Moving to Germany - Health Insurance Question

Hello,
I'm a US Citizen, currently living in Seattle with my husband, he is a German citizen. We met in Germany 4 years ago while I attended graduate school. After graduating, I moved to Seattle for work and soon he joined me and we got married in the US. My husband and I are planning on moving back to Germany in March so he can start a business. We both currently work and have been saving aggressively and our desire is that he start the business in the spring of 2020 with his business partner who currently resides in Germany. He is starting to file paperwork for the business in January (he can travel back and forth for a few months) in hopes that the business will open its doors in early April. I am looking for health insurance in Germany but the catch is, I just found out I am pregnant. I will be around 6.5 months when we plan on moving (in March).

I've been doing research online and it seems that finding insurance that would cover pregnancy AFTER becoming pregnant may be impossible. I am currently insured through my work but I plan on leaving my position in early March and I do not plan on working in Germany for the first few months (2-3 months before the baby is born and a few months after). I have an HSA account with nearly $6K in it and I have done research so it looks like I can use the HSA money abroad as long as it it for legal medical expenses. My husband and I have also saved a substantial amount of money to start the business and live in Germany without issue. I'm less worried about the cost of delivery and more worried about being denied services in Germany due to health insurance reasons. I would like to understand what my options are for health insurance in Germany.

Is it possible for my husband to have public insurance when he goes back and to have me on his public insurance? If so, does this take time after moving there? Obviously we will need insurance right away at that point in pregnancy (6 months+ pregnant).

Are there any private insurance options available that we could pay to waive the waiting period for pregnancy?

If I chose to stay on my work health insurance after leaving the company (paying the premium 100% out of pocket) would it cover pregnancy and delivery outside of the US? I have a high deductible PPO plan with an HSA account.

Our absolute last resort is to stay in the US until we have the baby and move soon after but we would both very much prefer to move before the baby comes and settle in Germany. My husband and his business partner would prefer to start in early April and not wait until at least August (2 months after the baby is born).

I appreciate any insight into our situation and any advice that you have. It seems the only obstacle holding up our move is health insurance which seems like there should be a solution out there!

Thank you in advance.

Madison

You have a number of issues and options here:
- First and foremost, you need to balance the need for reassurance at birth and in the first months as a mother, which count among the most emotionally stressful periods of a woman’s life: Being in a familiar environment and having medical and midwife support in your language will help tremendously, but having a loving husband and father at hand also does (if he isn’t too busy with the new business).
-Airlines won’t let you fly from 7 months onwards for safety reasons and your planned moving date is uncomfortably close to that.
- You will never be denied service in the German medical system. Without insurancce, you’d just have to pay from your own pocket - which will cost you an arm and a leg!
- I haven’t heard about waiting periods for pregnancy. They certainly do not exist in the public insurance scheme, which I would advise you to joint if at all possible. In any case such an exclusion would only affect the cost of normal delivery - all complications and the treatment of the baby are covered in any case.
On the other hand, your US$6k will not be enough even for a normal delivery!
- Germany has compulsory health insurance for all residents. Even if you complete the paperwork later (you have three months after arrival for this), you will be charged and covered retroactively from the day you arrived.
A foreign insurance does not suffice, you have to join the German system!
- If your husband can and does join a public health insurer (the ifs and hows of this are too complicated to describe here, but it depends largely on how he was insured in Germany in the past and abroad now), you and the baby can be covered free of charge as dependents, as long as you have no own income (worldwide and passive income also counts, above a very low threshold).
Please note that most self-employed opt for private insurers and there are reasons for this. Private insurers always cost extra for you and the baby!

Beppi has given good information. There is no such thing as German health insurance not covering one for pregnancy no matter when it happens. Only the American system could think up such a stupid idea. Yet one should double check on airline policies as to how along in the pregnancy they are willing to fly you. Some will be less restrictive but demand a doctor’s notice if towards the end of the allowed period. If you go too late, you might have little or no options of which airlines to take.

87% of people have a public option. Regular salaried employees must have public health insurance, unless their income exceeds 60,750€ per year (2019) – or (yes this sounds counterintuitive) be a civil servant. If their income exceeds that amount, they can have private health insurance instead. Freelancers can have public or private insurance, regardless of their income.

BUT - usually, your husband will have to take public or private depending on what he had before. There are also supplemental insurances one can opt to take which add extra perks. Most common is for dental work that is considered beyond the basic.

Like Beppi mentioned, if you have to go with private insurance you need your own policy. As long as you have no income you will be covered under your spouse’s policy under public insurance.  And the truth is that once it is decided between private and public policies, there is really little difference amongst basic policies. And even if the paperwork takes time, both coverage and payment for it will be done retroactively to when you registered in Germany – so no need to panic or think you will need a policy from America. It's doubtful any such policy would really cover you and travel health insurance certainly wouldn't.

You should look at the Wiki page about the German health system: https://en.wikipedia.org/wiki/Healthcare_in_Germany

But in addition to the health insurance you better be informed of the other requirements to immigrate. A spouse visa is not given without meeting some requirements. Married to a German, you still need to pass an A1 German exam and you both together need to have enough income and a big enough accommodation. I’m not sure how they do it when one is going to start up a new business and has no provable wage. Maybe they will then look at other assets. You should look at the German Immigration Authority (BAMF) website. It is in German and English but is not always easy to navigate. Many pages are rather skimpy but will have links to further documents where one finds the details.

The A1 language certificate requirement for the visa can be waived (after some additional paperwork and time needed, of course) in certain circumstances. Advanced pregnancy and taking care of a newborn count as such an exception.

beppi :

The A1 language certificate requirement for the visa can be waived (after some additional paperwork and time needed, of course) in certain circumstances. Advanced pregnancy and taking care of a newborn count as such an exception.

Theoretically this exemption is possible. From my understanding it is meant for people living in remote places in third world countries with no access to language instruction. They then require the people to do it after coming to Germany.

But this would not apply to people with internet and living in a large American city! And the baby is coming later; she is not in an advanced stage of pregnancy yet. She should be learning German NOW to later pass the exam before coming. For all I know she is already on this level (A1 is pretty basic) but I thought I would mention the requirement. It might sound counter-intuitive but the spouse of a German needs to pass this language test while the spouse of a non-German having been accepted to immigrate, at least with a blue card,  doesn’t.

Another thing I didn’t mention is that one’s visa will be denied if they have a serious criminal conviction. I am not trying to speculate, just let the rules be known. And this subject is even stricter in the States. I know an English guy who married an American yet got deported from the States because they found out he had been arrested for a joint 30 years earlier in the UK. Charges were dropped so there was no conviction and it wasn’t even in the States.

The upshot of these things is that one really needs to be aware of the rules for immigrating even with a spouse visa, it is not just a matter of which health insurance one gets.

Hi Beppi and Tomin,
Thank you both for the extensive information - it has been very helpful. A few things from the get-go, I've never had a criminal conviction or any run-in with the law, the most I've had is a single speeding ticket.

For the flight to Germany, I researched several airlines and most don't let you fly after 36 weeks, some have a policy of 32 weeks without a doctor's note. Right now the latest we would fly is 28 weeks with the goal or now trying to fly closer to 24-26 weeks. This of course, is all barring no complications which would be a totally different scenerio.

For the language requirement, I did have basic German from living in Germany for graduate school, it has since worn down quite a bit over the last 4 years where we spoke mostly English in the US. Because I need to pass the A1 I will start lessons ASAP to get back up to speed.

For health insurance, my husband was previously on public health insurance when he worked in Germany before moving to the United States. After your recommendations of getting on public insurance, he called several insurance organizations who confirmed that his public insurance will be reinstated from the day he arrives back and that his spouse (me) will also be covered. They advised of paperwork that needs to be filled out for both of us which we will complete and send back to them well before we arrive. This was my biggest concern in the immigration process since I know how complex and expensive the US system can be but wasn't sure about Germany. Pregnancy in the US is considered a 'preexisting condition' if you have not previously been covered with US health insurance and therefor is not covered - I agree this is ridiculous and unfortunate, just another way our health system can avoid covering basic healthcare costs.

I'll be looking over additional requirements for immigrating and making sure everything is complete. Thank you both for the information and if you have anything else thay seems relevant it is greatly appreciated!

Madison

In many other countries, pregnancy and childbirth are considered not sicknesses needing medical treatment, but lifestyle choices not covered by insurance.
We can count ourselves lucky that the German system is so generous here, even if a bit complicated.
I am glad everything worked out well for you!

Sounds like you have sorted things out pretty well. You still have some time to complete the A1exam and since you already lived in Germany it should not be much of a problem. But as we always recommend, to be happy in Germany over the long run it is worth making a strong effort to get as fluent as possible. Your student experience will probably be much different because then one has classmates and it's easy to create a social circle. Being married with a child is much more challenging for most expats and one often hears of loneliness. Just learning the language well is not a magical solution but makes things much easier.

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