Job centers must reimburse contributions for private health insurance

Job centers must fully reimburse contributions for private health insurance. The job centers are now threatening billions in expenditure. Associations call Hartz IV recipients to submit requests for review.

19/01/2011

The Job Center must fully accept contributions from ALG II beneficiaries for private health insurance. Thus, the Federal Social Court in Kassel on Tuesday in a corresponding ruling has decided. The job centers are now threatening to spend millions.

According to the basic judgment of the Federal Social Court, the Job Centers are obliged to fully assume the contributions for privately insured Hartz IV recipients up to the amount of the basic tariff. Since 2009, private health insurance companies (PKV) have been obliged to offer a so-called basic rate for insured persons who can no longer finance their previous contribution. Of the monthly 575 euros of the maximum contribution in the basic tariff, which must pay the most insured, take over the job centers so far however only 130 euro. The remaining contribution costs had to pay the ALG II recipients from their own pockets or hope that the PKV will grant them this. This will change in the future according to the judgment of the Federal Social Court. According to the PKV Association, about 6,800 Hartz IV recipients are affected by the current verdict with a basic rate of private health insurance.

Health insurance protection is part of the subsistence level
In the case to be negotiated, an unemployed lawyer had sued Jobcenter Saarbrücken for the full assumption of his insurance costs. The 4th Senate of the Federal Social Court decided now in the sense of the needy lawyer that the PKV contributions amounting to 207.39 euros per month to take over completely. Previously, the Job Center had only granted the usual statutory contribution of € 129.54. The remaining costs in the amount of just under 80 euros, the ALG-II referring lawyer would have to pay from his Hartz IV rule rate. However, as the plaintiff's lawyer emphasized, the ALG II beneficiary had not been able to pay that sum out of the standard rate, so that the person's monthly contribution costs accumulated as debts. However, since a sufficient health insurance coverage is part of the constitutionally protected subsistence minimum, the job center would have to fully assume the accruing contributions, the plaintiff now demanded before the Federal Social Court. Because the possibility to return to the statutory health insurance does not exist and the base rate is the last option for the affected ALG II recipients.

Federal Social Court judges in the sense of the insured
The Federal Social Court now ruled that it could not be assumed that the legislature wanted to worsen the health insurance protection of those affected, as in 2009, the base rates were introduced. Nor should a privately insured ALG II beneficiary be forced to accumulate contribution debts equal to the difference, the judges further emphasized. Rather, the legislator wanted to ensure affordable contributions in the PKV with the basic rate rules, however „but he has (this) implemented only inadequate“ so the statement at the Federal Social Court. The court saw one at this point „unpleasant gap“ in law. However, with their verdict, the judges of the BSG have now adopted a clear vote in favor of the ALG II recipients concerned that at least eliminates the financial problems associated with the basic tariff for the insured (file reference: B 4 AS 108/10 R).

Social minister and PKV satisfied with verdict
Both in the social minister and the Association of Private Health Insurance, the verdict of the Federal Social Court was welcomed. Ursula von der Leyen (CDU) emphasized: „It is good that there is now legal certainty for those affected“. The minister added that with the judgment „Hartz VI recipients can initially stay in their private health insurance, without having to come up with their own contribution.“ Her ministry will do its part to ensure that a coherent solution for private insured persons who are only temporarily dependent on unemployment benefit II, presented by the Leyen. Also Volker Leienbach, director of the Association of private health insurance was satisfied with the current verdict: „The private health insurance advocates the judgment of the highest German social court“. According to the PKV-Verbanddirektor must, „Legislators (...) are filling the gap in 2007 health care reform by reimbursing full health insurance contributions“. Because to a constitutionally guaranteed subsistence level also includes an appropriate health insurance. If the social authorities do not take on the necessary contributions from privately insured ALG II recipients, „the social state denies the needy the subsistence minimum“, emphasized Leienbach.

Statutory health insurance companies also demand higher reimbursements for Hartz IV recipients
As soon as the verdict at the Federal Social Court has been made, the statutory health insurances also have their say and demand a higher reimbursement from the job centers. „After the Federal Social Court has given the private health insurance much higher payments from the job centers, the amount for the legally insured ALG II recipients must of course also be adjusted“, said Doris Pfeiffer, CEO of the GKV-Spitzenverband. Because it could „It should not be that the Job Centers pay significantly more for insured persons of for-profit private health insurance than for people who are in a statutory health insurance fund“, so the statement from the direction of the GKV-Spitzenverbandes. Even in statutory health insurance, the costs are significantly higher than the reimbursements from the job centers, explained Pfeiffer. According to statements by the board chairmen of the GKV-Spitzenverband, an average of 278 euros a month is spent per member, but only 130 euros are reimbursed by the job centers for Hartz IV recipients. The remaining costs are covered by the insurance. However, increasing the reimbursements for SHI contributions from ALG II beneficiaries to the average cost would likely cost billions more, while the costs associated with the current verdict are estimated to be just under € 13 million.

Contradict Hartz IV-modest and ask for review
The jobless initiative „gegen-hartz.de“ advises all parties concerned to file an objection against the current Hartz IV decision as well as a petition for review of the previous decisions. Only in this way can it be ensured that the competent job center will reimburse the full costs of the PKV insurance contributions. However, those affected should not be allowed to do so for too long, because a new amendment to the Federal Council is currently being discussed, which foresees a reduction in retrospective back payments from the current four to one year. In the course of the judgment, which has now been passed, it may be that the Landkammer now initiates the implementation of the draft as soon as possible. (sb, fp)

Also read:
Hartz IV judgment: claim to full costs of PKV