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Online service providers claim that they can help you switch from private to statutory health insurance. The GKV criticize “systematic abuse of rights”, consumer advocates warn.
When pensions are low but private health insurance contributions continue to rise as you get older, desperation is often great. Some people would then like to switch back to statutory insurance in order to save on premiums.
But from the age of 55 onwards, it is very difficult for privately insured people to get back into statutory insurance. The legislature wants to largely prevent insured people who have not paid into the solidarity community for years from benefiting from it in old age.
Providers advertise aggressively
However, various providers are apparently taking advantage of this desperation among privately insured people and are specifically targeting people over 55 and pensioners. Veron Versicherungsmakler GmbH, based in Nuremberg, is just one of numerous providers. Your website has the catchy name “raus-aus-der-pkv.de”.
It says: “Unfortunately, it is often claimed that switching from private health insurance to statutory health insurance is not possible over the age of 55. This statement is wrong!” And such a change is worth money in many cases: savings of over 150,000 euros are not uncommon.
Starting a business in Czech Republic
Interested parties will only find out exactly how the change will work after a telephone consultation. In a conversation with an 85 year old pensioner, that Plus minus documented, the consultant explains on the phone that a service provider would open a business for him in the Czech Republic. This means he will be subject to social security contributions in the Czech Republic. A year later he could then switch to statutory health insurance in Germany. He doesn’t have to go to the Czech Republic once or do anything else.
For these services, he should pay 250 euros a month to Veron Versicherungsmakler Gmbh for a year, and if successful, 9,000 euros plus VAT to an external service provider. “So a total of 12,000 euros. The consultant says that Veron Versicherungsmakler GmbH has done this thousands of times. Is this procedure legal?
Regulation becomes a legal loophole
In fact, there is a legal loophole: Anyone who has had health insurance abroad for at least twelve months can switch to statutory health insurance in Germany after the end of their stay abroad. This regulation is intended for people who actually work abroad and spend most of their time there.
However, from the point of view of Anke Puzicha from the consumer advice center in Hamburg, it is clear from the telephone conversation we documented that this is a fictitious business, as the person is not actually moving the center of his life to the Czech Republic. Changing insurance in this way is therefore not permitted. “The providers know very well why they do not publish their method clearly. People who change insurance in this way risk being accused of social fraud,” she criticizes.
Opaque construct
Upon request, Veron Versicherungsmakler GmbH will inform you in writing that it is only a data record dealer. The customer data collected by the call center would be passed on to other service providers. You don’t have any contractual relationships with people willing to change.
In fact, the 85-year-old from Stuttgart who received advice over the phone received a letter from another service provider a few days after the phone call. Suddenly people are no longer talking about the Czech Republic, but about Poland. And now it becomes concrete: He has to sign a power of attorney. He is told on the phone that with the power of attorney, a Polish law firm will open a business for him as a commercial agent in Poland. After a year he could then switch to statutory health insurance in Germany.
A high risk
But the risk is high: If the insurance company subsequently discovers that it was a purely fictitious business, they can still reverse entry into statutory insurance years later. The affected person is then removed from statutory health insurance – with dramatic consequences.
Insurance broker Thorulf Müller always has customers who have accepted such offers and later bitterly regretted it. “And then suddenly they find themselves without health insurance – in a phase of life where I really need health insurance urgently,” he says. “That’s miserable. They can then go to the social welfare office with a basic tariff and have their social need confirmed in the sense of basic benefits, so that they can at least continue to have the basic tariff somewhat financed.”
“More systematic abuse of law”
The problem is obviously known to the statutory health insurance companies. As early as 2022, the National Association of Statutory Health Insurance Funds warned of “systematic abuse of the law” in a circular. The letter continues: “Recently there have been indications that people claim to have worked in the Czech Republic or Slovak Republic in order to gain access to statutory health and nursing care insurance in Germany based on the statutory insurance periods acquired as a result . There is a suspicion that the employment activities are fictitious.”
If this has been known for a long time, why do these offers still exist? Constantin Papaspyratos from the Association of Insured Persons says that in many cases the health insurance companies’ hands are tied. “They are dependent on requesting information from abroad – such as Poland in this case. In my opinion, the responsible institutions abroad are in many cases overwhelmed and do not understand the problem and therefore fail to provide data “Standing a little bit helpless,” he says.
“This leads to the difficulty when the statutory health insurance in Germany needs data from Poland and does not receive it promptly and completely, which massively drags out the entire test process – with the consequence that there may be nothing at all for years happened,” said Papaspyratos. Politicians are called upon to tighten the laws.
“We don’t have intellectual property rights for nothing”
Maria Klein-Schmeink is deputy leader of the Green Party and a member of the Health Committee. “We can look at which law is suitable to find a regulation,” she says. “But I don’t think it can be the case that someone earns 12,000 euros by circumventing German social law. It’s not for nothing that we have these protective rights for statutory health insurance.”
And Dirk-Ulrich Mende from the SPD wants to check whether there is an opportunity to take action against such providers as part of the planned health care strengthening law – GVSG for short.
Anke Puzicha from the Hamburg Consumer Center says there is no reason to get involved with such providers. She advises people who really have a problem with rising insurance premiums in old age to consider changing tariffs within private insurance. In most cases, the contributions can be reduced significantly. That is “a thousand times better” than accepting an offer that is not legally secure and exposing yourself to the risk of ultimately being excluded from statutory insurance.