FAQ on health insurance
If you have an employment contract the following obtains: According to Regulation (EC) 883/04 you are obliged to have statutory social security and you must therefore join the statutory health insurance scheme in the country in which you are employed, i.e. Germany. You can only apply to remain in the health insurance scheme in your own country in exceptional cases, such as when the duration of the stay in Germany is restricted and legally-recognised relations exist to an employer at home. This might take the form of leave of absence with the right to return to a job in your own country.
If you have a fellowship you are not required to join the health insurance scheme in Germany. But according to Art. 193, para. 3 of the German Insurance Contract Act ("Versicherungsvertragsgesetz"), as of 1 January 2009, every person residing in Germany is obliged to obtain insurance from a health insurance provider that is authorised in Germany. We therefore recommend that fellowship recipients obtain health insurance cover from a private German health insurance.
European health insurance cards issued by Greek health insurance schemes are only valid for a temporary stay in Germany (holidays, business trip or job search). And they only cover essential medical provision at the doctor, dentist or in hospital and necessary treatment for existing or chronic illnesses. It becomes invalid as soon as you are obliged to pay social security contributions in Germany according to Regulation (EC) 883/04, such as when you are employed by a German research establishment.
Numerous health insurance policies for guest academics do not provide cover for prior illness, disability or pregnancy. Under these circumstances how can guest researchers obtain adequate health insurance cover? As a host university are we permitted to ask about prior illness and similar issues in order to avoid problems with inadequate insurance cover?
When new, private health insurance policies are taken out they usually exclude previously diagnosed prior illness and impose waiting periods for pregnancy treatments, as otherwise their pricing system would break down. In principle this is also the case for temporary health insurance policies for trips abroad that do not require a health check up.
Insofar as the specific circumstances allow, the following possibilities exist for resolving such situations:
- continuation of the existing private health insurance policy with the addition of an international option
- continuation of membership in the statutory health insurance scheme in the employee's own country (if the employee is on a posting)
- joining a statutory health insurance scheme in the host country, whereby this usually presupposes an employment relationship in that country.
Where an existing private or statutory health insurance policy is continued, prior illness or waiting periods are irrelevant, and when taking out a new policy under a host country's statutory health insurance scheme, in most countries cover is available from day one without waiting periods, even in cases of prior illness. However care should be taken in Belgium where even for a statutory health insurance scheme there is usually a waiting period of one year.
As a host university you should make the researcher aware that there is usually no health insurance cover in the case of prior illness or an existing pregnancy. This will help you to avoid any potential liability due to insufficient clarification. It is then up to the researchers themselves whether or not they declare any prior illness.
A Belgian academic has been on an extended research stay in Germany, funded by a fellowship. During her stay she was covered by private health insurance. Her employment contract in her own country, along with her social security entitlements, were suspended for this period of time. On her return she would like to resume employment and rejoin the social security system in her own country. What does she have to do?
This question concerns adequate health insurance when applying for a residence permit. The question arose from the concrete case that the EU Erasmus Mundus Programme has 'minimum requirements' for health insurance coverage. Our Romanian programme partners offer private European health insurance that meets these 'minimum requirements'. In principle, German statutory or private health insurance would also be acceptable in the context of the Erasmus Mundus Programme. Upon examination, however, we found that German health insurance schemes (statutory and private) do not meet the 'minimum requirements' because they exclude certain benefits such as, in particular, 'repatriation or medical transport' or 'transportation and accommodation costs for family members'. Thus the question was whether the Immigration Office XX would accept the private European health insurance. In the past, the Immigration Office XX had taken the stance that there must be proof of GERMAN health insurance, explicitly confirming the following: 'This insurance coverage meets the requirements of the European Council’s decision of 22 December 2003 (2004/27/EC) and is valid in all those Member States which fully apply the Schengen Acquis. The insurance sum is not limited to the minimum coverage of 30,000 EUR. Furthermore, insurance coverage encompasses all benefits according to Section 11, subsection 1 - 3 SGB V (German social security code)'.
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