Hartz IV No GKV claim for ex-self-employed

Formerly self-employed are not entitled to change to a statutory health insurance during the Hartz IV benefit receipt if they previously belonged to a private health insurance.

Former self-employed in the Hartz IV relationship, who were previously insured with a private health insurance, are not entitled to a change in the statutory health insurance. This was decided by the Landessozialgericht in North Rhine-Westphalia (NRW).

The Landessozialgericht NRW ruled in an urgent procedure with the file number Az: L 16 KR 329/10 B ER that ex-self-employed persons are not entitled to switch to the statutory health insurance in the period of unemployment, if they previously belonged to a private health insurance.

In the present case, a plaintiff from Hamm had not paid his PKV insurance premiums and was therefore terminated by the insurance company in 2007. Following this, the man was no longer insured. When the plaintiff became unemployed, he applied for admission to the statutory health insurance (GKV). The health insurance company refused, however, on the grounds that the private health insurance would have priority over GKV. Anyone who is in the Hartz 4 reference receives only the amount reimbursed by the Employment Agency, which would also be paid for the GKV. Since most of the PKV contributions are higher, the victims must pay the difference from the standard rate.

Basically, Hartz IV recipients are included in the statutory health insurance. Because every person, whether or not unemployed, is subject to compulsory insurance. However, this does not apply if someone previously belonged to a private health insurance or no health insurance. Here then has the PKV priority. The National Social Court pointed out that the creation of compulsory insurance, the private health insurers must offer a base rate. This tariff is offered regardless of the general health of the insured person. The benefits roughly correspond to a statutory health insurance.

The plaintiff had argued that he had given up self-employment shortly before receiving unemployment benefit II benefits. But this argument did not apply to the social justice. The status before the benefit receipt was decisive. The plaintiff clearly acted before the Hartz IV-related self-employment. (19.10.2010, sb)

Also read:
Arge has to pay at Hartz IV PKV contributions
Solution for PKV insured at Hartz IV?
Study: Fear of Hartz IV makes you sick

Picture credits: Klaus-Uwe Gerhardt