LSG Darmstadt: Health insurance fund may not give a voluntary grant
(jur). Statutory health insurance companies are not allowed to pay cancer-free members to freeze egg or sperm cells. The so-called cryopreservation is a service that is not provided for by law and cannot be subsidized as a voluntary “statute service”, as the Hessian State Social Court (LSG) in Darmstadt decided in a judgment published on Wednesday, May 18, 2016 (file number: L 1 KR 357/14 KL).
In addition to the statutory benefits, the health insurance companies have also been able to introduce so-called statutory benefits since the beginning of 2012. This should strengthen the competition and the customer orientation of the cash registers.
Based on this, the plaintiff company health insurance company (BKK) wanted to introduce cryopreservation as a statute service. Because fertility can be lost through cancer chemotherapy, insured persons with proven cancer should receive a grant of up to 1,200 euros to freeze their egg or sperm cells.
The Federal Insurance Office has not approved the corresponding amendment to the articles of association - and rightly so, as the LSG has now decided.
As justification, the Darmstadt judges explained that statutory benefits should only refer to benefits provided by law. Numerous health insurances for artificial insemination grant a higher than the legal half-subsidy.
However, cryopreservation is not an “additional” service, but an “other” service that is not provided for by law. This should therefore “not be subsidized by virtue of the statute right”.
Basically, the law itself defines the benefits of statutory health insurance. "Insofar as the individual health insurance company is allowed to provide benefits in exceptional cases, the legislature does not want to issue a license to create a non-statutory benefit right in accordance with the articles of association", it says in the judgment of 28 April 2016, which has now been published in writing.
With similar reasoning, the Federal Social Court (BSG) in Kassel also rejected a health insurance company that wanted to pay a grant for artificial insemination even to illegitimate couples (judgment and JurAgentur report of November 18, 2014, file number: B 1 A 1/14 R) . mwo / fle