Health insurers can't block cards due to unpaid premiums, court rules

A court in Germany has ruled that it is illegal for health insurance companies to block insurees’ electronic health cards even if their entitlement to services is suspended due to premium arrears.

Can German health insurers block health cards?

The State Social Court in Bavaria has ruled a practice common among health insurance providers to be unlawful. 

In Germany, health insurance providers can suspend insured persons’ service entitlements if the person has received two reminders to pay premiums and is still in arrears. 

In these circumstances, the insurance company is only obliged to offer the insured person acute or emergency care, such as maternity care, pain management, or early-detection screenings. The company is entitled to suspend all other treatments.

During suspension, it has been the practice among insurance companies to block insurees’ electronic health insurance cards and instead issue them a so-called “eligibility certificate”. 

However, the court ruled that in these circumstances, health insurance companies cannot block insurees’ electronic insurance cards simply because the insuree’s entitlement to services has been suspended due to premium arrears. 

Entitlement to health insurance card remains

The law that permits insurance providers to suspend services due to unpaid premiums does not also permit them to revoke insurees’ electronic health insurance cards. 

This is despite the fact that the current electronic health insurance card system does not allow for health insurance providers to indicate on an insurance card if the holder has had their service entitlement suspended. 

However, the “eligibility certificate” that insurance companies were issuing to suspended insurees is legally intended only for specific services, such as medication, home nursing care, or household assistance, but not for a visit to a doctor or dentist, for example.