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BSG: No return to the statutory fund after deception of the private
If a private health insurance company successfully challenges the insurance contract because of fraudulent deception, the insured person can no longer return to the statutory health insurance. A retroactive ineffectiveness of the private insurance contract also does not affect the previously declared withdrawal from statutory health insurance, as the Federal Social Court (BSG) in Kassel ruled in a judgment of June 29, 2016, already published in writing (file number: B 12 KR 23/14 R) .
The plaintiff was last voluntarily insured with the statutory health insurance DAK. She terminated her membership on May 31, 2011. The DAK presented her with the certificate of the private German health insurance (DKV), which confirmed insurance coverage from June 1, 2011.
However, the applicant had provided incorrect information when applying to the DKV for insurance. When this came out, DKV challenged the insurance contract for fraudulent deception. The regional court confirmed this retrospectively from the start of the insurance.
Then the woman said that she was still legally insured in the DAK. Because her private insurance contract was never effective. This means that the corresponding certificate from the DKV has become irrelevant, which is why the DAK was not allowed to release it from statutory health insurance.
The statutory DAK rejected “resumption” and was now right by the BSG. The woman had effectively left statutory health insurance. The later contestation of the private insurance contract does not change anything.
The effectiveness of the termination only requires proof that health insurance coverage continues to exist. It cannot be clarified within the notice period whether the new insurance cover has legally existed in the long term.
In addition, the woman actually had private health insurance coverage until contested by the DKV. This means that statutory statutory insurance is also ruled out due to the lack of other forms of protection. It does not matter that the DKV can possibly return services rendered because of the deception.
Rather, the woman remains assigned to private health insurance, the BSG judged. Despite her attempt to cheat, she was also entitled to an insurance contract in the basic tariff there. Only the DKV can reject this, but not other private insurers. mwo / fle