Hartz IV: No entitlement to PKV premium surcharges

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Since highly judicial jurisprudence, recipients of Hartz IV benefits have a full right to cover the insurance costs of a private health insurance (PKV). However, these should be comparable to the tariff of the statutory health insurance companies. This does not include supplements for years in which those affected were not insured, as the Lower Saxony Bremen State Social Court recently ruled.

Beneficiaries of unemployment benefit II are entitled to full reimbursement of basic health insurance from the basic tariff. A complaint by a Hartz IV victim was not met, however, who also wanted the supplements for non-insured years to be reimbursed by the job center, as the Social Law Association in the German Lawyers' Association explained. If there are arrears in contributions, these must be paid by the unemployed insured themselves, as judges at the Lower Saxony Bremen State Social Court (AZ: L 9 AS 1241/11 B ER).

Surcharge for arrears of premium due to non-insurance In this specific case, an unemployment benefit II beneficiary had only signed a contract with a provider of private health insurance at the beginning of 2012, even though she had been subject to health insurance since September 2009. Because there was no health insurance coverage for this period, the insurance company asked for a surcharge of around 1,700 euros for the missing contribution period. Because the formerly self-employed insured is not gainfully employed and receives Hartz IV benefits, she was unable to pay the arrears and paid an application to the responsible job center for costs. However, the authority rejected the application and a subsequent objection was also not granted. Thereupon the woman filed a lawsuit.

In principle, Hartz IV recipients are entitled to full health insurance coverage without the benefit recipients having to pay the costs according to SGB II, according to the judges. However, the service provider is only obliged to pay PKV contributions up to half of the basic tariff. The job centers do not have to pay any claims for additional benefits or surcharges for insurance-free years. An interest-free loan from the job center as a so-called “can-benefit” is also ruled out in accordance with Section 24 Paragraph 1 Sentence 1 SGB II because the surcharge is not a requirement enshrined in the Hartz IV standard rate. In addition, in the opinion of the state social judges, it was “doubtful whether the lawsuit had to be brought to a speedy trial”. Finally, the applicant could have applied to the insurance provider for a deferral. (sb)

Also read:
Hartz IV recipients more often chronically ill
Job center requirements make you sick
Hartz IV: Debt relief for people insured with private health insurance
No Hartz IV reimbursement for private prescriptions
Merging of PKV and GKV required

Image: HHS / pixelio.de

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Video: Der ALG II-Leistungsbescheid einfach erklärt JobCenter Essen


  1. Welsh

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  2. Zulkimuro

    It's impossible.

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