Job centers have to reimburse contributions for private health insurance



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Job centers must fully reimburse contributions for private health insurance. Associations call Hartz IV recipients to submit review requests.

The job center must fully cover the contributions from ALG II recipients for private health insurance. The Federal Social Court in Kassel ruled on Tuesday in a corresponding fundamental judgment. The job centers are now threatened with additional expenditure in the millions.

According to the fundamental judgment of the Federal Social Court, the job centers are obliged to pay the full amount for the privately insured Hartz IV recipients up to the basic rate. Since 2009, private health insurance companies have been obliged to offer a so-called basic tariff for insured persons who can no longer finance their previous contribution. However, the job centers have so far only paid 130 euros out of the 575 euros per month of the maximum premium in the basic tariff that most insured persons have to pay. The ALG II recipients had to pay the remaining contribution costs out of their own pockets or hope that the private health insurance company will waive them for them. According to the judgment of the Federal Social Court, this will change in the future. According to the PKV association, around 6,800 Hartz IV recipients are affected by the current verdict with a basic tariff of private health insurance.

Health insurance coverage is part of the subsistence minimum In the case to be negotiated, an unemployed lawyer had sued the Jobcenter Saarbrücken for full payment of his insurance costs. The 4th Senate of the Federal Social Court decided in the sense of the needy lawyer that the PKV contributions of 207.39 euros per month are to be paid in full. So far, the job center had only granted the usual subsidy of EUR 129.54 for those insured by law. The remaining costs of almost 80 euros should have been paid by the lawyer receiving ALG-II from his Hartz IV standard rate. As the plaintiff's lawyer emphasized, however, the ALG II recipient was not able to pay this sum from the standard rate, so that the monthly contribution costs accumulated as debts for the person concerned. However, since sufficient health insurance coverage is part of the constitutionally protected subsistence level, the job centers would have to pay the full contributions, the plaintiff now challenged the Federal Social Court. Because there is no possibility of returning to statutory health insurance and the basic tariff is the last option for the ALG II recipients concerned.

Federal Social Court judges in the interests of the insured The Federal Social Court now ruled that it could not be assumed that the legislature wanted to worsen the health insurance protection of those affected when the basic tariffs were introduced in 2009. The judges also emphasized that no privately insured ALG II beneficiary should be forced to accumulate premium debt in the amount of the difference. Rather, the legislator wanted to use the rules on the basic tariff to ensure affordable contributions in private health insurance, but "he (has) implemented this insufficiently", according to the statement by the Federal Social Court. At this point, the court saw an “improper loophole” in the law. With their verdict, the judges of the BSG, however, have now given a clear vote in the interest of the ALG II recipients concerned that at least eliminates the financial problems associated with the basic tariff for the insured (file number: B 4 AS 108/10 R).

Minister of Social Affairs and PKV satisfied with verdict Both the Minister of Social Affairs and the Association of Private Health Insurance Funds welcomed the decision of the Federal Social Court. Ursula von der Leyen (CDU) emphasized: "It is good that there is now legal certainty for those affected". The minister added that with the verdict "Hartz VI recipients can initially stay in their private health insurance without having to pay for it themselves." Her ministry would be committed to finding a coherent solution for privately insured who only are temporarily dependent on unemployment benefit II, is submitted, said von der Leyen. Volker Leienbach, director of the Association of Private Health Insurance, was also satisfied with the current verdict: "Private health insurance supports the judgment of the highest German social court". According to the PKV association director, "the legislator (...) has to fill the gaps in the coverage that were bridged by the health care reform of 2007 by reimbursing full health insurance contributions". Because a constitutionally guaranteed subsistence level also includes adequate health insurance coverage. If the social security authorities do not pay the necessary contributions to privately insured ALG II recipients, "the welfare state will deny those in need the minimum subsistence level," emphasized Leienbach.

Statutory health insurance companies also demand higher reimbursements for Hartz IV recipients As soon as the verdict is passed at the Federal Social Court, the statutory health insurance companies also speak up and demand a higher reimbursement from the job centers. "After the Federal Social Court provided private health insurance with significantly higher payments from the job centers, the amount for the legally insured ALG II recipients must of course also be adjusted," emphasized Doris Pfeiffer, CEO of the GKV umbrella association. Because it "cannot be that the job centers for insured persons of profit-oriented private health insurance pay significantly more than for people who are in a statutory health insurance company", so the statement from the GKV head association. In statutory health insurance, too, the costs are significantly higher than the reimbursements from the job centers, Pfeiffer explained. According to the CEOs of the GKV umbrella association, an average of 278 euros per member is spent per month, but for Hartz IV recipients, the job centers only reimburse just over 130 euros. The remaining costs are borne by the insurance. However, an increase in the reimbursements for SHI contributions from ALG II recipients to the average costs would probably result in billions of additional expenses, while the costs associated with the current verdict are estimated at a maximum of just under EUR 13 million.

Objection to Hartz IV notices and submit a review request The unemployment initiative "gegen-hartz.de" advises all those affected to file an objection to the current Hartz IV notice and a review request for the previous notices. This is the only way to ensure that the responsible job center reimburses the full costs of the PKV insurance premiums. However, those affected should not allow themselves to do so for too long, because a new legislative amendment is currently being discussed in the Federal Council, which provides for a reduction in retroactive back payments from four to one year in the future. In the course of the judgment that has now been passed, it may be that the Chamber of States is now initiating an implementation of the draft as quickly as possible. (sb, fp)

Also read:
Hartz IV judgment: Entitlement to full costs of the PKV

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