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Apply for exemption from compulsory health insurance

In Germany, health insurance is compulsory. It is determined by law who is compulsorily insured in the statutory health insurance and for whom exemption from insurance applies.

In exceptional cases, you can be exempted from compulsory statutory health insurance. The exceptions apply mainly to persons who were previously exempt from insurance and become subject to compulsory insurance due to the statutory provisions.

Exemption from insurance means that you must voluntarily take out statutory health insurance or conclude a contract with a private health insurance company. In order to be exempted from compulsory statutory health insurance, you must prove that you are covered in the event of illness.

You can apply for exemption from compulsory insurance from the statutory health insurance company.

As a rule, you cannot undo the exemption. For example, a change from private to statutory health insurance is only possible under certain conditions.
 

Process flow

  • You can apply for exemption from compulsory insurance by post or – with many statutory health insurance companies – hand it in in person at the office.
  • Send the application to the statutory health insurance fund with which you are insured or – if you are not legally insured – to a statutory health insurance company that is open to insured persons at your place of residence or employment.
  • Fill out the application form of the statutory health insurance company and submit it to the health insurance company together with the required documents. As a rule, there are different forms depending on the reason for exemption.
  • The health insurance company will check whether you can be exempted from compulsory insurance and inform you of the result.
     

Requirements

The prerequisite for exemption from compulsory insurance is that you are entitled to coverage in the event of illness, for example

  • have private health insurance.
  • Allowance or free medical care and continue to receive your benefits in the event of illness. This is the case, among other things, with civil servants, in the police service or in the Bundeswehr.

You can apply for an exemption from compulsory insurance if:

  • the statutory annual remuneration limit for compulsory insurance is increased. You have become subject to compulsory insurance because your annual income is now below the annual salary limit.
  • You receive unemployment benefits and have not had statutory health insurance for the past 5 years.
  • You reduce your weekly working hours by at least 50 percent and you have been exempt from insurance for at least 5 years.
  • You reduce your weekly working hours due to care or family care leave.
  • You work a maximum of 30 hours per week part-time during parental leave.
  • You take up part-time employment after parental leave, caregiver or family caregiver leave, you have also been exempt from insurance for at least 5 years and your income would be above the annual salary limit if you were employed full-time.
  • You become subject to compulsory insurance due to receipt of a pension
  • You participate in a measure, such as pension insurance, to participate in working life.
  • You start a course of study.
  • You are engaged in an unpaid professional activity, for example an internship.
  • You are employed as a person with a disability in an institution, for example a recognised workshop for disabled people.

Which documents are required?

  • Proof of your entitlement to coverage in the event of illness, for example a confirmation of your private health insurance.
  • Depending on the special case, further documents may be required. Please contact your statutory health insurance company for more information.
     

What are the fees?

You don't have to pay anything for the application.

What deadlines do I have to pay attention to?

  • You must submit the application within 3 months of the start of compulsory insurance. The exemption from compulsory insurance then starts on the 1st day of the next calendar month.
  • You will be exempted retroactively if you or co-insured relatives have not yet claimed any benefits from statutory health insurance. For example, you must not have received any medical examinations or prescription medication from the pharmacy.
  • The exemption from compulsory insurance is valid as long as the reason for exemption exists.
     

Processing duration

Processing usually takes about 3 to 4 business days.

For a quick processing and decision, your health insurance company must have the necessary information and, if necessary, the necessary documents complete and meaningful. The health insurance company decides on applications in a timely manner.

Please note that the stated processing time is an average value of all health insurance companies. It may vary in individual cases. The exact processing time also depends on the complexity of the individual case and may be extended accordingly. The same applies if documents or records are sent by post to you or your health insurance company.

Applications / forms

  • Forms: yes
  • Written form required: no
  • Informal application possible: yes
  • Personal appearance required: no
  • Online service available: no

Appeal

  • Contradiction
  • Action before the Social Court

Technically approved by

Federal Ministry of Health (BMG)

Professionally released on

19.01.2023

Author

The text was automatically translated based on the German content.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)