State-insured person

What it means

A state-insured person is someone whose health insurance is paid by the state. Examples include dependent children and students up to a statutory age, pensioners, parents on maternity or parental leave, jobseekers registered with the labour office and people providing care.

The state thus becomes the contribution payer for groups who have no income of their own or who care for others. It pays contributions on a base set by law, and the insured person has the same entitlement to healthcare as anyone else.

State-insured status is not exclusive. If such a person starts working or doing business, contributions are also paid on that income, alongside the state's payment. A student on a work agreement or a pensioner with a trade licence is therefore both state-insured and an employee or self-employed person.

How it works in practice

Changes must be reported to the health insurer within the deadline, for example on finishing studies, taking a job or starting a business. In many cases the employer or a state body reports the change, but the insured person is responsible for completeness.

A graduate who leaves school without taking a job or registering with the labour office stops being state-insured and becomes a self-payer. Failing to report this and pay advances creates a contribution debt that the insurer collects with interest.

In the annual health insurance reconciliation, periods during which a person was state-insured are taken into account. For people with low income, such as pensioners with a trade licence, this can mean a smaller liability or a refund.

What to watch out for

When registering an employee, the employer must state whether they are state-insured, as this affects the calculation of contributions and some reliefs. Incorrect data lead to under- or overpayments that are corrected only in the annual reconciliation.

The rules on who is state-insured change, for instance the age limits for students or the conditions for parents. Before your situation changes, it is worth checking the current conditions with the insurer to avoid an unexpected shortfall.