German Health Insurance (GKV and PKV) Regulations and Contract Law

Vocabulary flashcards covering German statutory and private health insurance law, focusing on age-based exemption rules, tariff transfers, payment defaults, covered risks, and contract formation principles.

§ 6 Absatz 3a SGB V

A statutory regulation governing insurance freedom (Versicherungsfreiheit) that protects individuals aged 56 or older from being forced into compulsory statutory health insurance (GKV) when experiencing unemployment, provided they have not been insured in the GKV in recent years.

Befreiung von der Versicherungspflicht

An exemption from compulsory statutory health insurance (GKV) that is legally assessed on a fact-specific basis (tatbestandsbezogen), meaning an exemption granted for one reason does not automatically exempt an individual under a different event.

Versicherungspflichtgrenze

The compulsory insurance threshold in German health insurance, which, when exceeded by an employee's earnings, allows them to be exempt from statutory health insurance (GKV) and enroll in private health insurance (PKV).

Basistarif

A standardized private health insurance tariff offering benefits and coverage comparable to statutory health insurance (GKV), which must be made accessible to eligible policyholders such as those with certified financial need (Hilfebedürftigkeit).

§ 204 VVG

The section of the German Insurance Contract Act (Versicherungsvertraggesetz) that regulates an insured person's right to switch tariffs (Tarifwechsel) within their private health insurer while transferring accumulated aging reserves (Alterungsrückstellung).

Hilfebedürftigkeit

A certified state of financial distress or indigence that grants a privately insured person (such as an individual at age 45) the statutory right to switch into the Basistarif under § 204 VVG.

Alterungsrückstellung

Aging reserves accumulated by a private health insurance provider from an insured person's premiums to prevent steep rate increases in old age, which are credited when transferring to another tariff such as the Basistarif under § 204 VVG.

Kündbarkeit von Zusatzversicherungen

The contractual right of a private health insurance company (PKV) to cancel a supplementary insurance contract (Zusatzversicherung) if the policyholder defaults on premium payments after receiving the required statutory warning notices (Mahnungen).

Allgemeine Versicherungspflicht

The universal health insurance mandate under German law that renders statutory health insurance (GKV) contracts non-terminable (unkündbar) even when a member is in substantial payment arrears.

Leistungsfreiheit bei Beitragsrückstand

The legal suspension of insurance benefits that occurs when a policyholder defaults on premiums following statutory warnings, restricting coverage solely to emergency medical care (Notfallleistungen).

Arbeitsunfähigkeit

A temporary inability to perform one's current occupation due to illness or injury, representing the specific work-capacity peril covered within private health insurance (PKV), such as through daily sickness allowance (Krankentagegeld).

Berufsunfähigkeit

A permanent or long-term inability to practice one's specific trained profession, which is covered through separate disability insurance rather than private health insurance (PKV).

Erwerbsminderung

A statutory pension insurance classification describing a medically certified reduction in the capacity to work in any job across the general labor market.

Krankenvollversicherung

Comprehensive private health insurance that provides primary healthcare coverage for outpatient, inpatient, and dental care, replacing statutory health insurance (GKV) coverage entirely.

Zustandekommen des Versicherungsvertrags

The legal conclusion and formation of an insurance contract, which occurs upon the applicant's receipt of the insurer's written declaration of acceptance (such as on 19.03.), rather than the application date, the letter's writing date, or the later policy certificate delivery date.

Versicherungsschein

The formal insurance policy certificate delivered by an insurer (such as on 28.03.) that documents the contract, which itself came into legal existence previously when the policyholder received the declaration of acceptance.