Hartz IV PKV deductible is not accepted

Hartz IV recipients have to pay deductibles of private health insurance from the standard rates

25/08/2011

Hartz IV recipients who are insured with a private health insurance (PKV) must pay the deductible for special rates from the ALG II regular benefits. However, the contribution rate for private long-term care insurance must be taken over in full. That was the verdict of the Landessozialgericht Nordrhein-Westfalen.

Members of the private health insurance companies that rely on Hartz IV benefits are not entitled to take over the deductible. In the case of a deductible, the policyholder undertakes to pay the insurer himself the costs up to a stipulated sum for outpatient therapies. Only when this sum is exceeded, the private health insurance must take. With a deductible insured can reduce their regular contributions. The plaintiff therefore demanded from the competent service provider the assumption of the costs for the deductible. The Jobcenter refused to cover the costs. Subsequently, the plaintiff filed an appeal and then brought an action before the Social Court.

The State Social Court of North Rhine-Westphalia denied a claim for reimbursement in a judgment that has not yet been finally adopted. According to this, the plaintiff has to bear a deductible of 400 euros, although this minimizes the monthly contribution rate of private insurance. If the insured person chooses a PKV base rate, according to the latest case law of the Federal Social Court in Kassel, the Job Center must accept the full amount of the contributions. Since the deductible is not a regular burden - which is therefore only an involvement of health care costs - the plaintiff must bear the costs themselves. Alternatively, the plaintiff could choose a base rate offered by PKV Versicherungen (file reference: L 19 AS 2130/10).

Takeover of private long-term care insurance for Hartz IV recipients
The plaintiff was more fortunate in deciding whether the contributions of the private long-term care insurance must be taken over. A gap in coverage existed so far, since the authority only took over the legally prescribed minimum rate. Instead of the 36.31 Euro per month, took over the job center of the self-employed Hartz IV recipients only a half part of 18.04 Euro, which corresponds to the minimum contribution to the statutory long-term care insurance. Although in this case the authority would also comply with the requirements of the legislator, it was not taken into consideration when creating the legal situation that a coverage gap arises for those affected that are not provided for in the ALG II standard benefits. "It is not clear that the legislator deliberately and intentionally wanted to impose private health insurance claimants a contribution to the private care insurance that they can not carry because of their financial circumstances," said a spokesman for the State Social Court. The Supreme Social Court, the Federal Social Court in Kassel, had only decided in January 2011 that social assistance agencies and municipalities are obliged to take over full insurance, as far as they correspond to the range of services of the statutory health insurance. This decision is also not final and must be decided in all probability in the next highest instance, the Federal Social Court. (Sb)

Read about:
Hartz IV: Takeover of private long-term care insurance
Hartz IV: Debt relief for private insured
Hartz IV: Health insurance companies have to check 1 Euro jobs
Hartz IV: Debt through health insurance
Exemption of additional contributions from Hartz IV
Consequences of deleting the additional demand in Hartz IV
Federal agency ignores PKV judgment in Hartz IV
Hartz IV: additional contribution despite social assistance

Further information and assistance to Hartz IV in the net:
Hartz IV Forum
Tacheles social assistance
Against Hartz IV
Jobless Forum

Picture: Dr. Klaus-Uwe Gerhardt