Bundesportal | Apply for exemption from compulsory insurance in the statutory health insurance scheme

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Publisher

Federal Ministry of Health (BMG)

Last update or date of publication

January 19, 2023

Contact

The government service telephone number 115 – your point of contact for questions related to the federal, state and local.

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In Germany, there is a general health insurance obligation. 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 insurance in the statutory health insurance. The exemptions apply mainly to persons who were previously exempt from insurance and become liable to insurance under the statutory provisions.

Exemption from compulsory insurance means that you must take out voluntary statutory insurance or a contract with a private health insurance company. To be exempt from compulsory insurance under the statutory health insurance scheme, you must prove that you are covered in the event of illness.

You apply for exemption from compulsory insurance to the statutory health insurance fund.

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

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

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

Label

Preconditions

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

have private health insurance.
You can continue to receive allowances or free medical care and your salary in the event of illness. This is the case, among others, for civil servants, police officers or members of the German armed forces.

You can apply for exemption from compulsory insurance if

the statutory annual income limit for compulsory insurance is increased. You have become subject to compulsory insurance because your annual income is now below the annual income limit.
you are receiving unemployment benefits and have not been covered by statutory health insurance in 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 periods.
You work a maximum of 30 hours per week part-time during parental leave.
you take up part-time employment after parental, care or family care leave, you have also been exempt from insurance for at least 5 years and your income would be above the annual earnings limit if you worked full-time.
you become subject to compulsory insurance because you are drawing a pension
you participate in a measure, e.g. pension insurance, for participation in working life.
you are starting a course of study.
you are engaged in unpaid practical work, e.g. an internship.
you are employed as a disabled person in an institution, for example a recognized workshop for disabled people.

You do not have to pay anything for the application.

Basis for legal action

§ 8 Sozialgesetzbuch Fünftes Buch (SGB V)

Legal Remedies

Objection
Action before the social court

Procedure

You can apply for exemption from compulsory insurance by mail or - for many statutory health insurance funds - in person at the office.
Address the application to the statutory health insurance fund with which you are insured or - if you are not insured by the statutory health insurance fund - to a statutory health insurance fund 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. There are usually 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.

Deadlines

You must submit the application within 3 months after the start of the insurance obligation. 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 dependents have not yet claimed any benefits from the statutory health insurance. For example, you must not have received any medical examinations or prescription drugs from the pharmacy.
The exemption from compulsory insurance applies as long as the reason for exemption exists.

Processing time

Processing usually takes about 3 to 4 working days.

For rapid processing and decision-making, your health insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner. The health insurance company will decide on applications promptly.

Please note that the processing time indicated is an average value for all health insurance funds. It may vary in individual cases.The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your health insurer by mail.