FAQ Stefan Fielow HanseMerkur
This document is a comprehensive expert FAQ and knowledge base authored by Stefan Fielow for HanseMerkur, covering every major aspect of private health insurance (PKV) in Germany. It explains the basic principles, eligibility groups, and the legal income threshold that allows employees to opt out of statutory insurance. The guide details how premiums are calculated—highlighting age at entry, health status, selected benefits, deductibles, and the role of ageing reserves and statutory surcharge. It contrasts PKV with statutory health insurance (GKV) on contribution mechanisms, benefit scope, family coverage, and long‑term cost dynamics. Specific sections address families and children, employer contributions, the impact of retirement, and the financial consequences of part‑time work, unemployment, or self‑employment. The document outlines the legal pathways and age‑related restrictions for returning to statutory insurance, and it explains tariff‑change rights under §204 VVG, internal versus external switches, and the handling of ageing reserves. Critical misconceptions (e.g., unaffordability in old age, sustainability) are debunked, and a set of advanced advisor‑level questions is provided to deepen analysis of tariff quality, open‑list medical aids, GOÄ relevance, deductibles, risk assessments, and premium‑relief plans. Throughout, the tone is instructional and balanced, aiming to equip individuals and advisors with a nuanced, long‑term decision framework for choosing between private and statutory health coverage in Germany.
Topics
Private Health Insurance Fundamentals & Eligibility Criteria
Defines PKV, outlines who can choose it (high‑earning employees, self‑employed, civil servants), and explains the legal income threshold (Jahresarbeitsentgeltgrenze) and contribution assessment ceiling (Beitragsbemessungsgrenze).
Premium Calculation Drivers and Age‑Related Reserves
Details the factors that determine PKV premiums—age at entry, health status, selected benefits, deductible, and tariff‑specific elements—and explains how ageing reserves and statutory surcharge stabilize costs over a lifetime.
Income Threshold vs. Contribution Assessment Ceiling Explained
Clarifies the common confusion between the income threshold that permits opting out of GKV and the contribution assessment ceiling that caps statutory contribution calculations.
Benefit Comparison: Private vs. Statutory Health Insurance
Compares the scope of coverage (dental, hospital, specialist, alternative treatments) and the principle of solidarity versus risk‑based premiums, highlighting where private plans can be superior and where statutory may be advantageous.