BSG stops foreign insurance by company health insurance companies

Private group insurance from contributory funds inadmissible
(Jur). The statutory health insurance funds may not conclude a private group insurance for foreign treatment from the regular premium income. This does not belong to the legally permissible tasks of the cash registers, judged on Tuesday, 31 May 2016, the Federal Social Court (BSG) in Kassel (Az .: B 1 2/15 R). The affected health insurance now want to look for other solutions, such as a corresponding optional tariff.

The BKK Federal Association had developed the suggestion in 2007 that member funds offer their insured the foreign protection. 26 company health insurance funds with a total of 3.1 million insured concluded a corresponding group insurance with a private insurance company for all their members. The costs of about 4 Euros per annum per insured person are paid out of the regular cash contributions.

No private health insurance by company health insurance. Picture: sebra - fotolia

Before the BSG, the coffers justified this with the "social reality". Almost all the insured made trips abroad and Europe grew together. However, social security agreements would not really work with many countries. The bureaucratic effort is enormous. The participating health insurance companies would also save administrative costs, so that the offer was also economical for them.

Although the Federal Insurance Office, as the competent supervisory authority for most of the funds, had filed legal objections from the outset, it initially tolerated foreigners' protection for the insured. In September 2011, the authority ended its toleration practice and called on the coffers to end their overseas insurance.

Numerous funds came after, others went to court. Of three cases before the SPC, the Kassel judges have now decided on a model case.

Thereafter, the funds may not continue the private protection abroad. This was not the statutory health insurance assigned task. Also as a voluntary statute benefit the foreign protection according to the legal requirements is not permissible, because a corresponding authorization is missing.

Rather, the Social Security Code states explicitly that the protection of the statutory health insurance is suspended during a stay abroad. "It is therefore inadmissible that a statutory health insurance fund for this contribution funds used," said the Kassel judge.

After the verdict announced cashier representatives, the company health insurance funds would now look for other solutions. One possibility could be a corresponding elective rate. However, this would have to be approved by the supervisory authorities, and the insured would have to pay an additional fee for this. mwo / fle