Pronova BKK Online Application Form

Health Insurance Pronova BKK

1Personal information

2Work / Study details

3Previous insurance / Family details

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date

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provider

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ref

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partner

Start

When do you want your Pronova BKK coverage to start?*

DD dot MM dot YYYY

I would like to insure myself as*

since*

DD dot MM dot YYYY

and have been drawing/expect to draw unemployment benefits or ALGII 5) since/as of*

DD dot MM dot YYYY

This is / must be the date you start working (as is your work contract) or the start date of your studies. The date can be in the past.

Personal information

Name*

First Last

Date of birth*

DD dot MM dot YYYY

Gender*

Male

Female

Diverse

Marital status*

Single/not married

Married

Civil Partner

Address

Do you have a german address?*

Yes

We will send your health insurance confirmation to your employer.

Is your name on the mailbox?*

Yes

Please enter in the line “Address Line 2” the name which is written on the mailbox and insert a “c/o” in front of the name.
Example: “c/o Name” or “c/o Company Name”

Do you currently live in a boarding house?*

Yes

Example for VISION Apartments
Address Line 1: Otto-Braun-Str. 67
Address Line 2: c/o VISION Apartments
ZIP: 10178 City: Berlin

Address*

Street Address Address Line 2 City ZIP / Postal Code

Privacy

You have the possibility to save your entries at any time and continue later. In this case we will store your data for up to 30 days. I have read the privacy policy and hereby agree that the personal information I have provided voluntarily may be raised, processed and used in order to provide the specified request. I agree that my confirmation of insurance will be sent to the address of my employer if I do not yet have an address in Germany. The confirmation can be sent to me and my assigned relocation company by email.

Broker information*

I have read the broker information according to § 15 Insurance Mediation Ordinance.

I have read the broker Information.

Updates

I would like to be informed regularly by email about relevant insurance topics by Expats.de. We use the provider MailChimp to send our updates.
I have read the privacy policy and hereby agree that the personal information I have provided voluntarily may be raised, processed and used in order to provide the specified request.I can unsubscribe from this update service at any time.

I would like to be informed.

Employee

Is this your first time being employed in Germany?*

Yes

Employed/working as*

as written in the employment contract (exact job position)

Who is your new employer?*

as written in the employment contract (exact company name)

What is the address of your employer?*

Street Address City ZIP / Postal Code

What is the first day of your work contract?*

DD dot MM dot YYYY

Is this the same date you want to start your coverage?*

Yes

Why is there a difference between the dates?*

As a rule, the start date of the insurance should coincide with the first day of your work. A possible reason can be the start of work abroad (in home office due to Corona). Please enter the reason here.

Are you a partner in and/or managing director of the company you're employed by?*

In 99% of cases the answer is no, we just have to check…

Yes

How many per cent of the nominal capital?*

e.g. 55,5

What is your monthly income (before taxes)?*

Please include any bonus payments pro rata.

it does not exceed 520 EUR – mini-job

it is between 520 – 5.550,00 EUR

it exceeeds 5.550,00 EUR

Student

Please upload your current registration letter, stating the academic semester.

If you don’t have it right now we’ll follow up with you.

Drop files here or

Max. file size: 16 MB.

What university/college are you studying at in Germany?*

e.g. TU Berlin

What is your subject area?*

e.g. Mathematics – this doesn’t need to be super specific

What is your current academic semester?*

it’s 1 if you haven’t started yet

Please enter a number from 1 to 20.

What date did you begin studying*

DD dot MM dot YYYY

Do you study for a Masters Degree?*

Yes

Have you studied in any other countries besides Germany?*

Yes

How many semesters did you study abroad?

If you didn’t have semesters take: years studied / 2.

Do you get or have applied for benefits from the Federal Employment Agency [Agentur für Arbeit]?*

Yes

German pension number / Social security number

Do you have a German pension number?*

The pension insurance number has 12 characters and a letter in the ninth place. For example: 04 150872 P 08 0

Yes

What is your German pension number?*

If you do not yet have a number, it will be sent to you by the BARMER approx. 10 days after the insurance confirmation.

These next 3 questions are required instead of your pension number.

What was your family name / last name at birth?*

What is the place/city and country of your birth?*

e.g. Madrid, Spain

What is your nationality?*

Details of previous insurance

Were you last insured*

Yes

What's your last health insurance provider?*

e.g. “Name of your Insurance provider”

Location (city/country)?*

I am insured there since*

DD dot MM dot YYYY

I am insured there/private until the beginning of my work/study in Germany?*

Yes

I am insured there/private until*

DD dot MM dot YYYY

If you are already in Germany before the start of the statutory health insurance, please take out a visa travel insurance for this period. You can do this here.

What kind of insurance?

Compulsory insurance

Private insurance

Depedants insurance

Confirmation of cancellation from previous health insurance provider*

upload now

will be sent later

Please upload a copy of your Confirmation of cancellation from previous health insurance provider.

If you don’t have it right now we’ll follow up with you.

Drop files here or

Max. file size: 16 MB.

Insurance policy of*

Name, First name; of the person, where you are insured with (as dependant)

Insurance policy of*

Name, First name; of the person, where you are insured with (as dependant)

I have a physical injury/health impairment*

The purpose of this question is exclusively to check possible reimbursement or compensation claims against third parties (e. g. damages resulting from an accident, malpractice, occupational illness Sections 102 et seqq., 116 German Social Code, Title X [SGB]). Our partner stores these data for 6 years and then deletes them.

Yes

Compulsory health/pension insurance

Have you been exempted from compulsory health insurance coverage in Germany?*

Yes, if you applied for it you would have done that proactively and know about it.

Yes

Please upload a copy of your confirmation of exemption from compulsory health insurance coverage.

If you don’t have it right now we’ll follow up with you.

Drop files here or

Max. file size: 16 MB.

Have you been exempted from compulsory pension insurance coverage in Germany?*

In 99% of cases the answer is no, this only applies for a few really specific professions.

Yes

Please upload a copy of your confirmation of exemption from compulsory pension insurance coverage.

If you don’t have it right now we’ll follow up with you.

Drop files here or

Max. file size: 16 MB.

Do you currently receive or have you applied for a state pension?*

In 99% of cases the answer is no, this only applies for a few really specific professions.

Yes

Do you currently receive a non-state pension and related benefits (e.g. company pension).*

In 99% of cases the answer is no, this only applies for a few really specific professions.

Yes

Family details

Would you like to have your dependents covered by non-contributory dependants insurance?*

e.g. children or partner who isn’t working

Yes

We will send you an Email with further information after your application.

You will receive more information in your confirmation email when you submit this application.

Are you exempt from social long-term care insurance?*

Yes

Please upload a copy of your confirmation of exemption from social long-term care insurance.

If you don’t have it right now we’ll follow up with you.

Drop files here or

Max. file size: 16 MB.

Do you have any children?*

Children, who live in the same household. Your contributions to long-term care insurance are lower if you have children. Please submit the relevant proof in the next step, e.g. a copy of the birth certificate.

Yes

Please upload a copy of the birth certificate here.

If you don’t have it right now we’ll follow up with you.

Drop files here or

Max. file size: 16 MB.

Contact details

We will pass it on to Pronova in case of any queries.

Email*

Enter Email Confirm Email

Phone*

Signature

Signature*