Statutory Health Insurance and Debt: What Do “Suspended Benefits” Mean?
- Carolin Ochs
- 1 day ago
- 3 min read
People in Germany who are no longer able to pay their contributions to statutory health insurance (GKV) are only entitled to so-called suspended benefits. In this article, we explain what these benefits include and how you can still receive medical care.
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Why Do People Have Suspended Benefits?
Suspended benefits in statutory health insurance usually result from unpaid insurance contributions. In other words, the insured person has debts with their statutory health insurance fund.
This most often affects self-employed people. However, other groups who pay their own contributions — such as students or retirees — can also face financial difficulties. Sometimes this leads to monthly health insurance contributions no longer being paid. Once contributions remain unpaid for two months, benefits are suspended.
Can You Still See a Doctor If Your Benefits Are Suspended?
Yes.
People with suspended benefits are still entitled to medical care in cases of acute illness, pain, pregnancy, childbirth, and postnatal care.
In most cases, you should no longer use your electronic health insurance card, as it indicates full insurance coverage. It is best to clarify this directly with your health insurance fund.
Most statutory health insurance funds issue a so-called treatment certificate (Behandlungsschein), also known as Form 85. This certificate must be presented at the doctor’s office or hospital.
How Do You Get a Treatment Certificate (Form 85)?
Ideally, the health insurance fund sends the certificate together with the notification about suspended benefits by post. If you no longer have a valid treatment certificate, you can obtain one in the following ways:
by calling your health insurance fund; the certificate can be sent by post or fax, and some funds also send it by email
by visiting a service center of the health insurance fund, where it can be printed and handed over directly
The certificate can also be requested by phone and faxed directly to the doctor’s practice or hospital.
What Does a Treatment Certificate Look Like?
The treatment certificate (Form 85) looks like this:
Which Services Are Covered Under Suspended Benefits?
With suspended benefits, the following conditions and situations can still be treated:
all acute illnesses and emergencies
pain conditions (including dental pain)
pregnancy, childbirth, and postnatal care
vaccinations recommended by law
preventive medical examinations recommended by law
chronic illnesses if lack of treatment would worsen the person’s health condition (e.g. diabetes, HIV, dialysis)
What is considered medically necessary is decided by the treating physician.
Which Services Are Not Covered Under Suspended Benefits?
Planned and non-medically necessary services are not covered by statutory health insurance while benefits are suspended.
In addition, the following services are not covered during the suspension period:
individual dental prophylaxis
medical preventive services such as medicines, therapeutic remedies, and medical aids (e.g. medication, physiotherapy, wheelchairs)
counseling and services related to contraception
abortion and sterilization
rehabilitation services
This list is not exhaustive. You can find more detailed information in our blog post "Pregnancy, Pain, and Acute Illnesses: Which Doctor Visits Are Possible If You Owe Health Insurance Contributions?"
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