Perfeccionamiento, ejecución y liquidación del Contrato

As an employee you are compulsorily insured if your regular income before deductions exceeds €450 per month and remains below a set annual limit (Jahresarbeitsentgeltgrenze). The annual income limit up to which employed people are automatically and compulsorily insured officially ceased to be linked to pension insurance on 1 January 2003 and now consists of a general annual income limit or a special reduced annual income limit. The general annual income limit for 2014 is €53,550 and thus remains at 75% of the general pension insurance contribution assessment limit in western Germany. For reasons of fairness, a reduced annual income limit of €48,600 in 2014 applies for workers who were exempt from compulsory health insurance because they exceeded the contribution assessment limit on 31 December 2002 and switched to an alternative private health insurance fund. This amount is identical to the annual income limit applied in the state health insurance scheme.

The rule on when you cease to be subject to compulsory insurance on account of exceeding the annual income limit has changed under new legislation on the financing of the statutory health insurance system. With effect from 31 December 2010, the rule has reverted to the annual income limit only having to be exceeded for a single year in order for compulsory membership of the statutory health insurance scheme to cease.

The following are also compulsory members of the state health insurance schemes:  Students at state and state-approved universities

 People on work experience or in second-chance education

 Old-age pensioners who have been in a statutory health insurance scheme or insured as a family member for most of the latter half of their working life

 Disabled people employed at an approved workshop or on employment promotion schemes

 Unemployed people receiving unemployment benefit (Arbeitslosengeld and in some circumstances Arbeitslosengeld II)

 Farmers

 Members of farming families who are primarily employed on the farm and are at least 15 years old or are in training

 Retired farmers who have claimed Altenteil (the right to continue living on the farm after making it over to their children)

 Artists and members of the publishing professions as provided in the Artists Social Insurance Act (Künstlersozialversicherungsgesetz)

Voluntary membership of the state health insurance scheme is normally possible on first entering employment in Germany and following previous compulsory insurance or insurance through a family member, and, subject to certain requirements, for people with severe disabilities.

Individuals who are voluntarily insured in the statutory health insurance system, for example employees whose pay exceeds the annual ceiling (Jahresarbeitsentgeltgrenze), civil servants and self-employed persons, may opt for private health cover with a private health insurer. In doing so, they should give careful consideration to which of the two systems is the best given their personal circumstances, and take into account that once they have switched to a private health insurer, a return to the statutory health insurance system is only possible in very exceptional circumstances.

No patients’ contributions are payable for early detection screening, inoculations, other preventive measures or dental prophylaxis. Health insurance funds can also grant members partial or full exemption from paying patients’ contributions, for example for certain types of treatment.

According to German health insurance law, anyone living in Germany receives health insurance cover in either the statutory or private health insurance system but has no entitlement to other types of insurance cover.

From 1 April 2007, anyone lacking other provision for the event of illness and who has previously been in the statutory health insurance system is made a compulsory member (Section 5 (1) 13 of Book V of the Social Code/SGB V). You become a compulsory member of your previous statutory health insurance fund or its legal successor, beginning on the day you cease to have other provision for the event of illness within Germany or on 1 April 2007, whichever is the later. The same applies for anyone who has never had statutory or private health cover and comes under the statutory health insurance system. Please seek advice on this from a statutory health insurance fund.

In accordance with Section 193 (3) sentence 1 of the German Insurance Contract Act

(Versicherungsvertragsgesetz, or VVG), as of 1 January 2009 anyone living in Germany who is neither insured or required to be insured under the statutory system nor covered by other means must have private health insurance that at minimum covers out-patient and in-patient medical treatment. The annual deductible is limited to a maximum €5,000.

Full-time self-employed persons are not subject to compulsory statutory health insurance and must thus have private health insurance cover unless they were insured under the statutory system before entering self-employment.

Since 1 January 2009, anyone exempt from the requirement to have insurance cover, especially civil servants, pensioners and others who may claim state contributions towards the cost of health care (Beihilfe) and who have no supplementary insurance to cover healthcare costs, are not covered by the statutory health insurance system even if they were covered by that system

previously. Since 1 January 2009, these individuals are required to have private health insurance to cover healthcare costs not covered by the amount covered by Beihilfe received. This requirement for private insurance also applies for employees who are exempt from the requirement to have insurance cover, i.e. blue-collar and white-collar workers whose regular annual pay exceeds the compulsory insurance ceiling.

The requirement for insurance cover can be met with basic coverage (‘Basistarif’). Private health insurance carriers have been required to offer this type of coverage alongside existing policy options since 1 January 2009.

The following applies with regard to provision for recipients of social assistance in case of illness:

For anyone in receipt of regular assistance provided under Chapter 3, 4, 6 or 7 of Book XII of the Social Code (SGB XII) since 1 April 2007 or before, the social assistance agency that provides that assistance will also provide assistance in the event of illness. Under Section 264 of SGB V, the medical treatment is generally paid for by a statutory health insurance fund and then refunded by the social assistance agency. The continued responsibility of social assistance agencies for such recipients of social assistance in the event of illness after 1 April 2007 is expressly laid down in Section 5 (8a) of SGB V. It is unaffected by an interruption in entitlement to the regular social assistance of less than one month, irrespective of whether the social assistance agency

deregisters a person from the procedure under Section 264 of SGB V – the sole requirement is that the person was in receipt of regular assistance provided under Chapter 3, 4, 6 or 7 of SGB XII and remained in receipt of that assistance without an interruption in excess of one month.

Anyone in receipt of regular assistance provided under Chapter 3, 4, 6 or 7 of Book XII of the Social Code since 1 April 2007 and subject to insurance on a subordinate basis on that date (Section 5 (1) 13 of SGB V) remains a member of the statutory health insurance scheme.

Anyone solely in receipt of assistance in the event of illness provided under Chapter 5 of SGB XII will become subject to compulsory statutory health insurance if they come within the scope of statutory health insurance and, with effect from 1 April 2007 or later, satisfy the requirements for being subject to compulsory insurance on a subordinate basis in the absence of any other entitlement to provision in the event of illness (Section 5 (1) 13 of SGB V). Being subject to compulsory insurance on a subordinate basis, such individuals also remain members of the statutory health insurance scheme if they later receive regular assistance towards living expenses (assistance under Chapter 3, 4, 6 or 7 of SGB VII).

Recipients of regular assistance under Chapter 3, 4, 6 or 7 of SGB VII are required to have private health insurance if they began receiving assistance on or after 1 January 2009 and are not insured or required to be insured under the statutory health insurance scheme (Section 193 (3) sentence 2 no. 4 of the Insurance Contract Act (Versicherungsvertragsgesetz/VVG). In such instances, social assistance providers pay the insurance premiums provided that they are reasonable in amount (Section 32 (5) of SGB XII). Premiums are assumed to be reasonable up to amount of the basic coverage (Basistarif) premium as reduced by half for recipients of social assistance.