Hartz IV No right to private health insurance premium supplements

07/14/2012

Since highly juridical jurisprudence, recipients of Hartz IV benefits have a full right to take over the insurance costs of a private health insurance (PKV). However, these should be comparable to the tariff of the statutory health insurance. This does not include surcharges for years in which those affected were not insured, as the Landessozialgericht Niedersachsen-Bremen recently ruled.

Beneficiaries of unemployment benefit II are entitled to full reimbursement of a private health insurance of the basic rate. A claim of a Hartz IV sufferers was not met, however, which also wanted to get the supplements for uninsured years from the Job Center, as Arbeitsgemeinschaft Sozialrecht explained in the German Bar Association. If arrears of contributions have arisen, they must be settled by the unemployed insured person themselves, as judged by the judges of the Landessozialgericht Niedersachsen-Bremen (AZ: L 9 AS 1241/11 B ER).

Supplement for arrears by non-insurance
In this specific case, an unemployment benefit II recipient had not signed a contract with a provider of private health insurance until the beginning of 2012, even though it had been subject to health insurance since September 2009. Because there was no health insurance coverage for this period, the insurance company demanded a supplement of around 1700 euros for the missing contribution period. Because the formerly independent insured pursued no gainful employment and Hartz IV benefits, she could not pay the arrears and then submitted an application for reimbursement at the responsible job center. However, the authority rejected the request and subsequent opposition was also not granted. Then the woman complained in an express procedure.

In principle, Hartz IV recipients have a right to full health insurance coverage, without the benefit recipients have to pay according to the SGB II for the costs, the judges. However, the service provider is only obliged to take over private health insurance contributions up to half of the basic tariff. Claims for additional benefits or supplements for years without insurance do not have to be paid by the job centers. An interest-free loan from the job center as a so-called „Can performance“ Divorce too § 24 para. 1 sentence 1 SGB II, because the surcharge is not a requirement anchored in the Hartz IV ruleset. In addition, according to the Land Social Justice „doubtful whether the lawsuit must be heard in an emergency procedure“. Finally, the applicant could have applied for a moratorium from insurance providers. (Sb)

Also read:
Hartz IV recipients more frequently chronically ill
Job center requirements make you sick
Hartz IV: Debt relief for PKV insured
No Hartz IV refund for private recipes
Merger of PKV and GKV required

Picture: HHS