Application for health insurance and long-term care insurance

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Personal data

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Title*:
Date of birth*:


Please enter either the pension scheme number or the general health insurance policy number. In the following, select the number that you wish to enter*:

Pension scheme number General health insurance policy number*

Country*:


The fields 'City of birth' and 'Country of birth' only needs to be filled out if there's no Pension scheme number and General health insurance policy number.

Contact

For enquiries regarding processing

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Information from the Bosch BKK


Consent to data use*:

I consent to Bosch BKK using and storing my personal data in order to inform and advise me on the benefits of becoming a member of Bosch BKK, the services of Bosch BKK and the innovations on the statutory health insurance market, both by telephone and by e-mail. You are free to withdraw your consent at any time with future effect; an e-mail or a phone call will suffice. In this case, your personal data will be deleted from the files of Bosch BKK.

Yes, I agree. I would like to be contacted by telephone or e-mail.
No, I do not agree. I would not like to be contacted by telephone or e-mail.


Insurance and employer details

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I would like to become a member of Bosch BKK as of*:


Are you an employee of the Bosch Group?
No Yes


Do you earn more than €59.400,00 per year?*
No Yes

You will receive an e-mail with a PDF attached that you should print out, complete and return to us.



Additional income such as a pension or other contributions?*
No Yes

Details of previous health insurance provider

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Insured since:


Would you like to terminate your current health insurance immediately?*
No Yes

We will issue you a termination and send it via e-mail so you can submit it to your current health insurance provider.

Further details

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I would like to include other relatives in the insurance. Please send me the relevant documents.*
No Yes

My photo for the eGK*
has already been uploaded will be submitted in due course

You may submit your photo for the eGK on our website.


I would like to know more about Bosch BKK. Please inform me of other services provided by Bosch BKK in the area of:

Bosch BKK "G-win" bonus programme
Extended family services
Vaccination services of Bosch BKK
BKK "Option S" selection tariff
Bosch BKK "TopVersorgt" programme
Bosch BKK Newsletter

*Yes, I have read privacy policy below and agree to the usage of my information by the Bosch BKK in order to send me periodic mails.
> Privacy Policy





Your personal data is collected, stored and processed by Bosch BKK with the purpose of fulfilling their legal requirements in accordance with the German Social Security Code. Your details are governed by data protection and treated as confidential.


I confirm that my details are correct. I will inform Bosch BKK of any changes immediately.



* Compulsory fields