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Anybody with Legal Advice for Me?

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Hello all!

 

This is my first post, I hope I'm not asking something too out of the ordinary!

 

I am a student from Canada and I recently completed a foreign exchange term in Germany. As per German law, I was required to have valid health insurance in Germany while I was a student. I recently completed my studies in Germany and have returned to Canada. Originally the contract was for the duration of 18 months, however, I left Germany after 16 months and do not require the 2 extra months of service. In the contract, it was explicitly stated that, 

 

"Membership in (health insurance company) will begin exactly on the date of arrival. In this case, the coverage is expected to commence (date agreed upon) and valid until (date agreed upon), except the student returns earlier to his home country."

 

My health insurance company says that as long as I am a matriculated student, I must still pay for the health insurance. When I showed them the contract, they said the part where it says "except the student returns earlier to his home country" is a mistake and should not have been there in the first place.

 

As I am not aware of German laws, and I don't expect many people on this forum to be either, but I was hoping for any helpful advice :)

 

I really do not want to pay over 200 Euros for health insurance that I won't be using, please help!

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I don't know about German law, but in America (I'm a law school grad), the insurance company would be screwed for two reasons:  1) the parol evidence rule and 2) the rule  of interpretation that any ambiguity in a contract is interpreted against the drafting party.
 

Of course, your biggest problem is that retaining a German lawyer will cost you more than 400 Euros.  There is probably something like a Versicherungsamt or other German government agency regulating insurance that might intervene on your behalf, but I can't say.  Do some checking and good luck.

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15 minutes ago, hasenpfad1 said:

 There is probably something like a Versicherungsamt or other German government agency regulating insurance that might intervene on your behalf, but I can't say

 

That would be BaFin - Complaints to financial ombudsman services in Germany  and the primary law with which German insurance contracts must comply would be the VVG Insurance Contract Act 2008 - Index - English albeit all German contracts must also be in compliance with standard business contract terms according to the German Civil Code BGB (Index of Titles and Sections).

 

However the question arises as to whether the insurer concerned is actually a German health insurance provider or a BaFin-approved foreign health insurer or A.N.Other insurer which may, in certain rare circumstances, have been accepted by the OP's educational institute.

 

@CanadaOneFifty you need to either post a link to the webpage where the T&Cs of that specific policy are available or scan and post the relevant sections of your contract.

 

2B

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1 hour ago, CanadaOneFifty said:

Hello all!

 

This is my first post, I hope I'm not asking something too out of the ordinary!

 

I am a student from Canada and I recently completed a foreign exchange term in Germany. As per German law, I was required to have valid health insurance in Germany while I was a student. I recently completed my studies in Germany and have returned to Canada. Originally the contract was for the duration of 18 months, however, I left Germany after 16 months and do not require the 2 extra months of service. In the contract, it was explicitly stated that, 

 

"Membership in (health insurance company) will begin exactly on the date of arrival. In this case, the coverage is expected to commence (date agreed upon) and valid until (date agreed upon), except the student returns earlier to his home country."

 

My health insurance company says that as long as I am a matriculated student, I must still pay for the health insurance. When I showed them the contract, they said the part where it says "except the student returns earlier to his home country" is a mistake and should not have been there in the first place.

 

As I am not aware of German laws, and I don't expect many people on this forum to be either, but I was hoping for any helpful advice :)

 

I really do not want to pay over 200 Euros for health insurance that I won't be using, please help!

Which company is it?

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1 hour ago, 2B_orNot2B said:

 

That would be BaFin - Complaints to financial ombudsman services in Germany  and the primary law with which German insurance contracts must comply would be the VVG Insurance Contract Act 2008 - Index - English albeit all German contracts must also be in compliance with standard business contract terms according to the German Civil Code BGB (Index of Titles and Sections).

 

However the question arises as to whether the insurer concerned is actually a German health insurance provider or a BaFin-approved foreign health insurer or A.N.Other insurer which may, in certain rare circumstances, have been accepted by the OP's educational institute.

 

@CanadaOneFifty you need to either post a link to the webpage where the T&Cs of that specific policy are available or scan and post the relevant sections of your contract.

 

2B

 

This is great help! I searched for the health insurance provider in BaFin's database for companies but could not find it. Is it still possible for me to use BaFin to resolve this dispute?

 

10 minutes ago, john g. said:

Which company is it?

 

BARMER GeK. They are one of the larger health insurance providers, so I am assuming they no their laws well.

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Depends who you talk to, CanadaOneFifty! Mostly , the average employee at a public insurance company - whether BARMER or anyone else -  knows very little when it comes to foreigners leaving the country.  (Or arriving in the country!!)

Did you send them a cancellation  letter and include a copy of your deregistration from Germany? (The latter:essential ). If so, they haven´t got a leg to stand on.

 

PS: the 18 month rule is for people publicly insured and wanting to switch to another public provider!! It has nothing to do with leaving the country!

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I went to one of their offices while I was in Germany and the person I talked to had no idea what to do in this case. She said she'd have another person email me. A couple of days later another lady emailed me asking for a copy of my flight ticket out of Germany and a letter from my university proving I'm leaving. I sent them copies of everything they asked.

 

A couple of days later, she took a complete 180 reversal and said that as long as I am a matriculated student in Germany (key word being "matriculated" - which I am), I am still obliged to pay for the remaining 2 months. That's when my fellow Canadians and I who were studying in Germany all got surprised and did not expect such a tough time from a well-known company.

 

Again, I would like to know if the signed contract has more weight that the "matriculated student" law in this case.

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Ok, a bit more research reveals that, as BARMER GeK are a public health insurer which operate in more than 3 Länder, the Aufsichtsbehörde responsible for their legal supervision is in fact the Bundesversicherungsamt. (If they were a public insurer which operated in less than 3 states, such as the locally established AOKs do, their supervisory authority would be the applicable state's Ministry of Health or Landesgesundheitsministerium).

 

You can verify that they are listed in the relevant database by scrolling down to Ersatzkasse on this page. The procedure to follow if you should choose to initiate a legal supervision complaint (Rechtsaufsichtsbeschwerde) is explained in detail here.

 

Here's a layperson's summary of the process rules and some comments on the limitations and possible outcomes.

 

To be considered at all a legal supervision complaint must be submitted in the correct written format (i.e. be signed and dated and bear the full name and title of the complainant) and composed in a neutral tone and be factually based.

 

There are certain rules all public offficials in Germany are bound by you which should be aware of. By law they cannot give legal advice or opinion. For legal liability reasons they may only communicate official statements in the German language.

 

What they can do is examine your complaint to ensure that you have been fairly and justly dealt with by your health insurer insofar as any aspect of your complaint pertains to the laws of Germany. What they must do is inform, and present a copy of your complaint to, the senior management of the Ersatzkasse. Whatever their decision and response may be, they are not obligated to supply, nor is a complainant entitled to require the provision of, any further explanation or reasoning for their decision.

 

Whether their decision, however it may turn out, would move the insurer to act in a different way or not is not a given and you may still need to seek legal advice or help to enforce any claim their decision may potentially support.

 

That linked page also points to the difference between a legal supervision complaint and a service supervision complaint (Dienstaufsichstsbeschwerde) which is the correct means to use where the complaint relates to the performance of their duty of service by an employee of the insurer. Since the boards of public health insurers are responsible for service or technical supervision such a complaint should be directed in the same format and manner to the board of directors of the insurer in question.

 

Quote

Von der Rechtsaufsicht zu unterscheiden ist die Dienstaufsicht, bei der nicht die rechtliche Überprüfung einer Entscheidung der Kasse im Vordergrund steht, sondern bei der es um die Erfüllung der dienstlichen Pflichten der Mitarbeiter der Kasse geht. Die Dienstaufsicht übt der Vorstand der Kranken- bzw. Pflegekasse in eigener Zuständigkeit aus. Eine Dienstaufsichtsbeschwerde ist daher unmittelbar an den Vorstand einer Kasse zu richten.

 

In my opinion you may have more chance of success by trying a slightly less hard course of approach than the final throw of the dice which I suspect either of the above options may prove to be (in your case).

 

I think I'd have a go at writing a neutral, factual but charming letter, possibly including some hints or details of the fears and reactions of your fellow Canadian student clients to the insurers' latest response, to the chief of department (Abteilungsleiter/in) of the office which appears on their correspondence.

 

The reason I'm suggesting this is because, after a lot of deep searching in the full text of the SGB 5 - (regulates Health Insurance etc. i.e. Krankenversicherung),  I eventually found the following sentence in 

 

§ 190 Ende der Mitgliedschaft Versicherungspflichtiger

Quote

(9) Die Mitgliedschaft versicherungspflichtiger Studenten endet einen Monat nach Ablauf des Semesters, für das sie sich zuletzt eingeschrieben oder zurückgemeldet haben.

Approximately....

The membership of compulsorily insured students ends one month after the end of the semester for which they were last admitted or had re-registered to.

 

There's no mention of any variation of the word Matrikuliert in that law but my guess would be that a determinedly awkward Krankenkasse official could link such a negatory decision to SGB V §190 Abs. (9) whilst thinking "und damit Basta!"

 

I hope do you manage to save your €200 but, for the sake of the next poor studis with the same worry, please let us know how you get on.

 

2B

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I would just ask this:  are you ever coming back to Germany to live ?  If you've moved out of the country to Canada and arnt planning on coming back  what are they going to do if you just don't pay?  I'm assuming you've closed down your bank account here  and have switched your life over to Canada. 

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Sheesh. 2B_or Not2B is the Panda of German insurance law.  Stirling Uni must offer some funky courses these days.

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On 7/2/2017, 11:59:59, 2B_orNot2B said:

 

 

UPDATE

 

That was some great help 2B_orNot2B! I recently emailed them and it does look like they are also taking a tougher stance and willing to take this to a third party.  

 

Now I would like to ask you, since you mentioned the Bundesversicherungsamt communicates only in German, does this mean that I am allowed to submit a complaint in English? Or must I also submit a complaint in German?

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