Judgment lies make changes in private health insurance not ineffective

BSG: No return to legal coffers after deception of private
If a private health insurance fund successfully enforces the insurance contract for fraudulent misrepresentation, the insured person can no longer return to the statutory health insurance. Even a retroactive invalidity of the private insurance contract leaves the previously declared withdrawal from the statutory health insurance unaffected, as the Federal Social Court (BSG) in Kassel in a ruling already published in writing of June 29, 2016 (Ref .: B 12 KR 23/14 R).

The applicant was last voluntarily insured with the statutory health insurance DAK. She quit her membership on May 31, 2011. The DAK presented her with the certificate of the private German health insurance (DKV), the insurance from 1 June 2011 confirmed.

© stockWERK - fotolia

However, in her application for insurance at DKV, the applicant had provided false information. When this came out, DKV challenged the insurance contract for fraudulent misrepresentation. The district court confirmed this retroactively from the beginning of the insurance.

Then the woman said she was still legally insured in the DAK. For her private insurance contract had never been effective. Thus, the corresponding certificate of DKV has become obsolete, which is why the DAK did not have to dismiss them from the statutory health insurance.

The legal DAK refused a "resumption" and was now right by the BSG. The woman had effectively withdrawn from the statutory health insurance. The later contestation of the private insurance contract changes nothing.

The effectiveness of the termination only requires proof that health insurance protection continues to exist. Whether the new insurance cover was permanently legally valid can not be clarified within the notice period.

In addition, the woman until the challenge by the DKV actually had private health insurance. Thus, a statutory compulsory insurance is also waived due to lack of other protection. The fact that the DKV could reclaim any services rendered because of the deception, does not matter.

Rather, the woman remains assigned to the private health insurance, judged the BSG. Despite her attempted deception, she is also entitled to an insurance contract in the base rate. Only the DKV may refuse this, but not other private insurers. mwo / fle