Verdict: Lies do not make a switch to private health insurance ineffective

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BSG: No return to statutory health insurance after deception of private funds
If a private health insurance company successfully challenges the insurance contract due to fraudulent misrepresentation, the insured person can no longer return to statutory health insurance. Even a retrospective ineffectiveness of the private insurance contract does not affect the previously declared withdrawal from the statutory health insurance, as the Federal Social Court (BSG) in Kassel decided in a written judgment of June 29, 2016 (Ref .: B 12 KR 23/14 R) .


The plaintiff was last voluntarily insured with the statutory health insurance company DAK. She canceled her membership on May 31, 2011. She submitted the certificate from the private German health insurance (DKV) to the DAK, which confirmed insurance coverage from June 1, 2011.

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However, when she applied for insurance at DKV, the plaintiff had given false information. When this came out, the DKV challenged the insurance contract for fraudulent misrepresentation. The district court confirmed this retrospectively from the start of insurance.

The woman then said that she was still legally insured with the DAK. Because her private insurance contract was never effective. This also meant that the corresponding DKV certificate had become irrelevant, which is why the DAK was not even allowed to release her from statutory health insurance.

The statutory DAK refused a "resumption" and was now given the right by the BSG. The woman had effectively withdrawn from statutory health insurance.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. Whether the new insurance coverage is legally in place on a permanent basis cannot be clarified within the notice period.

In addition, the woman actually had private health insurance cover until the appeal by the DKV. This means that statutory compulsory insurance is also ruled out for lack of other protection. It is irrelevant that DKV may demand that the services rendered be returned due to the deception.

Rather, the woman remains assigned to private health insurance, ruled the BSG. Despite her attempt to deceive, she was also entitled to an insurance contract in the basic tariff. Only the DKV can refuse this, but not other private insurers. mwo / fle

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