Artificial insemination: Judgment confirms health insurance benefit only for married couples

Verdict

The health insurance company only pays this benefit for spouses

If you want the costs of artificial insemination to be paid by your statutory health insurance, you must be married. Single people are not entitled to this benefit. The Bavarian State Social Court confirmed this in a recent judgment (Az: L 20 KR 62/26).

The lawsuit was filed by a single woman who, due to her infertility, demanded that her health insurance company cover the costs of artificial insemination with donor sperm. However, the health insurance company referred to the Social Security Code. This ties the assumption of costs to certain conditions: In addition to the age of the insured, their marital status is also crucial.

However, the court did not recognize a violation of fundamental rights. The fundamental right to a personal lifestyle also includes the decision to have children. However, this does not result in any obligation for the state to finance the realization of the desire to have children at the expense of the insured community. The Basic Law does not contain any requirement for specific social security benefits – their determination is rather a matter for the legislature.

The judges also made it clear: The differentiation between married and unmarried insured persons has a clear purpose. Marriage, as a long-term community, offers a special guarantee that the “stresses associated with artificial insemination” can be overcome together.

As long as the legislature does not change the relevant paragraph in the Social Security Code, the health insurance companies will remain bound to the legally anchored spousal exemption.

The costs of artificial insemination are subsidized by 50 percent by the health insurance company. However, many health insurance companies have significantly increased their cost sharing and are covering up to 100 percent. However, in addition to the marriage status, certain conditions must be met:

• Only the spouse’s eggs and sperm may be used.
• Both partners must be at least 25 years old. The woman must also be younger than 40 and the man younger than 50.
• The spouses must first seek advice from a doctor who does not carry out the treatment themselves.

The measure must also have a reasonable chance of success. This can no longer be assumed if the corresponding measure has already been carried out three times without success.