health insurance
October 4, 2009 | 25,00 EUR | answered by Michael Vogt
I cancelled my health insurance as of March 1, 2009 and have been privately insured since then. Now my health insurance company is claiming that I received benefits after March 1 and they want the money back from me. The doctor's visit was on February 16, 2009, and the billing date according to the health insurance company was March 3, 2009. Since I was no longer insured with the health insurance company as of March 1, 2009, they are now demanding the money back from me.
Question: Is this really true? Do I have to repay the money to the health insurance company?
Kind regards,
Ingrid Büsse
Dear seeker of advice,
Your question may I answer based on the facts you have provided and taking into account your commitment as follows:
According to § 19 para. 1 SGB V, the entitlement to benefits from statutory health insurance generally ends with the end of membership.
It should be noted, however, that according to general principles, the health insurance fund that was liable for benefits at the time of the insurance event and at the time of the benefit event is always liable for benefits.
This means that in case of a change of health insurance fund, the claims that were already established and not yet fulfilled until the end of the membership can still be asserted afterwards. (LSG NRW, judgment of 11.04.2002, L 16 KR 155/01)
A different legal opinion would ultimately result in whether the health insurance fund is still liable or not being left to chance.
Since the doctor's visit was on 16.02.2009, but the change of health insurance fund was only on 01.03.2009, you should therefore file an objection against the health insurance fund's decision.
I hope that my answer has given you an initial overview of the legal situation.
I would like to point out that this answer, based on the information you have provided, is only a first legal assessment of the situation. It cannot replace a comprehensive evaluation. By adding or omitting relevant information, the legal assessment can be completely different.
You are welcome to contact me through the follow-up option on this platform or via my email address.
For legal representation beyond this initial consultation, my law firm is also available to assist you.
I wish you a pleasant Sunday and remain
Yours sincerely
Lawyer Michael Vogt
