No Hartz IV reimbursement for private prescriptions



We are searching data for your request:

Forums and discussions:
Manuals and reference books:
Data from registers:
Wait the end of the search in all databases.
Upon completion, a link will appear to access the found materials.

Hartz IV: No reimbursement of over-the-counter medicines by the job center. In case of doubt, the health insurance company must be sued.

Hartz IV recipients cannot receive over-the-counter medications from the service provider. Instead, according to a recent judgment of the Federal Social Court in Kassel, the statutory health insurance companies should be made responsible. A decision must be made here in each individual case.

Recipients of unemployment benefit II (ALG II) cannot apply for reimbursement of over-the-counter medicines at the responsible service provider (job center). According to a judgment of the Federal Social Court (Kassel) in Kassel, the statutory health insurance companies should instead pay for the “minimum health existence” of those affected. In this specific case, an ALG-II beneficiary had submitted an application to the Berlin Job Center for additional requirements beyond the Hartz IV standard benefits. The doctor in charge had issued the woman with a private prescription that is not listed in the benefits catalog of the statutory health insurance companies. Usually the patient has to pay for the prescription out of his own pocket. The plaintiff subsequently claimed additional needs due to iron deficiency anemia, osteoporosis, chronic headaches and skin allergy. The job center declined to assume the costs with reference to the lack of responsibility. After a rejected objection, the person concerned sued through all instances up to the highest social court BSG.

The complaint must be addressed to the health insurance company. Again, the complaint was rejected by the top social judges (file number: B 14 AS 146/10 R). If the health insurance company does not accept the prescriptions, the service provider is not automatically responsible, it said in the reasoning of the judgment. According to the judges, the statutory health insurance fundamentally has an obligation to ensure that the insured persons have a minimum subsistence level. If there are any discrepancies and the health insurance company refuses to cover the costs of medication or therapy, the plaintiff must file a lawsuit against the fund in case of doubt. An additional need in the sense of the SGB for medical reasons can only be considered if additional payments for the cash benefits overstretch the Hartz IV recipient.

In the further ruling of the 14th Senate of the Federal Social Court, it is stated that the health insurance companies basically fulfill their duties and the livelihood mandate. Over-the-counter medications are taken on a case-by-case basis if patients suffer from serious illnesses and the remedies are considered standard therapy. In the negotiated case, the applicant suffers from osteoporosis and chronic iron deficiency. Under certain conditions, the costs for adequate preparations are also borne here.

Additional requirements possible due to costly nutrition In practice, the ruling means that in the case of over-the-counter medicines and rejection of costs, the individual decision in court always applies. Tip: Doctors should get Hartz IV benefits from their patients and talk about additional needs due to costly nutrition. In the justified case, an additional requirement can very well be requested from the job center. (gr)

Also read:
Hartz IV makes people permanently sick
Hartz IV Sanctions against pregnant women Normally?
Job centers have to reimburse contributions for private health insurance
Practice fee in future included in the Hartz IV rate
Hartz IV: Additional contribution despite social assistance

Picture: Dr. Klaus-Uwe Gerhardt / pixelio.de

Author and source information



Video: LAWYER EXPLAINS. New $1,000 Stimulus Check Proposed + 2nd Stimulus Check and Stimulus Package


Previous Article

False start for the new consumer protection portal

Next Article

Study: Allergy risk for autumn babies