Additional contribution to the DAK ineffective?



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Berlin social court: The DAK has only insufficiently informed about the special right of termination

Can 4.5 million insured people hope to have the additional premium already paid reimbursed? The Berlin Social Court has decided in three cases and in the first instance that the additional contribution from the German Employee Health Insurance Fund (DAK) is ineffective. In a letter, the health insurance company did not point out the possibility of the special right of termination in an appropriate form. The DAK rejected media reports in which it is already assumed that all insured persons will now receive the additional contributions. After all, the legislature had not clearly stated in what form the health insurance companies must inform.

Another current judgment of the social court in Speyer (Az: S 11 KR 226/10) came to a different decision in a model dispute. The DAK's procedure had been approved there. The way in which the health fund had drawn attention to the right of special dismissal was completely sufficient, according to the social court. The judges ruled that the notice on the back of the information letter on the special right of termination was sufficient within the meaning of Section 175 (4) of the Social Code Book V. Because “a form for the reference is not prescribed in the law. In this respect, the court assumes that a written note is sufficient, ”said the social judge at the time.

But the Berlin Social Court has now declared the collection of additional contributions to be ineffective in three cases. Here, too, the insured were not advised of the possibility of changing the insurance fund on the back of the cover letter, but only on the back "in a significantly smaller font". In addition, the extraordinary termination was only discussed from point 6. Accordingly, the hint could have been overlooked. (File number: S 73 KR 2306/10, S 73 KR 15/11)

Since 2010, the health fund has been charging its members an additional contribution of eight euros per month. In the opinion of the Berlin social judges, however, the plaintiffs are only obliged to pay from the point at which a circular clearly indicates the right to terminate the contract. That was only the case with the objection notices issued in November and December 2010, respectively.

In a statement by the DAK, reference is made to the fact that in the cover letter "visually different" than the already closed City BKK, in addition in the members' newspaper and on the in-house website, detailed information about the additional contribution and the special termination was given. In addition, the media had reported widely on the subject. The chief lawyer Eckhard Bloch therefore refers to the assessments of other courts. The legislature has not made clear references to the form of the information. For this reason, the lawyer emphasized that the "duty to report is fully met," emphasized the law. The Federal Insurance Office (BVA), as the responsible supervisory authority for the nationwide health insurance companies, also agrees that the DAK insured persons were sufficiently informed about the special right of termination.

The health insurance company now reserves the right to appeal. First, the reason for the judgment should be available and then further steps should be discussed. It should already be clear that a confirmation of the judgment in the higher courts could lead to a severe financial loss. Because only the health insurance companies charge an additional contribution that does not get by with the allocations of the health fund. Since the introduction of the additional contribution, around 300,000 members have left the fund (as of first quarter 2011). If the DAK had to pay back all additional contributions retrospectively, this could at least exacerbate the situation of the fund. The verdict is not yet legally binding. (sb)

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Photo credit: Claudia Hautumm / pixelio.de

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