Private group insurance from contributions is not permitted
(jur). The statutory health insurance companies may not take out private group insurance for foreign treatment from the regular premium income. This is not one of the statutory tasks of the health insurance funds, ruled on Tuesday, May 31, 2016, the Federal Social Court (BSG) in Kassel (file number: B 1 2/15 R). The affected health insurance companies now want to look for other solutions, such as an appropriate tariff.
The BKK federal association developed the proposal in 2007 that member funds offer their insured persons international protection. 26 company health insurance companies with a total of 3.1 million insured persons took out appropriate group insurance with a private insurance company for all of their members. The costs of around 4 euros per year and insured according to the health insurance fund are paid from the regular health insurance contributions.
Before the BSG, the health insurance companies justified this with “social reality”. Almost all insured people went abroad and Europe grew together. However, the social security agreements would not really work with numerous countries. The bureaucratic effort is enormous. The health insurance companies involved would also save administrative costs, so that the offer would also be economical for them.
The Federal Insurance Office, as the supervisory authority responsible for most of the health insurers, reported legal concerns right from the start, but initially tolerated international protection because of the advantages for the insured as well. In September 2011, the authority ended its tolerant practice and asked the health insurance companies to end the international insurance.
Numerous cash registers followed suit, others went to court. The Kassel judges have now decided one of three cases before the BSG as a model.
After that, the health insurance funds are not allowed to continue the private protection abroad. This is not a task legally assigned to health insurance companies. Foreign protection is also not permitted as a voluntary statute service according to the legal requirements because there is no corresponding authorization.
Rather, the Social Code expressly states that the protection of statutory health insurance is suspended during a stay abroad. "It is therefore inadmissible that a statutory health insurance company uses contributions for this," said the Kassel judges.
After the verdict was announced, health insurance representatives said that the company health insurance companies would now look for other solutions. One option could be an appropriate tariff. However, this would have to be approved by the supervisory authorities and the insured would have to pay an additional contribution. mwo / fle