Artificial insemination also for unmarried people?

OLG Karlsruhe: Marriage clause in private health insurance ineffective
According to the Higher Regional Court (OLG) Karlsruhe, the restriction of reimbursement for artificial insemination to married couples in private health insurance is inadmissible. There is - unlike in the statutory health insurance - there is no justifiable cause, as the Higher Regional Court on Friday, October 13, 2017, decided (Az .: 12 U 107/17). Thereafter, even without complete sterility, there may be a claim to reimbursement if a pregnancy were associated with high risks.

Artificial insemination, even if the couple is not married? (Image: Herrndorff / fotolia.com)

Although the applicant can become pregnant naturally. Because of a chromosome change, the probability of a successful pregnancy and a healthy child but then less than 50 percent.

Therefore, before her marriage, she had tried to get pregnant through artificial insemination. This failed.

The private health insurance of the woman refused to pay. According to the insurance conditions, there is a corresponding claim only for married couples. In addition, a partner must be sterile. That was not the case here, because the woman could well become pregnant.

On the complaint of the woman, the OLG dismissed both obstacles. Due to the fundamental importance of both issues, however, it was possible to revise the Federal Court of Justice.

While private health insurance generally covers the costs of artificial insemination, there is only a half-subsidy in the statutory health insurance. The restriction to married couples is prescribed by law there.

In the opinion of the Higher Regional Court of Karlsruhe, however, this is ineffective in private health insurance. It is true that the legislature can prescribe a difference in treatment for sociopolitical reasons. Private insurers, however, would pursue "exclusively economic interests". "Against this background, however, the distinction between married and unmarried insured persons with a desire to have children is arbitrary and the contract provision thus ineffective."

Also, that the applicant could become pregnant naturally, does not preclude reimbursement. As justification, the Higher Regional Court referred here to the high risk of possible genetic damage to the egg cell. This is a disease for which the insurance must be responsible. mwo / fle