Emergency tariff: Health insurance pays for 24-hour care after an accident

Emergency tariff

Health insurers must pay for 24-hour care

The emergency tariff in private health insurance only covers the bare essentials. However, the Coburg regional court has now made it clear that this can also include 24-hour care.

Anyone who is temporarily no longer able to pay their private health insurance premiums will fall into the so-called emergency tariff. This is significantly cheaper, but in return you only pay for what is absolutely necessary. Only treatment for acute illnesses and pain conditions is covered. The insured person must pay for all medical services that go beyond this out of their own pocket.

In principle, however, the following applies: When it comes to securing vital functions, private health insurance has to pay. This is what the Coburg Regional Court (Az: 24 O 267/22) decided in a current case.

This was about a motorcyclist who was in need of care after a serious traffic accident and had to be monitored at home around the clock by medical professionals. This should be able to react quickly in the event of oxygen drops and life-threatening aspiration – the unintentional inhalation of foreign bodies. This resulted in monthly costs of sometimes over 25,000 euros

However, after initially covering the costs, the health insurance company refused to pay for the round-the-clock care. She referred to the emergency tariff in which the motorcyclist was insured due to arrears in contributions. This only includes services for acute illnesses and pain conditions, but not later care.

Health insurance does not only have to cover the costs of other nursing services and household care. Private nursing care insurance is responsible for this.

The health insurer lodged an appeal against the verdict, but this was rejected by the Bamberg Higher Regional Court.