Verdict Private health insurance companies have to pay eye lasers

BGH: Glasses are only aids and no treatment
Private health insurance companies have to pay for eye lasers if a defective vision significantly affects reading and driving. This was decided by the Federal Court of Justice (BGH) in Karlsruhe in a ruling issued on the previous day on Thursday, March 30, 2017 (Ref .: IV ZR 533/15). The insurers can not refer to glasses after that because this is only an aid but not a cure.

Every year around 140,000 so-called Lasik operations are carried out in Germany - and the trend is rising. A refractive error of up to eight diopters can be corrected with the use of laser beams.

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In the case now decided by the Federal Supreme Court, a short-sighted woman from Baden-Württemberg had "laserned". She had previously minus 3.0 or minus 2.75 diopters. The cost of the treatment in the amount of 3,500 euros, she asked for their private health insurance. This refused.

The insurance conditions here correspond to the sample conditions of private health insurers. "Insured event is the medically necessary medical treatment of an insured person due to illness or accident consequences," it says.

An expert commissioned by the District Court of Heidelberg stated that a "disease" could not be discussed here. A certain refractive error is completely normal in middle and older age. From a morbid state of the eyes is spoken by international standards only from minus 6.0 diopters.

District Court Heidelberg rejected the lawsuit. The BGH however overturned these judgments and justified the plaintiff.

As justification, the Karlsruhe judges emphasized that "understanding in medical circles" is not the standard here. Rather, it depends "on the understanding of an average policyholder".

However, this assumes that "the normal state of vision is a complaint-free reading and a risk-free participation in road traffic". If these skills are significantly impaired, policyholders would therefore assume that they have a disease. This is also the case according to the report.

Insurers could not refer to a Bille or on contact lenses, emphasized the BGH. It is customary to wear visual aids. These are not a treatment, but "only aids". However, the terms of insurance did not make the reimbursement of costs for a necessary treatment dependent on whether the insured person can resort to aids instead. mwo / fle