PKV base rate not for all welfare recipients

Welfare recipients without general entitlement to inclusion in the basic rate

07/18/2014

Basic rates are used in the private health insurance (PKV) to secure the insured, who can not afford (more) normal private health insurance rates. Nevertheless, access is far from being granted to everyone. Thus, the Federal Supreme Court has decided in an actual case that in welfare recipients „no general entitlement to inclusion in the basic rate of private health insurance“ consists.

According to the decision of the IV. Civil Senate at the Federal Court „Persons who are recipients of current benefits according to the Twelfth Book of the Social Code (SGB XII) (welfare recipients), and who would be subject to compulsory insurance in the statutory health insurance without the receipt of social assistance, not eligible for inclusion in the basic rate of private health insurance.“ This also applies to persons who received benefits on the basis of SGB XII for the first time after 1 January 2009.

Application for inclusion in the basic tariff rejected
In the current case, the plaintiff, who has been living in Germany for about 10 years, had tried to assert her admission to the basic rate of the private health insurance for herself and her three minor children. The plaintiff referred to the notification of the Federal Court of Justice „until the end of April 2012 benefits under the Asylum Seekers Benefits Act and was treated by the local AOK regarding the treatment of the sick.“ Since May 2012, she has been entitled to social assistance under SGB XII. She was informed by the responsible social welfare office, „she must file an application for insurance at the basic rate of a private health insurance“, the Federal Court reports further. However, the selected insurance company refused the application, whereupon the woman filed suit against the refused admission.

This complaint was initially granted by the Regional Court of Cologne (Cologne Regional Court, judgment of 10 July 2013 - 23 O 396/12), but in the near future on appeal of the defendant health insurance of the Higher Regional Court of Cologne (OLG Cologne, judgment of 8 November 2013 - 20 U 137/13). This decision has now been confirmed by the Federal Court of Justice (Federal Court of Justice, judgment of 16 July 2014 - IV ZR 55/14). Accordingly, recipients of social assistance have no fundamental right to inclusion in a basic rate of private health insurance. (Fp)