Health insurance company terminates: Tischler loses GKV membership

False information

Shortly after switching: Health insurance company terminates the policy for the insured person

Switching to statutory health insurance from the age of 55 is hardly possible. A self-employed carpenter succeeded – but incorrect information now became his downfall.

According to a ruling, an elderly self-employed person loses his newly acquired membership in statutory health insurance because a health insurance employee provided false information about him. The cash register can terminate the carpenter’s contract, as the Berlin-Brandenburg State Social Court decided on Wednesday. The employee invented that the man had previously been legally insured in another EU country.

Until this year, this was a loophole for those over 55 with private health insurance who wanted to switch to statutory health insurance because of rising costs. Such a change should only be possible in rare, exceptional cases so that those with statutory health insurance do not alone bear the higher health costs for older people. The loophole has now been closed by a new legal regulation.

The carpenter’s case began in 2020. At that time, after eight years of private insurance, he turned to an insurance broker. He was in contact with a health insurance employee who stated that his insurance company also easily accepts people over 55 years old.

• Verdict: This health insurance gift is prohibited
• Current verdict: Return to the GKV: Court remains tough

The carpenter canceled his private health insurance and sent the insurance broker his application for inclusion in statutory insurance. Without his knowledge, the health insurance company employee included fake documents about alleged previous insurance periods Poland added, whereupon the health insurance company accepted the man.

However, after inquiring with the responsible Polish insurance provider, she discovered that the information was incorrect. After a year, she canceled her membership at Tischler. He sued, but was unsuccessful. The court explained that the public’s interest in a proper condition was more important.

An appeal against his verdict was not permitted. The carpenter can still do this at the Federal Social Court kassel apply for. His misconduct also had consequences for the health insurance employee. He lost his job, court records show. He was later sentenced to prison for fraud.