path to employment that is subject to insurance is also subject to high hurdles. People who are self-employed as a full-time job are generally excluded from compulsory health insurance, despite any employment relationships as employees. Before being accepted into the statutory health insurance system, the applicant's main job is checked by the health insurers using a questionnaire, explained Andre Fasel from the miners' association. In addition to the salary from dependent employment, the questionnaire also examines income from other areas such as self-employment. In particular, the time spent and the income from self-employment are a particularly important evaluation criterion for the health insurers with regard to the insurance obligation.

New guideline reduces the discretionary freedom of interpretation in the assessment of self-employment by the respective statutory health insurance, but has so far allowed considerable discretion, which was sometimes interpreted in favor and sometimes to the disadvantage of the applicant. In order to reduce the amount of work involved in submitting an application, the rule of thumb for many insurance companies has so far been: the main profession is always employed as an employee, if this is not exactly a mini-job. However, this generous interpretation will no longer be possible in the future. Because a new guideline of the National Association of Statutory Health Insurance Funds now clarifies the classification of "full-time self-employed activity". From now on, applicants will be assessed as full-time self-employed if they spend more than 20 hours a week on self-employment and / or derive the majority of their income from it. The new guidelines also stipulate that self-employment is always a full-time job if at least one employee with a not insignificant job is under contract with the applicant.

The application is mostly rejected from the age of 55. If the applicants earn the majority of their income as a dependent employee and also spend most of their time here, it is also possible to return to statutory health insurance in the future. Although the new guidelines impose stricter requirements than previously, the examination of full-time work is still basically a case-by-case decision, explained Andre Fasel. From the age of 55, however, the decision is usually to the disadvantage of the applicant. Older people who were previously privately insured as self-employed are generally not re-included in the statutory health insurance even if they take up compulsory insurance.

Detour via the voluntary unemployment insurance Self-employed persons who voluntarily pay into the unemployment insurance, as the Federal Employment Agency has been offering it for start-ups since 2006, are far better off when there is a drop in income and a corresponding return to the SHI. If you give up your independence and slip into unemployment, you are automatically compulsorily insured again in the SHI and can remain in the SHI even if you resume work. This means that the self-employed can also return to the statutory health insurance via the detour of voluntary unemployment insurance.

Stricter guidelines are supposed to save costs With the stricter guidelines, SHI primarily want to save costs, because the decision whether someone is self-employed or part-time has a significant impact on the finances of insurance companies. Full-time self-employed persons, for example, can no longer be insured in the free family insurance via their parents or partner, are exempt from the statutory health insurance obligation in a possible part-time job as an employee and, as a voluntarily insured person in statutory health insurance, have to pay a minimum premium of currently € 274.02 (as of January 1, 2011, increase to € 285.52). In addition, with the new guideline, the umbrella organization of the GKV hopes to withdraw the basis from questionable constructions in which, for example, the wife of a well-earning man takes advantage of free family insurance, but at the same time claims tax losses from self-employed activities. According to the experts, most of the self-employed will only be marginally affected by the new directive, although on the one hand they may have to accept somewhat stricter rules, but on the other hand they will benefit from the clearly understandable basis for decision-making. (fp, 16.12.2010)

Also read:
Numerous private health insurance companies are planning to increase premiums in 2011
Hartz IV draft law: rescue for private health insurance?

Image: Rainer Sturm /

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