Health insurance contributions: court makes decision

Verdict

Didn’t pay a contribution? Your health insurance company can go that far

Anyone who falls behind on their health insurance contributions loses their right to benefits. But the Bavarian State Social Court has now drawn a line in the sand when it comes to revoking the health card.

Health insurance companies are not allowed to withdraw the health card from their insured persons because they have not paid their contributions. The Bavarian State Social Court (LSG) banned this widespread practice on the grounds that there was no legal basis for blocking or revoking the electronic health card due to the suspension of the right to benefits. With its decision of May 19, the LSG overturned a different ruling by the Augsburg Social Court.

According to the State Social Court, the entitlement to benefits is generally suspended if insured persons are in arrears with the payment of their health insurance contributions for two months despite a reminder. The only exceptions to this are examinations for the early detection of illnesses and services that are used to treat acute illnesses and pain conditions pregnancy and motherhood are required.

Because this “rest status” still cannot be marked on the card despite the introduction of the electronic health card in 2015, some health insurance companies block or withdraw the card from their insured persons and refer them to so-called authorization certificates. “The Bavarian LSG has now rejected this widespread practice,” the court said in a statement.

Every insured person is entitled to have an electronic health card issued, it said. In accordance with the system, dormant claims to benefits could only be marked by electronic identification of the card, but not by withholding the card combined with the issuance of authorization certificates. Especially since these are not intended for the use of medical or dental services, but rather for medicines, home nursing or household help. The verdict is not yet final.