Rechtsstand Herbst 202643 life situations645 topic pages41 roadmapsFree, no account

My health insurer should pay for a benefit or has refused

For people with statutory health insurance: how to apply for a benefit properly, use the insurer's decision deadlines, object (Widerspruch) to a refusal and, if it is urgent, turn to the social court. Also covers exemption from co-payments, contribution arrears and switching insurers.

How the roadmap works. Answer the questions. They produce your roadmap: which deadlines the insurer must meet, by when you must act yourself and who helps you free of charge. Important: an objection costs nothing, and a lawsuit at the social court costs insured people no court fees. Privately insured people take a different route: in a dispute, the Ombudsman for Private Health and Long-Term Care Insurance helps; this roadmap does not fit them.

Your answers are not stored or transmitted; they only appear in your browser's address bar. Anyone who shares the link also shares the answers. Legal position as of November 2026: SGB V (including § 13 Abs. 3 and 3a, §§ 16, 27b, 55, 60–62, 175), SGB IX (§§ 14, 18), SGB X (§ 25, deemed notification 4 days after posting under § 37 Abs. 2), SGB IV (§ 24), SGG (§§ 84, 86a, 86b, 87, 88, 183), BerHG; case law: Federal Social Court (BSG), judgment of 26 May 2020, B 1 KR 9/18 R. Statutory Health Insurance Contribution Rate Stabilisation Act (GKV-Beitragssatzstabilisierungsgesetz, promulgated July 2026): changes to co-payments and dentures mostly apply from 1 January 2027.

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As of November 2026. The roadmap arranges general information according to your answers. It does not review an individual case, does not replace legal advice and does not assess your dismissal or any deadline as valid, met or missed. Whether an entitlement exists is decided by the responsible office; deadlines and amounts change often – check important details with an advice centre.

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On a decision, deadline, application or responsibility. You get an answer with the matching page, the responsible office and the next step, usually within two working days. No legal advice in individual cases, no sharing of your data.