Statutory health insurance funds have filed the first lawsuits against the federal government, seeking relief from the high costs of insuring citizens' benefit recipients. The administrative board of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) announced on Monday that it had "adopted a fundamental resolution to file lawsuits on behalf of and in the name of the health insurance funds against the inadequate financing of healthcare for citizens' benefit recipients.” The initial lawsuits have been submitted to the Regional Social Court in North Rhine-Westphalia.
The wave of lawsuits has been in preparation for months. The dispute centers on the coverage of costs of insuring citizens' benefit recipients. Under current practice, these costs are largely borne by the statutory health insurance funds, and therefore by the 75 million statutory insured individuals and their employers. According to the GKV, the issue concerns around ten billion euros annually. "This is unfair to the statutory insured and their employers, and it is also economically counterproductive," said Susanne Wagenmann, Chair of the Administrative Board of the GKV-Spitzenverband.
Insured persons and employers “should no longer be burdened with a financing task for the state; they are already reaching their financial limits,” added her co-chair, Uwe Klemens.
The North Rhine-Westphalia State Social Court is handling the first lawsuits, which have now been filed, with more expected in the coming days. The association representing the statutory health insurance funds argues that covering these costs is a responsibility that lies solely with the federal government, yet the funds receive financing for only one-third of the expenses through state contributions.”
The subject of the lawsuit is the notices sent to individual health insurance companies since mid-November by the Federal Social Security Office (BAS) in Bonn regarding allocations from the health fund for the year 2026. The GKV is ultimately seeking a ruling by the Federal Constitutional Court on the unconstitutionality of the “systematic underfunding of health care for citizens receiving social welfare benefits who are covered by statutory health insurance,” as the association explained. It therefore intends to propose a procedure in which the state social court reviews the applicable rule from Karlsruhe.
The Federal Ministry of Health announced that the government was “taking note” of the lawsuits. The decision now rests with the courts. Furthermore, the government is of the opinion that the BAS “issued the allocation notices in accordance with applicable law and that this is in line with the Basic Law.” A spokeswoman for the Ministry of Labor and Social Affairs added that the amount of GKV contributions to be paid by citizens receiving social welfare benefits is based “on clear legal regulations.”
Against this backdrop, the individual health insurance funds emphasized their criticism of the federal government. “The state is not fulfilling its financial responsibility with regard to health insurance contributions for citizens' income recipients,” explained Jens Baas, CEO of Techniker Krankenkasse. “It is shifting the financial burden to contributors to the statutory health insurance system. That has to change.”
This problem has been going on “for over a decade,” said Carola Reimann, head of the AOK Federal Association. As a result, the “volume of misappropriated funds can now be estimated at well over 100 billion euros.” Since nothing has happened politically so far, the only option left for the health insurance funds is to take legal action.
The DAK is also supporting the action and calling for “adequate funding for citizens receiving welfare benefits.” He also drew a connection to the general contribution rates: if the health insurance funds had received the federal funds they were entitled to, “contributions for insured persons and employers could remain stable in 2026,” explained DAK head Andreas Storm.
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