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Hartz IV recipients must deduct the personal health insurance deductible from the standard rates
Hartz IV recipients who are insured with a private health insurance (PKV) have to pay the deductible of special tariffs from the ALG II standard benefits. The contribution rate for private long-term care insurance must, however, be taken over in full. That judged the State Social Court of North Rhine-Westphalia.
Members of private health insurance companies that rely on Hartz IV benefits are not entitled to the deductible. In the event of a deductible, the policyholder undertakes to pay the insurer up to a fixed amount for outpatient therapy. Only when this sum has been exceeded does private health insurance have to step in. With a deductible, insured persons can reduce their regular premiums. The plaintiff therefore requested the responsible service provider to assume the costs for the deductible. However, the job center refused to cover the costs. The plaintiff then filed an objection and then brought an action before the social court.
The State Social Court of North Rhine-Westphalia denied a claim for reimbursement in a judgment that has not yet become final. Accordingly, the plaintiff has to pay a deductible of 400 euros, although this minimizes the monthly contribution rate of private insurance. If the insured person chooses a basic PKV tariff, the job center must pay the full amount according to the new case law of the Federal Social Court in Kassel. Since the deductible is not a regular burden - it is therefore only a contribution to health costs - the plaintiff must bear the costs himself. Alternatively, the plaintiff could choose a basic tariff, which is offered by the PKV insurance (file number: L 19 AS 2130/10).
Takeover of private nursing care insurance for Hartz IV recipients The plaintiff was lucky in deciding whether the contributions of private nursing care insurance had to be taken over. So far there was a coverage gap, since the authority only took over the legally prescribed minimum rate. Instead of 36.31 euros per month, the job center took over only half of the 18.04 euros from the independent Hartz IV beneficiary, which corresponds to the minimum contribution to statutory long-term care insurance. In this case, too, the authority would orientate itself to the requirements of the legislature, but when the legal situation was created, no consideration was given to the fact that there is a coverage gap for those affected that are not provided for in the ALG II standard services. "It is not apparent that the legislature deliberately and intentionally wanted private health insured beneficiaries to pay a contribution to private long-term care insurance that they cannot afford due to their financial circumstances," said a spokesman for the state social court. The highest social court, the Federal Social Court in Kassel, had only decided in January 2011 that social welfare providers and municipalities are obliged to take out full insurance, insofar as this corresponds to the range of services provided by the statutory health insurance companies. This decision is also not final and must in all likelihood be decided in the next highest instance, the Federal Social Court. (sb)
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More information and help on Hartz IV online:
Hartz IV Forum
Tacheles social assistance
Against Hartz IV
Picture: Dr. Klaus-Uwe Gerhardt / pixelio.de