Private or statutory health insurance? What makes sense for children of civil servants

Why health insurance is a special issue for children of civil servants

Should the child be insured privately or under statutory health insurance? Civil servants who become parents are faced with this important question.

For civil servants, the employer contributes to medical expenses with an individual allowance, but only if private health insurance is chosen. This then covers the remaining costs. In  many federal states, the allowance rate is 50% if you have one child, 70% if you have two children and more, and 80% for the children themselves.

Entitlement to assistance for children

Children of civil servants are generally entitled to assistance in their own right. The entitlement to assistance is usually 80%. Parents must cover the remaining medical costs with additional insurance.

Assistance regulations vary depending on the employer, federal state, and status of the respective regulations. Nevertheless, the basic principle remains the same: without supplementary private insurance, there is no complete insurance coverage.

Which parent must the child be insured with?

A key question for parents is: which parent must the child be insured with? The decisive factors here are the insurance status of both parents, their respective incomes, and whether one parent has private or statutory insurance.

If both parents have different insurances, special regulations apply. If one parent is a civil servant and has private health insurance and earns more than the partner with statutory insurance and above the JAEG, family insurance in the GKV does not apply.

Is family insurance in the statutory health insurance system possible for children of civil servants?

Family insurance in the statutory halth insurance system is not possible for many civil servant families. This is particularly the case if one parent has private health insurance and exceeds the income threshold for compulsory insurance.

A common mistake is to assume that the child can automatically be co-insured through one parent's health insurance. This is very often the case for civil servants if their spouse is insured under the statutory health insurance system, as most civil servants do not earn above the JAEG (income threshold for compulsory insurance).

Private health insurance vs. statutory health insurance for civil servants' children: private or statutory insurance?

The comparison between private and statutory health insurance is particularly relevant for civil servants' children. While statutory health insurance is income-based, private health insurance is based on an individual tariff and the desired scope of benefits. We have summarized the important aspects for you: 

What specifically changes when entitlement to subsidies ends?

When entitlement to subsidies ends - usually on the child's 25th birthday - this has two immediate effects on the child's existing health insurance. Firstly, the required insurance coverage increases from 20% to 100%, as subsidies will no longer cover medical expenses in the future. Secondly, the previous subsidy rate cannot be continued, making it necessary to switch to a so-called follow-up or subsequent rate. This rate change takes place within the private health insurance system and usually means a significantly higher premium.

How does switching to another private health insurance company work?

Important to know: This change in contract alone does not automatically give you a special right of termination, meaning that the insurance company is not formally onliged to agree to a termination. In practice, however, many insurers are accommodating and accept a termination nonethless. The reason for this is that insured persons can usually enforce their special right of termination in other ways with legal certainty. Since this involves additional administrative work for the insurance company and the result - a change of provider - remains the same anyway, many companies agree to a mutual termination of the contract.

If the insurer does not agree to termination, there is still a clear legal option: According to Section 205 (3) of the Insurance Contract Act (VVG), a special right of termination can be asserted if there is a change in tariff to a tariff with aging provions. Specifacally, this means that at the end of the entitlement to assistance, a change to an employee or full tariff can be requested. Since this tariff includes aging provisions, this automatically creates a special right of termination that allows a switch to another insurer.

Co-insuring children

Co-insuring of children allows parents to enroll their child in private health insurance without a health check. This regulation applies from birth and also provides protection in the event of pre-existing conditions that arise later.

Requirements for supplementary insurance rights

• at least one parent must be privately insured and the contract must have been in place for at least three months
• application must be submitted within two months of birth
• coverage up to the maximum benefit level of the parent

Advantages for parents

• no risk from later diagnoses
• planning security from birth
• seamless insurance coverage

What happens if you register late?

If the deadline is missed:

• a health check is required
• risk surcharges or benefit exclusions may apply
• coverage may be denied due to pre-existing conditions

Conclusion: Decision for civil servant families

For children of civil servants, private health insurance in combination with subsidies often offers clear advantages in terms of costs, benefits, and care. However, the decision should always be made on an individual basis. A well-founded comparison, reliable information, and a realistic assessment of the options help parents avoid mistakes and find the best solution for their child.