No Hartz IV refund for private recipes

Hartz IV: No reimbursement of over-the-counter medicines through the Jobcenter. In case of doubt, the health insurance must be sued.

29/10/2011

Hartz IV recipients can not get over-the-counter medicines from the service provider. Instead, according to a recent decision of the Federal Social Court in Kassel, the statutory health insurance to be taken into account. Here, each case must be decided on an individual basis.

Unemployment Beneficiaries II (ALG II) can not apply for reimbursement for over-the-counter medicines to the responsible service provider (Jobcenter). According to a judgment of the Federal Social Court (BSG) in Kassel should instead the statutory health insurance for the „health subsistence minimum“ the person concerned. In this particular case, an ALG-II recipient at Jobcenter Berlin had made an application for additional demand in excess of Hartz IV's regular benefits. The attending physician had issued the woman a private prescription that is not listed in the catalog of benefits of the statutory health insurance. Normally, the patient has to pay the prescription out of his own pocket. The plaintiff then alleged an increase in demand for iron deficiency anemia, osteoporosis, chronic headache and skin allergy. The job center refused a reimbursement with reference to the lack of responsibility. After a rejected opposition, the person concerned complained through all instances to the highest social court BSG.

Lawsuit must be addressed to health insurance
But here, too, the lawsuit was rejected by the supreme social justice (Az .: B 14 AS 146/10 R). If the health insurance company does not take the drug prescriptions, the service provider is not automatically responsible, it was said in the verdict. The statutory health insurance is in the opinion of the judge in principle in the obligation to provide for the health subsistence level of the insured. If it comes to disagreements and refuses the health insurance company to take over the cost of drugs or therapies, the plaintiff must file a claim against the fund in case of doubt. An additional need within the meaning of the SGB for medical reasons only comes into consideration, if additional payments to the cash benefits overburden the Hartz IV recipient financially.

In the further verdict of the 14th Senate of the Federal Social Court it is said that the health insurance in principle comply with their duties and the livelihood. Over-the-counter medicines are taken on a case-by-case basis when patients suffer from serious diseases and the remedies are considered to be standard therapy. In the case under negotiation, the applicant suffers from osteoporosis and chronic iron deficiency. Under certain conditions, the costs for adequate preparations are also covered here.

More demand due to costly nutrition possible
In practice, the judgment means that for over-the-counter drugs and rejection of costs, the case-by-case decision always applies. Tip: Physicians should refer to the Hartz IV services with their patients, talk about an additional need for cost-intensive nutrition. In case of justified reasons an extra demand can be applied for at the Jobcenter. (Gr)

Also read:
Hartz IV makes people permanently ill
Hartz IV sanctions against pregnant women normal case?
Job centers must reimburse contributions for private health insurance
Practice fee in the future Hartz IV rate included
Hartz IV: additional contribution despite social assistance

Picture: Dr. Klaus-Uwe Gerhardt