Questions and Answers on the consequences of separation and divorce for health insurance

How do separation and divorce affect the health insurance of family members?

One of the most pressing questions that arise during a separation is how to secure continued health insurance coverage.

Different rules apply to the different insurance regimes for statutory health insurance, private health insurance and allowances for civil servants.

Does the separation already affect the health insurance cover of the family insured spouse in the statutory health insurance?

If one spouse is compulsorily insured in the statutory health insurance scheme, the insurance cover extends to the spouse and minor children of the insured in the family insurance scheme (§ 10 SGB V). This non-contributory family insurance of the spouse depends, among other things, on the amount of his or her total income, which may not regularly exceed one seventh of the monthly reference value according to § 18 SGB IV. In 2020, the monthly reference value is € 3,010 in the old federal states and € 3,185 in the new federal states, resulting in a limit of € 455 (= € 3,185 / 7) and € 430 (= € 3,010 / 7) respectively. From 2025, the reference value will be determined uniformly. Family insurance naturally also applies to same-sex spouses and partners in a registered partnership. This regulation is intended to ease the burden on low-income families (§ 10 SGB V, § 18 SGB IV).

The family insurance of minor children of the compulsorily insured spouse survives separation and divorce and does not depend on whether the children live in his or her household or in that of the other spouse. The family insurance of the spouse is not affected by the separation from the compulsorily insured spouse. Even if the separation lasts a long time (e.g. ten years), the spouse's family insurance remains unrestricted until the divorce becomes final, i.e. even during the ongoing divorce proceedings, which often take more than a year (see pension rights equalisation). For the economically weaker, family-insured spouse, who is often exposed to particularly serious economic uncertainties as a result of the separation, it is of particular importance that the previous non-contributory family insurance cover continues to exist during the separation period.

 

What happens with the family insurance after the divorce?
After the divorce proceedings have been concluded with legal effect, which usually occurs one month after the divorce decree has been served with the expiry of the appeal period, the family insurance ends automatically and is continued as a contributory voluntary statutory health insurance. In order for this effect to occur, no corresponding declaration to the statutory health insurance is required. The advantage is that insurance cover continues without interruption even if the person concerned has not taken care of it (e.g. out of ignorance) and even if no contributions are paid for a long period of time. The disadvantage is that premiums are incurred immediately, which accumulate over a longer period of time and can then reach a considerable amount. Therefore, it is certainly important to contact the statutory health insurance soon because of the fixing of the contribution amount according to the actual income situation, in order to avoid an excessive fixing of contributions according to the average rates. In the voluntary statutory health insurance, the amount of contributions is determined not only by the income from employment, but, unlike in the compulsory insurance, also by other income, e.g. the return on a stock portfolio or income from the landlord of a condominium. As soon as the person concerned receives the instruction from the GKV about the change to voluntary health insurance, there is a two-week period within which he or she can change to a health insurance company or private health insurance, whereby proof of complete continued insurance coverage must be provided. This regulation is intended to ensure that protection in health insurance continues without interruption. The previous model provided for the continuation of family insurance for a transitional period of six months after the divorce became final. Upon expiry of this "grace period", however, the insurance cover ended, which often led to insurance gaps for the persons affected, which are to be closed by the new regulation.
 
What applies to the civil servant's spouse after separation and divorce?
If one spouse is a civil servant, his or her children and the other spouse are also entitled to assistance. The contributions in the supplementary private health insurance are significantly lower than in the other cases of private health insurance. While nothing changes for the children here either, and they remain eligible for assistance, the entitlement to assistance of the other spouse ends with the legal force of divorce - i.e. regardless of what other protection exists. This leads directly to the fact that the contributions in the private health insurance existing beside it immediately rise substantially. Here it is particularly important to check, with sufficient lead time before the divorce, how to proceed with the health insurance in case of illness and to inform yourself comprehensively about the different offers in order to choose the most advantageous model in time. If necessary, there is the possibility of returning to statutory health insurance.

 

What happens to private health insurance after separation and divorce?
 
If all family members have private health insurance while living together, separation and divorce have no effect. In contrast to the family insurance in the statutory health insurance, in the private health insurance contributions for each individual family member are already incurred during the cohabitation.
What can I do after the separation if I cannot afford to pay the private health insurance premiums myself?
After the separation, the dependent spouse may request that the economically stronger spouse provide separation maintenance. The amount of the maintenance claim covers all needs and is based on the circumstances of the marriage. If the private health insurance already existed during the cohabitation, the contributions then also belong to the marital needs, which are to be claimed separately for the time after the separation until the divorce becomes legally effective as separation support and for the time after that as post-marital spousal support. In addition to the standard rates of the Düsseldorf Table, the children's claim to maintenance also extends to the contributions to private health insurance, which are then, however, to be deducted from the income of the party liable to pay maintenance when determining the table maintenance according to the Düsseldorf Table (Guidelines on Maintenance Law of the Higher Regional Courts, no. 11.1 - in Berlin: Kammergericht).
 
If it is uncertain whether the other spouse is capable of providing maintenance and/or the spouses cannot reach a mutual agreement on the provision of maintenance in connection with the separation, it will be necessary for the economically weaker spouse to apply for JobCenter benefits in accordance with SGB II (so-called Hartz IV benefits) as a precautionary measure after a separation to bridge the gap, so that the contributions (in the basic tariff) are paid from there. This may help to avoid a build-up of large arrears in contributions in private health insurance. Experience has shown that if a dispute arises about the claim for maintenance, it can take some time before the matter is clarified in court. Since it may turn out that the income of the other spouse is not sufficient to cover the maintenance, it is always advisable to apply for benefits from the JobCenter as a precautionary measure - at least for the transitional period.

Rechtsanwalt Wolfgang Sattler, Fachanwalt für Familienrecht und Fachanwalt für Sozialrecht

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