Patients who clearly do not have health insurance form a heterogeneous group of homeless people, EU nationals, non-EU nationals, asylum seekers, war refugees, and people with illegal immigration status. Their legal rights vary widely.
homeless german nationals
According to the Social Code yeah. [24]. Depending on whether short-term or long-term support is needed, the social assistance office covers medical expenses directly or indirectly through the health insurance fund (Article 12, Article 98 of the Social Assistance Law). , Sections 1 and 2). [24]. Doctors do not have to worry when treating homeless Germans, as the medical costs are covered by the social assistance office.
european union [EU]/ Citizens of the European Economic Society [EEC]
Regulations apply to uninsured EU nationals and nationals of EEC states in accordance with the Freedom of Movement Act/EU. [25]. The European Court of Justice recently tasked the German government with this. [26] Providing assistance in case of illness, pregnancy or childbirth to non-German nationals who actually resided in Germany (see Article 12, Section 23 of the Social Law) [24]. Again, the responsible authority is the Social Assistance Office. Social assistance is subordinate to other sources of benefits under Article 1(1). 2. 12th Social Norms [24]Therefore, the patient or hospital must provide relevant evidence. Also, if the non-German national is not an employee/self-employed person, is within the first three months of their stay, is primarily looking for work, does not have a residence permit, or has entered the country only for the duration of their stay. This benefit will not be granted in this case. For the purpose of receiving public assistance or being a family member of the above individual. According to the section. According to Articles 23, 3 and 12 of the Social Code, people who do not have the right to reside in Germany are entitled to a bridging allowance for up to one month within two years, until they leave Germany. [24]. This was recently confirmed by the 8th Senate of the Federal Social Court in the summer of 2023. [27]. Insurance laws change constantly, so in addition to continuing medical education, emergency room physicians in Germany must receive regular legal updates.
Non-EU nationals
Non-EU nationals with residence permit under residence law [28], but if you do not have health insurance, you will fall within the scope of Article 2. 23, 12th social norm similar to EU nationals [24]. According to the section. 23 Article 12 of the Social Law, local social assistance offices must provide bridging assistance [24]. However, proof must be provided that there are no other sources of benefits in the sense of subordination of social assistance under Article 2. 2, Section 1, Section 12 Social Code [24]. It is unlikely that hospitals have the ability to ascertain the source of patient profits. The introduction of state-funded clearinghouses would be one way to save hospitals. Currently there are only a few clearinghouses in Germany.
asylum seeker
People receiving benefits under the Asylum Seeker Benefits Act receive care for acute illnesses, pain conditions and pregnancy under section 2.Article 4 of the Residence Law [28, 29]. Even in the case of forced deportation, medical care is made possible within the framework of bridging benefits under Article 2. 1.Residence Law Article 4 [28]. Depending on the federal state, the person concerned receives a health insurance card for each medical consultation or applies for a treatment voucher from the relevant social assistance office. In the case of an acute phase emergency treatment certificate, it is also possible to apply after the fact. Asylum seekers who have been in Germany for more than 18 months receive benefits under Article 2. It is similar to what aid recipients receive on the basis of religion under Article 2 of the Residency Act. 47-52 of the 12th Social Code [24, 28] Physicians should be aware that asylum seeker status may cover medical costs.
war refugees
War refugees who arrive in the EU as a result of a mass influx authorized by the Council of the EU and who subsequently arrive in Germany will be granted temporary residence rights. [30]. Local social welfare authorities would primarily bear the costs, which would then be passed on to the federal government under Article 2. 24, Residence Law [28]. The proof is a so-called “friction certificate” issued by the local immigration office. However, the right to temporary residence begins with the fulfillment of the criteria for which protection is sought. The demand for medical care is already a demand for such protection.
Those with illegal resident status
People who cross the German border without an official residence permit (illegal immigration status) cannot work legally and cannot obtain health insurance. If you are legally employed, you are required to have health insurance. Again, the health insurance is obliged to report to the immigration office that it is aware of the loss of the residence permit.As a result, illegal immigrants may be subject to fines or prison sentences and be deported from Germany. [28]. If an illegal immigrant without health insurance visits an emergency room, doctors may refuse to admit him.Some doctors believe they can be prosecuted if they provide medical care to people with illegal immigration status. [31]. According to Articles 95 and 96 of the Residence Law, this assessment is clearly incorrect. [28].The German Federal Ministry of the Interior recognized this in 2007. [32].
In principle, illegal aliens can also receive emergency medical benefits under Article 2. 48 of the 12th Social Code [24, 29]. However, due to subordination to welfare, [Sect. 2, Subsection 1, Twelfth Social Code]it is difficult to prove that the person or hospital involved is in need. [24].Hospital administrators find it difficult and time-consuming to maintain the necessary evidence, given the lack of documentation in most cases of undocumented immigrants. [31]. Additionally, significant uncertainties exist regarding the transfer of data from hospitals to social assistance offices. This, according to the sect, Article 87, Section 2, No. 2a of the Residence Law requires public authorities to notify the Immigration Department when they discover people who do not have a valid residence permit. [28]. However, for data derived from the doctor-patient relationship, [see Sect. 203, Subsection 1 numbers 1, 2, 4, and 6, and Subsection 3, German Criminal Code]this should be prevented by the so-called “extended protection of secrecy”. [22, 33]. This is only an administrative regulation and not a law, so in some cases the regulations may be interpreted differently by different federal states. [31]. Applications for assistance may therefore lead to reporting to immigration authorities. Emergency department staff should know what special protections apply to people with undocumented status when it comes to medical care. And you should know that the cost of emergency medical care will be covered by the Social Assistance Administration.
