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Medical law :

claiming for contraceptive pill on health insurance

Should mentally disabled women receive the contraceptive pill for free? A social security tribunal in Germany found itself faced with the question whether German health insurance companies should pay for mentally disabled women over the age of 20 to receive the contraceptive pill (Az.: L 4 KA 17/12).

Free contraceptive pill refused to mentally disabled women ©-Thomas-Jansa-Fotolia
Krankenkasse muss manchmal auch bei Erwachsenen für die Pille aufkommen ©-Thomas-Jansa-Fotolia

Background

The case was brought by a German health insurance company against a residential care association for disabled women.

The association saw fit to provide women over the age of 20 with the pill and to invoice a Germany health insurance company for the cost.

The health insurance company sought reimbursement of almost 1000 euros on the basis that under § 24a of Germany’s 5th Social Security Code (SGB V) only women under aged 20 and under have the right to claim for contraception, provided it is on prescription.

The association was of the opinion that the ladies represented an exception to the rule. In defending the claim, the association argued that the mentally disabled women lacked the capacity to understand the nature of their actions. It argued the women would be unable to lead a healthy lifestyle during pregnancy and appreciate the dangers of taking medication whilst pregnant.

Paying for the contraceptive pill

The social security tribunal found in favour of the German health insurance company.

It held that the rationale for the German parliament’s decision to introduce § 24a SGB V was to protect young women from unwanted pregnancies during their educational development. This was the reason for the age limit. In the tribunal’s view, the legislation did not permit exceptions.

As a result, mentally disabled women over the age of 20 cannot claim for the contraceptive pill on their German health insurance.