Anwartschaft Familienversicherung: How to optimally secure your family
8 May 2025
4
Minutes
Katrin Straub
CEO at nextsure
Are you planning an extended stay abroad or facing a career change that may affect your insurance status? A prospective insurance policy can be crucial for ensuring your family's coverage. Learn how to avoid coverage gaps and the role of family insurance in this process.
The topic in brief and concise terms
A deferred insurance policy secures important rights for re-entry at a later date during interruptions in your insurance career, particularly regarding health condition and, where applicable, entry age.
In families, it must be precisely clarified how relatives are insured during the main policyholder's waiting period, especially if they remain in the country or go abroad.
The costs of a deferred membership are low, but the benefits upon re-entry can be substantial, as it can protect against high additional contributions or exclusions from benefits.
Understanding entitlements and family insurance: The basics
A deferral insurance secures your right to either rejoin an existing health insurance plan or enroll in a new one at a later date, often without a new health examination. This is especially relevant if you are temporarily unable to be insured within the usual system. The 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 challenging when the main policyholder requires a deferral, but at the same time, family members still need insurance coverage. Careful planning is essential here to avoid coverage gaps for the family, particularly when 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 provider and individual circumstances, so early clarification is important. This section lays the foundation for understanding the complex interactions.
Quick Facts: The Essentials of Family Insurance Entitlement at a Glance
To quickly grasp what eligibility means in the context of family health insurance, here are the key points summarised. These will help you assess its relevance to your situation.
Secure terms: Eligibility locks in your health status and/or your entry age for health insurance.
Family members abroad: If family members go abroad, the main insured's standby insurance can often include them.
Family members in Germany: If relatives stay in Germany and are, for example, co-insured under the statutory health insurance, this can impact the eligibility options for the main insured.
No entitlement to benefits: During the period of eligibility, there is usually no entitlement or only limited entitlement to benefits from the inactive insurance. Alternative cover, such as foreign health insurance, is necessary for this period.
Contributions: Contributions for eligibility are significantly lower than for full insurance, as there are no ongoing health benefits covered. At HKK, the costs are approximately sixty-four euros per month with one child.
Check requirements: The exact conditions, particularly whether eligibility is possible for the main insured if relatives remain in Germany, must be clarified individually with the health insurance company.
These points highlight the need to carefully examine your individual circumstances. Following, we look at specific practice cases.
Practical Scenarios: When Does Entitlement Become Relevant for Families?
Various life situations may require a deferred insurance policy for families. A typical example is a work-related overseas stay of the main breadwinner. If the entire family moves abroad for several years, the deferred insurance ensures the option to return to the German health insurance under old conditions. Bosch BKK points out that for company-related trips, the deferment begins on the day of dispatch. 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 deferred insurance in the PKV can be useful to be able to return without problems when the income rises again. For families, it is crucial to clarify how the insurance for children is managed in the meantime, for example, whether a private or statutory health insurance for children is more sensible. Also for civil service candidates or temporary soldiers who receive medical care, a deferred insurance for later entry into regular health insurance, often including the option of family insurance, is an important consideration. The costs for a small deferred policy are often only five to ten per cent of the regular PKV contribution. These examples show how varied the need for a deferred insurance can be.
Weighing costs and benefits: Is the commitment worthwhile?
The decision for or against a provisional health insurance should be based on a careful cost-benefit analysis. The contributions for a provisional insurance are relatively low. At HKK, the monthly costs for health insurance within the framework of a provisional cover amount to about forty-nine euros, plus nursing care insurance and additional contributions. Opposed to this is the invaluable advantage of not having to undergo another health check upon return or change of status, or being insured at the original entry age. This can mean savings of many hundreds of euros monthly, or even gaining access to the desired insurance in case of illnesses that occurred in the meantime. Especially for families with children, planning and security are highly valued. Consider the potential additional costs or benefit exclusions without provisional insurance. An example calculation: A 35-year-old today, returning to private health insurance in ten years without provisional insurance, pays significantly more due to the higher entry age and possible health risks. Provisional insurance can more than offset this difference over the years. The costs of a private health insurance can rise significantly without provisional cover. The exact conditions and whether a small or large provisional cover (the latter also secures the entry age) is more sensible depends on the individual situation and the planned duration of the interruption. Next, we will discuss the legal aspects and expert tips.
Expert Depth: Legal Basics and Design Tips for Prospective Family Insurance
The legal framework for the prospective insurance in the statutory health insurance (GKV) can be found, among other places, in the Social Code Book V (SGB V). Section 10 SGB V is particularly relevant for family insurance, as it regulates the conditions for the contribution-free co-insurance of relatives. For stays abroad, special regulations often apply, such as those described in the information leaflet of Bosch BKK for prospective insurance. It explains that prospective insurance for private stays abroad is only possible after a duration of three months. Our expert tip: Always clarify in writing with your health insurance provider whether and how family members are insured during your prospective insurance period, especially if they remain in Germany. A judgement by the Social Court of Hamburg (Ref.: S 38 KR 853/23 ER D) highlights the complexity in assessing family insurance claims and income thresholds in connection with stays abroad and prospective insurance. It shows how important accurate information and forward-thinking consideration are. Pay attention to the precise wording in the insurance conditions and statutes of the health insurance companies. For example, with HKK, the prospective insurance must be notified informally within three months after the end of the insurance obligation or family insurance. An insurance obligation in Germany generally exists, which makes prospective insurance an important option during interruptions. These details are crucial for seamless protection.
Checklist: The Right Steps to Family Health Insurance Eligibility
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 most important considerations and actions:
Needs Analysis: Determine whether a deferred insurance is necessary for your situation (e.g., stay abroad, job change) and how long the interruption is likely to last.
Check Family Status: Identify exactly which family members are going abroad and which will stay in Germany. This is crucial for the type of deferred insurance and the family’s coverage.
Obtain Quotes: Compare offers for deferred insurance from your current health insurance provider or other providers (especially with private health insurance). Pay attention to the difference between limited and extended deferred insurance.
Clarify Insurance Coverage for Family: Ensure that all family members are comprehensively insured during the primary insured's deferral period - whether through inclusion in the deferral, their own insurance, or an insurance for the child after birth.
Foreign Health Insurance: Consider taking out separate foreign health insurance for the period when the German insurance is on hold. The deferred insurance itself usually does not offer coverage.
Observe Deadlines: Familiarise yourself with application deadlines. Often, deferred insurance must be applied for within a few months after the reason occurs.
Written Confirmation: Obtain written confirmation from the insurer for all arrangements, particularly concerning the inclusion of family members and the conditions.
Regular Review: If your plans change (e.g., duration of stay abroad), inform your insurer immediately.
These steps will help you make an informed decision and provide the best possible protection for your family. nextsure is happy to assist you in analysing your situation.
Avoid common mistakes and steer clear of pitfalls
When setting up deferred insurance, especially with regard to family insurance, mistakes can easily be made that may lead to problems later on. A common mistake is the assumption that with the primary insured's deferred insurance, all family members are automatically comprehensively covered, even if they remain in Germany. This is often not the case, as shown by the Bosch BKK regulations, where it might not be possible for the primary insured to have deferred insurance if relatives remain in Germany and are eligible for benefits. Another pitfall is the insufficient clarification of the scope of benefits during the deferred insurance period. Many assume that 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 deferred insurance. The HKK explicitly points out that there is no entitlement to benefits during deferred insurance. Missing application deadlines is also a critical issue. The deadline for applying for deferred insurance 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 indicated in the case described by Sozialrecht Siegen. Also, the distinction between small and large deferred insurance (especially relevant in private health insurance) is often not sufficiently considered, which can later lead to higher premiums if the entry age is not frozen. A combination of different insurance policies needs to be well planned. Comprehensive advice can minimize these sources of error.
Your individual situation matters: Advice from nextsure
More useful links
Wikipedia provides a comprehensive overview of family insurance in Germany.
The Federal Ministry of Health provides information for statutory insured individuals.
The Consumer Advice Centre provides information on the requirements for family insurance in the health insurance system.
The vdek (Association of Substitute Health Funds) offers comprehensive information on family insurance.
The vdek provides a PDF document with essential guidance on total income in the context of family insurance.
The Federal Office for Social Security informs about digital customer service and the processing of family insurance and self-pay patients.
The Techniker Krankenkasse (TK) offers information on entitlements when working abroad.
The AOK provides information on family insurance and health insurance contributions.
FAQ
What is the difference between small and large entitlement?
The small entitlement secures your right to return to your old tariff later without a renewed health check. The large entitlement (mainly relevant in private health insurance) additionally freezes your original entry age, which leads to lower premiums upon resumption.
How long can a deferred insurance run?
The duration of a provisional insurance policy is generally not limited and can continue as long as the reason for the provision exists (e.g., the stay abroad).
Do I need to register my family members separately for the entitlement?
Yes, it is very important to clarify the situation of your family members (whether they are travelling with you, have their own income, etc.) accurately with the health insurance provider and state this correctly, as it affects the terms of coverage.
Can I also take out a pre-insurance for long-term care insurance?
Yes, an entitlement insurance for health insurance often automatically includes an entitlement for long-term care insurance as well. It is also possible to arrange a separate entitlement exclusively for long-term care insurance.
What happens to the entitlement after the end of the stay abroad?
Once the reason for the entitlement ceases to exist (e.g., return from abroad), you must actively reactivate the insurance. Usually, there are deadlines of two to three months for this.
Is it also sensible to maintain an entitlement when switching from private health insurance to statutory health insurance?
Yes, if you switch from private health insurance (PKV) to statutory health insurance (GKV) (e.g., because your income falls below the threshold), it may be sensible to maintain an entitlement in the PKV to keep the option of returning to the old conditions open for the future.
