Pregnancy, Pain, Acute Illnesses – Which Doctor Visits Are Possible If You Owe Health Insurance Contributions To A Statutory Health Isurance In Germany?
- Carolin Ochs
- 1 day ago
- 3 min read
Sometimes it happens: People who pay their health insurance contributions themselves may fall behind on payments. Self-employed people, students, and retirees are particularly affected by contribution arrears.
But what happens if you can no longer pay your contributions on time? Are you still entitled to medical care at all? And which conditions will still be treated?
In this article, we explain which medical complaints you can still see a doctor for despite suspended benefits, and which services remain guaranteed.
In our previous article, “Statutory Health Insurance and Debt: What Do Suspended Benefits Mean?”, you can learn more about the basics of suspended benefits in statutory health insurance.
What Do “Suspended Benefits” Mean in Statutory Health Insurance?
If health insurance contributions have not been paid for more than two months, your benefits under statutory health insurance are suspended. This means you can no longer access the full range of services provided by your health insurance fund.
However, don’t worry! You are not left completely without medical care. Important medical services remain available to you even while your insurance status is suspended.
Medical Treatment You Are Still Entitled to Despite Suspended Benefits
Even if you have outstanding contributions, you can still see a doctor for acute conditions or certain preventive examinations. The most important exceptions include:
1. Acute illnesses
If you develop sudden symptoms that require prompt treatment – such as an infection, injury, or fever – you are still entitled to medical care even if your contributions have not been paid.
Acute illnesses are health conditions that occur unexpectedly and may develop quickly and severely, requiring urgent medical treatment to prevent deterioration.
2. Pain
Whether the pain is acute or related to a chronic illness, pain must always be treated. You do not have to go without medical help if you are experiencing severe pain.
3. Pregnancy and maternity care
Pregnant women are entitled to full prenatal and maternity care even if they have contribution arrears. This includes gynecological check-ups, midwife services, and medical care during and after childbirth.
4. Preventive examinations under Sections 25 and 26 of the German Social Code Book V (SGB V)
Certain preventive examinations remain covered even if your benefits are suspended. These include:
the general health check-up from age 35, every three years
cancer screening examinations as recommended by statutory health insurance
review of vaccination status (please note: vaccinations themselves are not covered)
all U and J preventive examinations for children and adolescents
Services That Are Excluded When Benefits Are Suspended
Unfortunately, not all services are covered by statutory health insurance if you are behind on your contributions. The most important excluded services include:
dental prostheses (except in medically unavoidable emergency cases)
physiotherapy, occupational therapy, and other therapeutic remedies (except in connection with pregnancy and childbirth)
medical aids such as wheelchairs, crutches, or nursing beds
preventive services and vaccinations, such as dental prophylaxis for adults
maternity benefit payments and sickness benefits
rehabilitation measures and health cures
These services are only reinstated once you either pay all outstanding contributions in full or enter into a repayment plan with your health insurance fund and comply with it.
How Can You End the Suspension of Benefits?
If you can no longer pay your health insurance contributions, it is important to act as quickly as possible. As soon as all outstanding amounts have been paid or a repayment plan has been agreed upon, you will regain full access to health insurance benefits.
Important:If you have little or no income and are legally entitled to social assistance under German law - for example under SGB II (unemployment benefits) or SGB XII (social assistance) - the suspension of benefits ends automatically once you provide proof to your health insurance fund.
In this case, contact your health insurance provider to ensure that your full access to medical care is restored.
Conclusion: You Will Still Receive Help for Acute Conditions
Even if you are unable to pay your health insurance contributions, you will not be left without medical care in cases of acute illness, pain, or pregnancy. However, it is important to address the issue as soon as possible in order to regain full coverage.
Talk to your health insurance fund about repayment options to avoid long-term debt.
You may also want to read my blog post “Statutory Health Insurance and Debt: What Do Suspended Benefits Mean?” for more details.
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