Liability & Law
Family legal protection insurance
entitlement to family insurance
Entitlement to Family Insurance: How to Provide Optimal Coverage for Your Family
Are you planning an extended stay abroad or is there a career change on the horizon that might affect your insurance status? Holding a deferred insurance policy can be crucial to maintaining coverage for your family. Learn how to avoid coverage gaps and understand the role family insurance plays.
The topic in brief and concise terms
A contingency insurance preserves important rights during breaks in your insurance career for later re-entry, particularly regarding health status and possibly the entry age.
For families, it is important to clarify how relatives are insured during the main policyholder's waiting period, especially if they remain in the country or move abroad with them.
The costs of an entitlement are low, but the benefits upon re-entry can be significant, as it protects against high additional contributions or exclusions of benefits.
Understanding Anwartschaft and Family Insurance: The Basics
A waiting period insurance secures your right to return to an existing health insurance tariff at a later date or to enter a new one, often without a new health check. This is particularly relevant if you are temporarily unable to be insured within the usual system. Family insurance in the statutory health insurance (GKV) allows relatives to be co-insured free of charge under certain conditions. The combination of both concepts becomes a challenge if the main insurer requires a waiting period, but at the same time family members still need insurance cover. Careful planning is essential here to avoid gaps in coverage for the family, especially if an income of over five hundred and thirty-five euros (as of 2025) requires relatives to have their own insurance. The exact conditions can vary depending on the health insurance company and the individual situation, so early clarification is important. This section lays the foundation for understanding the complex interactions.
Quick Facts: The Essentials of Family Insurance Eligibility at a Glance
To quickly grasp what an entitlement means in the context of family insurance, here are the key points summarised. These will help you assess its relevance to your situation.
Securing Conditions: An entitlement preserves your health status and/or entry age for health insurance.
Family Members Abroad: If family members accompany you abroad, the main insured's entitlement insurance can often include them.
Family Members in Germany: If family members remain in Germany and are insured through the statutory health insurance, this can influence the possibility of an entitlement for the main insured.
No Entitlement to Benefits: During the entitlement period, there is typically no or only very limited entitlement to benefits from the dormant insurance. Alternative coverage, such as foreign health insurance, is necessary for this period.
Contributions: The contributions for an entitlement are significantly lower than for full insurance, as no ongoing health services are covered. At HKK, the costs are, for example, around sixty-four euros per month with one child.
Check Requirements: The exact conditions, especially whether an entitlement is possible for the main insured if family members remain in Germany, must be individually clarified with the health insurance provider.
These points highlight the necessity of carefully examining your individual circumstances. Below, we will look at specific practical cases.
Practical Scenarios: When Does the Family Entitlement Become Relevant?
Various life situations may necessitate a prospective insurance policy for families. A typical example is the work-related stay abroad of the main breadwinner. If the entire family moves abroad for several years, the prospective policy ensures the option to return to the German health insurance under the previous conditions. Bosch BKK points out that in the case of job-related travel, the prospective policy begins on the day of assignment. Another scenario is the switch from private health insurance (PKV) to statutory health insurance (GKV) due to falling below the annual income threshold. Here, a prospective policy in the private health insurance might be sensible to ensure an easy return when income rises again. For families, it is crucial to determine how the children's coverage should be arranged in the meantime, for example, whether health insurance for the child is better privately or in the statutory system. Also, for trainee civil servants or temporary soldiers receiving health care, considering a prospective policy for eventual entry into regular health insurance, often including the option for family insurance, is important. The costs for a small prospective policy are often only five to ten percent of the regular PKV premium. These examples demonstrate how diverse the necessity for a prospective policy can be.
Weighing costs and benefits: Is it worth considering the entitlement?
The decision for or against a dormant health insurance policy should be based on a careful cost-benefit analysis. The contributions for a waiting period are relatively low. At HKK, the monthly costs for health insurance as part of a dormant policy amount to about forty-nine euros, plus long-term care insurance and an additional contribution. In return, there is the invaluable advantage of not having to undergo a new health examination or being insured at the original entry age when returning or changing status. This can mean savings of several hundred euros a month or even access to the desired insurance when illnesses have occurred in the meantime. Especially for families with children, planning and security are of great importance. Consider the potential additional costs or benefit exclusions without a dormant policy. An example calculation: A 35-year-old returning to private health insurance in ten years without a dormant policy pays significantly more due to the higher entry age and possible health risks. The dormant policy can more than make up for this difference over the years. The costs of a private health insurance can increase significantly without a waiting period. The exact conditions and whether a small or large dormant policy (the latter also secures the entry age) is more sensible depends on the individual situation and the planned interruption duration. Next, we will address the legal aspects and expert tips.
Checklist: The Right Steps for Family Insurance Entitlement
To ensure you don't overlook anything when planning your deferred insurance within the context of family insurance, the following checklist will assist you. It guides you through the key considerations and actions:
Needs analysis: Determine whether deferred insurance is necessary for your situation (e.g. time abroad, job change) and how long the interruption is likely to last.
Check family status: Clearly identify which family members will go abroad and which will stay in Germany. This is crucial for the type of deferred insurance and securing the family.
Obtain quotes: Compare quotes for deferred insurance from your current health insurer or other providers (especially with private health insurance). Be aware of the difference between small and large deferred insurance.
Clarify insurance cover for the family: Ensure that all family members are comprehensively insured during the insured's deferred insurance period – whether through co-insurance in the deferred insurance, their own insurance, or insurance for the child after birth.
Travel health insurance: Consider separate travel health insurance for the period when the German insurance is inoperative. Deferred insurance itself usually offers no performance protection.
Observe deadlines: Inform yourself about application deadlines. Deferred insurance often needs to be applied for within a few months of the reason arising.
Written confirmation: Get all agreements, particularly regarding the co-insurance of family members and conditions, confirmed in writing by the insurer.
Regular review: If your plans change (e.g. duration of time abroad), inform your insurer immediately.
These steps will help you make an informed decision and offer your family the best possible protection. nextsure is happy to support you in analysing your situation.
Avoid common mistakes and navigate around pitfalls
When setting up entitlement, especially concerning family insurance, mistakes can easily be made, leading to problems later. A common mistake is the assumption that entitlement for the main insured person automatically provides comprehensive protection for all family members, even if they remain in Germany. This is often not the case, as the regulations of Bosch BKK show, where it may not be possible to have entitlement for the main insured if relatives remain in Germany and are eligible for benefits. Another pitfall is the inadequate clarification of the scope of benefits during the entitlement period. Many assume they have at least emergency coverage, which is usually not the case. Be sure to take out separate international health insurance if you go abroad, even if you have entitlement. The HKK explicitly points out that there is no entitlement to benefits during the entitlement period. Missing application deadlines is also a critical issue. The period for applying for entitlement is often only a few months after leaving the previous insurance. Another mistake is relying solely on verbal assurances. All agreements should be documented in writing to avoid misunderstandings, as suggested in a case described by Sozialrecht Siegen. The distinction between small and large entitlements (especially relevant in private health insurance) is often not sufficiently considered, which can later lead to higher contributions if the entry age has not been frozen. A combination of different insurances needs to be well planned. Comprehensive advice can minimise these sources of error.
Your individual situation counts: Advice from nextsure
The topic of entitlement to family insurance is complex and dependent on many individual factors. General recommendations are hardly possible. Whether a small or large entitlement is sensible for you, how best to secure your family members, and which deadlines and formalities need to be observed all depend on your personal life and work situation. Nextsure stands by you as a competent partner to analyse your situation precisely and find the optimal solution for you and your family. We take your plans into account, whether it's a stay abroad, a change between different insurance systems, or other professional changes. Our mission is to offer you tailored and easily understandable insurance solutions. We help you keep track of regulations such as those of the voluntary health insurance or the specific features of an occupational health insurance. Use our expertise for your security. Request your individual risk analysis now.
More useful links
Wikipedia provides a comprehensive overview of family insurance in Germany.
The Federal Ministry of Health provides information for those with statutory health insurance.
The Consumer Advice Centre provides information about the requirements for family insurance in health insurance.
The vdek (Association of Substitute Health Funds) offers comprehensive information on family insurance.
The vdek provides a PDF document with basic information on total income in the context of family insurance.
The Federal Office for Social Security provides information on digital customer service and the processing of family insurance and self-payers.
The Techniker Krankenkasse (TK) provides information on entitlements when employed abroad.
The AOK provides information about family insurance and health insurance contributions.
FAQ
What is the difference between small and large Anwartschaft?
The small Anwartschaft grants you the right to return to your previous tariff without a renewed health check at a later date. The large Anwartschaft (mainly relevant in private health insurance) additionally freezes your original entry age, leading to lower premiums upon resumption.
How long can an Anwartschaft insurance policy last?
The duration of an Anwartschaft insurance is usually not limited and can last as long as the reason for the Anwartschaft exists (e.g., during a stay abroad).
Do I need to report my family members separately for the Anwartschaft?
Yes, it is very important to clearly discuss the situation of your family members (whether they are travelling with you, have their own income, etc.) with the health insurance provider and specify this correctly, as it influences the conditions of the Anwartschaft.
Can I also take out an Anwartschaft for the long-term care insurance?
Yes, an Anwartschaft insurance for health insurance often automatically includes an Anwartschaft for long-term care insurance. It is also possible to take out a separate Anwartschaft exclusively for long-term care insurance.
What happens to the Anwartschaft after the end of the stay abroad?
After the reason for the Anwartschaft ceases (e.g., returning from abroad), you must actively reactivate the insurance. Usually, deadlines ranging from two to three months apply.
Is an Anwartschaft advisable when switching from private to statutory health insurance?
Yes, if you switch from private to statutory health insurance (e.g., due to falling below the income threshold), an Anwartschaft in private health insurance can be sensible to keep the option of returning to previous conditions open later.
