The earnings limit for family insurance

If dependents have low incomes and these are below the earnings limit for family insurance, there is the possibility of co-insuring the corresponding person free of charge. However, this only applies to members of a statutory health insurance, as the entitlement is based on paragraph 10 of the Fifth Social Security Code. To find out what the current income limits are and what happens if the family member's earnings are higher, see the guide below.

The most important facts in brief

  • The earnings limit for family insurance is usually increased annually.
  • From the surplus income of the co-insured person, the income-related expenses can still be deducted.
  • Members of a statutory health insurance may in principle both partners and children (biological, adopted, stepchildren and grandchildren) also insure.
  • If the family member exceeds the income limit, he or she must purchase his or her own health insurance policy.

Who can be included in the family insurance?

In principle, it is only possible to co-insure family members. The following groups of persons are considered as such in this context:

  • Physical children
  • Spouse or same-sex partner
  • Adopted children, as well as children who already live with the family that wants to adopt them
  • Stepchildren and grandchildren
  • Foster children who live in a domestic community with their foster parents

Children can be insured at least until they reach the age of 18. If they are not gainfully employed, they can be included in the family insurance until they reach the age of 23. Students must be at least one year old. If the offspring is in school or vocational training or is doing a voluntary social/ecological year or federal voluntary service, the child is covered even up to the age of 25. Co-insured for the second year of life. The same applies to students. If there is an interruption in schooling or vocational training due to the fulfillment of a statutory service obligation, the insurance remains in force thereafter, but only for a period corresponding to the duration of the service performed. For people with a disability, the age limit does not apply under certain conditions.

What are the earnings limits for family members?

The earnings limit for family insurance corresponds to one seventh of the monthly reference amount according to paragraph 18 of the Fourth Social Security Code. However, the legislator raises the amount almost every year, as a result of which the income limit also increases slightly. This is justified with the average remunerations of the legal pension insurance, at which the variable orients itself. While the earnings limit in 2020 was still 455 euros per month, it has been increased to 470 euros for 2021. Always inform yourself accordingly about the current earnings limit. This amount must not exceed the total monthly income of the co-insured person.

What counts as total income?

The term total income is defined by paragraph 16 of the Fourth Social Code. It states that the total income is the "sum of the income in the sense of the income tax law". According to paragraph 2 of the Income Tax Act, this includes above all:

  • Gross pay as well as one-time payments, such as vacation or Christmas bonuses
  • income from capital assets, for example interest income or dividends
  • Income from renting and leasing
  • Pensions (including pensions paid abroad)
  • Earnings from self-employment
  • Taxable alimony payments

However, income does not include, for example, BAfoG benefits, depreciation, lump sums for savers, parental, child and housing allowances and amounts for child-raising periods in the case of pensions.

How the statutory health insurance calculates the monthly income in detail depends on the type of income. In the case of wages, the months in which the person to be co-insured earned them are decisive. Regular payments, on the other hand, are calculated on a pro rata basis. If income from self-employment is available, the health insurance company uses the last income tax assessment to derive the future income.

Take into account income-related expenses

Employees may still deduct income-related expenses from their gross pay. You can at least pay the legally fixed flat rate of 1.000 Euro, which corresponds to an additional monthly amount of 83.33 Euro. If you can prove higher income-related expenses, the earnings limit for family insurance increases even further.

Earnings limit for family insurance exceeded: What to do?

If the family member included in the family insurance exceeds the income limit set by the legislator, there is an obligation to inform the health insurance company and to take out a separate insurance policy. Usually, the insurance company sends a questionnaire to families every year regarding income. This enables the insurance industry to check whether the necessary requirements are still met.

Nevertheless, it is advisable for insured persons to inform the health insurance fund as early as possible if they exceed the earnings limit for family insurance. If you do not declare the relevant changes, in the worst case scenario you can expect that the insurance company will demand an additional premium payment.

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