Suspension of Health Insurance Due to Unpaid Premiums

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If premiums for statutory health insurance are not paid for an extended period, the health insurance provider may declare a “suspension of benefit entitlements.” Many affected individuals do not know what this specifically means or what consequences it may have.

When can the health insurance provider suspend benefits?

Benefits may be suspended if:

• Premium arrears accumulate
• No payment is made despite a reminder
• And arrears amount to at least two months’ premiums.

The health insurance provider then sends policyholders a written notice.

What does “suspension of benefits” mean?

During the suspension period, only limited benefits are available. Generally, only the following are covered:

• Treatment of acute illnesses
• Pain management (severe pain)
• Benefits related to pregnancy and maternity
• Medically necessary preventive examinations

Other benefits may be denied. Treatments that have already begun or been approved may also be affected.

Important!

• Health insurance does not end automatically; you must cancel it.
• Premiums and late payment penalties continue to accrue.
• Treatment costs paid out of pocket are often not reimbursed.
• An appeal alone does not stop the suspension of benefits.

When does the suspension end?

The suspension ends only when:

• all outstanding premiums have been paid,
• a payment plan is reliably adhered to, or
• needs for assistance are determined under SGB II or SGB XII (citizen’s income or social assistance).

What should you do if you are affected?

If you have received such a letter from your health insurance provider, you should:

• respond as soon as possible and not ignore the letter
• verify the amount of the claim
• contact the health insurance provider
• apply for an installment plan if necessary

How we can help you

We support our clients with:

• understanding such notices
• communicating with health insurance providers
• drafting responses
• applications for installment plans
• as well as general organizational matters

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