Being pregnant and applying for German health insurance

Of course you have to check with the insurance company. But pregnancy is covered or it isn't, I don't think anyone will calculate the conception and disqualify paying for it based on that. Besides people often don't know they are pregnant until months later. If the insurer would claim this is a pre-existing condition then they can possibly claim higher premiums but not decline to pay the costs - unless giving birth is specifically not covered by the policy - something unlikely if even legal in Germany.

Dear John and Bepi,

Thank you very much for your kind advices for so many years.

I am facing a similar situation that needs you kind advices.

I am a Chinese-government-sponsored visiting professor to Germany. My monthly salary is paid by the Chinese government, and the German university does not pay.

My wife is pregnant for ~4 month, and we arrived Germany ~10 days ago. My wife and me are currently both in Care Concept private insurance.

My wife does not work here at Germany, so no salary for her. As non-EU citizens, our visa will be expired at September 1st 2019.

We wish that the maternity could be covered by Care Concept, but Care Concept refused immediately (and rudely), even though I am willing to pay 400 euros/month for my wife.

My collaborator here at Germany once agreed to give me a job with 451 euros/month, so that I could be covered by public insurance, and so the maternity could be covered too.

However, today he just realized that although I only get 451 euros/month, the institute will pay ~2 times of that money every month for me. That would shrink the budge of the institute, and I will feel extremely uncomfortable even if he agrees to offer such a job.

Therefore, there seems to be only three options:

1) Go back to China immediately, and me and my wife both have good insurance coverage.

2) Find a private insurance company that is willing to cover the maternity. I am willing to pay 400 euros a month for that if the private insurance company can do as good as the public insurance for maternity. Is there any insurance company offer such service?

3) Ask my collaborator here at Germany to offer me the job with a salary of 451 euro/moth, but only from January 1st 2019 to June 30th 2019. This period will be the 3 months before the delivery and 3 months after the delivery, when possible conditions most likely occur. Yes, I am taking the risk to take care of unexpected conditions [finger crossed for no such things]. Offering such a short-term contract would decrease the financial burden of the institute, and we can be involved in the public insurance.

I am wondering that is my understanding correct? Please Kindly advice.

Thank you very much for your kind help.

Best regards,
                 Beary

If this Care Concept insurance does cover your wife AND fulfills German health insurance requirements (without which they would not be accepted for visa purposes), then they MUST cover the medically necessary expenses of pregnancy and child birth.
Get their reply in writing and then consult a lawyer of theVersicherungsombudsmann (a kind of mediation authority for insurances)!
All your other suggestions will either not work or cause more problems than they're worth (fake employment just to get an insurance is a criminal offense!) - you should have checked the situation before coming.
Of course returning to your country is always an option.

Dear Beppi,

Thank you for the suggestion.

I wish to further explain two points: (1) My wife was pregnant before we arrived Germany, it is the pre-existed pregnancy that Care Concept refused to take care; (2) my German collaborator and me are not trying to cheat for public insurance, it is an unfair judgement; we have  government approved collaboration framework; before I came to Germany, we have agreed on the contract for our combined research; of course the pregnancy issue was the major consideration; the problem now turns out because we do not wish to spend too much money from the institute, so that our future students will not be affected by the expense.

That is why I am asking which private company would accept pre-existed pregnancy, and I am willing to pay 400 euros/month for the insurance.

Thank you for the advice again.

I don't think that a German health insurer can exclude pregnancy and child birth, as you claim.
If you have that in writing, do consult the Ombudsmann or a lawyer!

If she can find an employer that pays her €451/month or more (and all the associated social security and insurance fees), she will be able to join the public health insurance scheme cheaply. (Although you deny it, your email still sounds like you want to cheat the system here: If she does not in fact work, or all the costs are borne by the employer, it is a criminal act.)
There is no cost for future students involved, so I have no idea where you get that from.

I doubt that any private insurance would accept her for just €400/month. Double it and you may have a chance - or maybe not. The private insurers will be able to give you a quote.

First of all, thank you for the not-so-pleasant-to-hear advice.

I think you have misunderstood the situation, twice.

"Cheat for public insurance" is definitely not the correct words to say here. Actually, it is a shame to me even read it.

1) The contract will be between me and the German university where I am visiting now; in this case, I assume my wife can be included in the public insurance at the same time since I am an employee whose salary is >450 euro/month, so that maternity can be covered. I wish this understanding is correct.

2) My wife has nothing to do with the contract, only me and my collaborator (or say me and the German University). Your understanding sounds like we are faking for a contract and cheat the university and government.

3) If I take the offer, my German collaborator will spend 451 euro/month for my salary, and also ~2 times that money per month for other fees. In total, that would be ~1300 euro/month for my cost. The research fund is limited on the other hand. In this case, any future Ph.D or master students that would use the fund will have less money.

Although I think my explanation is not necessary at all, and we are talking about a totally different issue, but I think it is about defending the morality, and we  should stay at the correct track.

So, instead of getting her employed and eligible for public health insurance, you want to get a 451EUR side job for yourself (on top of your professor salary) and think you can then claim a subsidized public health insurance (which is meant for the poor) and cover your wife in it as dependent free of charge?!?
I think you are a bit naive about how the German system works and how it is protected against cheating!

First, your main income (i.e. your professor salary) determines which insurance you can or must join. For you (assuming the initial assessment was correct) it is the private scheme - and you chose Care Concept as insurer.
(It is not possible to have  two health insurances, and it is difficult to switch from private to public insurance - the 451EUR job would have to be your only income!)
Furthermore, assuming that you came as foreign researcher, your visa might not even allow 451EUR employment. I know a non-EU visiting researcher (doing a PhD with a scholarship from her country) who is not allowed any work - but her husband, who joined her on a dependent's visa, can.

I had a look at the Care Concept webpage and found that all shown plans include pregnancy and child birth, some incurring a higher premium or deductible for such treatment.
If you really have a plan that excludes it (which is not shown on their webpage and, as I wrote above, is difficult to believe), you must have chosen it despite knowing that your wife was already pregnant. Sorry, but In that case you have only yourself to blame and should probably try to change within Care Concept to a different plan - or change to another private insurer if you can find one that accepts your wife.

xiaobeary wrote:

First of all, thank you for the not-so-pleasant-to-hear advice.

I think you have misunderstood the situation, twice.

"Cheat for public insurance" is definitely not the correct words to say here. Actually, it is a shame to me even read it.

1) The contract will be between me and the German university where I am visiting now; in this case, I assume my wife can be included in the public insurance at the same time since I am an employee whose salary is >450 euro/month, so that maternity can be covered. I wish this understanding is correct.

2) My wife has nothing to do with the contract, only me and my collaborator (or say me and the German University). Your understanding sounds like we are faking for a contract and cheat the university and government.

3) If I take the offer, my German collaborator will spend 451 euro/month for my salary, and also ~2 times that money per month for other fees. In total, that would be ~1300 euro/month for my cost. The research fund is limited on the other hand. In this case, any future Ph.D or master students that would use the fund will have less money.

Although I think my explanation is not necessary at all, and we are talking about a totally different issue, but I think it is about defending the morality, and we  should stay at the correct track.

Even for „pre-existing“ conditions it can be that the private insurance is required to pay for them but might be able to demand a higher premium. Another question is if one was aware of the pregnancy when the insurance was settled on? If yes, then why was it not clarified at that time? Like I mentioned, this would possibly influence the cost of the insurance but rejecting someone or excluding paying for the cost of the birth is not usual - if even legal. The other possibility is that one didn't know yet that they were pregnant. An insurance company cannot fault one for this. A condition, even if it exists, cannot be seen as an issue if it wasn't known. Thus calling something a pre-existing condition really means a known condition.  But like Beppi mentioned, you should get the statement in writing from the insurance that they won't cover the birth cost and then contact a lawyer or Versicherungsombudsmann.

Xiaobeary: Here are some links to websites about German health insurance (German only). The passages I have copied and given links to suggest that even the basic tariff private insurance must give coverage equal to the public insurance. More comprehensive tariffs can include additional coverage – and addition cost - but not disallow basic coverage! And under public insurance, birth and many pre-birth associated costs are covered. Pregnancy is also not a disease –so it cannot be called a “pre-existing condition” since the word “condition” in this sense refers to disease or injury – things like cancer or damages from accidents but NOT pregnancy. Details in an insurance contract should be able to clarify such points but the general rules appear to contradict what the insurance company is claiming about not covering pregnancy cost.

The last link provided gives information about the Ombudsman that Beppi mentioned. This is an neutral arbitrator to help in conflicts with the insurance company. The position is regulated by EU finance protection laws and is free to the insured. The insurance companies are obligated to deal with them. At the Ombudsman's suggestion, if you need to additionally get a lawyer because no resolution is found, this will be at your cost. But this is your best hope. These people are experts trained in the subject and it's their job to help you with just such situations.


„Grundsätzlich kommt die Krankenkasse für Kosten von Heilbehandlungen und für Krankheitskosten auf. Doch eine werdende Mutter ist keine Kranke.“
https://www.recht-finanzen.de/faq/5091- … ankenkasse

„Seit 2009 ist eine Neuerung für die Privaten Krankenkassen hinzugekommen, denn nun sind sie gesetzlich dazu verpflichtet, ihren Versicherten einen Basistarif anzubieten, dessen Beitrag nicht über dem durchschnittlichen Höchstbeitrag der Gesetzlichen Krankenversicherung liegen darf.

Der Basistarif ist auch in den Leistungen vergleichbar mit der Gesetzlichen Krankenkasse. Durch diesen Basistarif soll gewährleistet werden, dass sich auch Personen in der Privaten Krankenkasse versichern können, die sich normalerweise wegen ihrer Vorerkrankungen keinen Privattarif leisten können oder die keinen Anspruch auf die Mitgliedschaft in einer Gesetzlichen Krankenkasse haben.“

https://krankenkassen.net/private-krank … h-pkv.html


„Für die Schwangerschaftsvorsorge, Geburtsvorbereitung und Entbindung übernimmt die GKV die Kosten. Einschränkungen gibt es lediglich bei der Haus- und Geburtshausentbindung, bei denen nur Hebamme und medizinische Versorgung übernommen werden. Wer krankengeldberechtigt ist, erhält das Mutterschaftsgeld von der Krankenkass.“

https://krankenkassen.net/gesetzliche-k … chaft.html

Außergerichtliche Problemlösungen in der PKV durch den Ombudsmann

https://krankenkassen.net/private-krank … erden.html

Hallo. Thanks a lot for your time spending on the threat. I learn lots of useful information on the German health insurance system. I would be very much appreciated if you can confirm what I understand from the discussion and if the information here is updated (as the discussion has started over the years) when applied to my case.

My case:

I have accepted an offer for a (post-doctoral) position at a public university in Hamburg, starting from this summer. The gross salary is 3700 Euros/month. And I am eligible for "all the benefits for public employees, such as health insurance and retirement benefits". I (a Vietnamese) had also lived in Europe for 4 years in the last 5 years (if this info is useful somehow).

My wife will come to Germany with me and she is also doing her doctoral study at the same university as mine (a public university). However, she won't get pay for health insurance and living costs from the University. I learn from this threat and other sites that my wife will also be covered by the German public health insurance system. Is this correct?

The situation becomes more complicated when we have learnt that she has been pregnant for 7 weeks. By the time we come to Germany (as the plan), she will be pregnant for 5.5 months. My question is whether or not she will still be covered by the German public health insurance?  And will the child also be under the same insurance coverage? If yes, how long does it normally take to get all the paperwork done in Germany (for newcomers, meaning applying for a resident permit, health insurance, etc.)?

Many thanks for your time!
Cheers.

As far as I can tell, from the information in your post, I think your situation regarding health insurance is as follows:
1. You are an employee and, since you earn below the private insurance threshold (of around EUR60k/year), must join a public insurer. A certain percentage (7.3 - 8%) is then automatically deducted from your salary every month.
2. Your wife is not an employee (since she gets no pay), and Ph.D. candidates are also not counted as students for health insurance purposes (students can join the public insurance at a subsidized rate of approx. EUR80/month).
You should ask the public insurer you join if she can be covered as dependant, as long as she has no own income. I am not sure if this is possible, but I think so (maybe some more knowledgeable forum members can confirm this?). If she joins the public scheme, her pregnancy and child birth are covered.
If she cannot be your dependant, it gets complicated. She then might or might not be able to join a public insurer at the rate for "voluntary members" (which starts at around EUR170/month and again would cover the pregnancy), or she may have to join a private insurer (which might be cheaper if she is young and healthy, but the pregnancy could be excluded and payable from your own pocket - budget at least EUR10k for that, more if there are complications!)
3. For the child things are clear again: It will be covered from birth by the insurance of the better earning parent - which means in your case free coverage as dependant in your public scheme.

To sort out the formalities (which is only possible after your arrival) will take between a couple of weeks and a few months. So I am not sure if it is a wise decision to move such a short time before birth.
(Also note that from the sixth month of pregnancy onwards, airlines will not let her board - and they might even earlier require a doctor's certificate saying that she is fit for travel.)