In its judgment of March 10, 2022, case number B 1 KR 30/20 R, the Federal Social Court (BSG) ruled that individuals receiving basic benefits under Sections 3 and 3a of the Asylum Seekers' Benefits Act (AsylbLG) who were previously covered by statutory health insurance fall under the so-called "compulsory follow-up insurance" pursuant to Section 188 Paragraph 4 of the German Social Code, Book V (SGB V). This group of people is therefore to remain in the statutory health insurance system even if, for example, they were previously a member of a statutory health insurance fund following employment subject to compulsory insurance. A relapse into the limited health benefits under Section 4 of the Asylum Seekers' Benefits Act (AsylbLG) should not occur.

Some social welfare offices subsequently refuse to cover the monthly health and long-term care insurance contributions, arguing that, according to Section 6 of the Asylum Seekers' Benefits Act (AsylbLG), these contributions are neither essential for securing subsistence nor health. As a result, those affected continue to face demands for these monthly health and long-term care insurance contributions, which they must pay from their basic benefits.

This therefore threatens debt and, in turn, limited health insurance benefits, so legal action must be taken against the social welfare offices' refusal to cover the monthly health and long-term care insurance contributions.

Update from April 1, 2025: In a decision dated March 31, 2025, under file number S 12 AY 706/25 ER, the Karlsruhe Social Court, in expedited proceedings for a preliminary injunction, provisionally ordered the State of Baden-Württemberg, represented by the Rastatt District Office, to cover the health and long-term care insurance contributions for the mandatory follow-up insurance pursuant to Section 6 of the Asylum Seekers' Benefits Act (AsylbLG). The decision, which is highly recommended in several respects, can be found here:

Update from May 28, 2025: The Stuttgart Social Court, in a decision dated May 27, 2025, under file number S 9 AY 300/25 ER, also issued a preliminary injunction in expedited proceedings, ordering the City of Stuttgart to cover the health and long-term care insurance contributions for the mandatory follow-up insurance pursuant to Section 6 of the Asylum Seekers' Benefits Act (AsylbLG). The decision can be found here:

Update from July 15, 2025: The Heilbronn Social Court, in a decision dated June 13, 2025, under file number S 15 AY 1361/25 ER, also issued an interim injunction in expedited proceedings, ordering the responsible social welfare office to assume the health and long-term care insurance contributions for the mandatory follow-up insurance pursuant to Section 6 of the Asylum Seekers' Benefits Act (AsylbLG). The decision can be found here: https://www.landesrecht-bw.de/bsbw/document/NJRE001613191

Update July 24, 2025: The Karlsruhe Social Court has reaffirmed in several rulings its position that health and long-term care insurance contributions for mandatory follow-up insurance under Section 6 of the Asylum Seekers' Benefits Act (AsylbLG) must be covered. Two of the rulings are listed here:

Update August 29, 2025: The Dresden Social Court, in a decision dated August 22, 2025, under file number S 3 AY 61/25 ER, also issued an interim injunction in expedited proceedings, ordering the City of Dresden to cover the health and long-term care insurance contributions for the mandatory follow-up insurance pursuant to Section 6 of the Asylum Seekers' Benefits Act (AsylbLG). The decision can be found here:

Update 04.09.2025: Now the Baden-Württemberg State Social Court has also ruled very clearly in its decision of 05.08.2025 under file number: L 7 AY 1344/25 ER-B:

„However, the assumption of contributions to the mandatory follow-up insurance is essential in this case to secure the livelihood within the meaning of Section 6 Paragraph 1 Sentence 1 of the Asylum Seekers' Benefits Act (AsylbLG). This exception is systematically linked to the lump-sum allowances of Sections 3 and 3a of the AsylbLG and supplements these regulations as a fundamental right. Where there are unavoidable needs not covered by the lump-sum benefits, the coverage of which is necessary to guarantee a dignified minimum standard of living, this provision functions as a hardship clause. Benefits are therefore essential where the minimum standard of living for human dignity is not met or is at risk of being not met. This is assessed primarily based on the quality of the affected right, the extent and intensity of the actual impairment in the event of benefit denial, the anticipated duration of the (further) stay in Germany, the availability of equally suitable and cost-effective benefits, and the possibility of meeting needs in another way (Spitzlei in BeckOK AuslR, 44th ed., April 1, 2025, AsylbLG § 6 para. 4). The circumstances of the case must always exhibit a certain degree of atypicality, which constitutes a particular hardship in the individual case. This hardship was not taken into account by the legislator in the lump-sum benefits under §§ 3, 3a AsylbLG, or, due to the atypical nature of the case, could not be factored in abstractly and generally (Spitzlei, ibid., para. 5). In this respect, benefits for renting or obtaining accommodation in the case of an officially ordered relocation, or costs of preliminary proceedings – which are not exempt from court fees under asylum seeker benefits law – with at least a sufficient prospect of success have been considered essential for securing subsistence (see Frerichs in Schlegel/Voelzke, jurisPK-SGB XII, 4th ed., § 6 AsylbLG, as of December 23, 2024, para. 48 f.).

Contributions to mandatory follow-up insurance are not covered by the benefits under Sections 3 and 3a of the Asylum Seekers' Benefits Act (AsylbLG). According to Section 3 Paragraph 1 of the AsylbLG, those entitled to benefits under Section 1 of the AsylbLG receive benefits to cover their needs for food, accommodation, heating, clothing, healthcare, and household goods and consumables (essential needs; sentence 1), as well as additional benefits to cover their personal needs of daily life (essential personal needs; sentence 2). The payment of contributions for mandatory follow-up insurance is specifically not a need covered by healthcare needs as defined in Section 3 Paragraph 1 Sentence 1 of the AsylbLG; the latter refers to specific necessary goods and services such as bandages, plasters, and wound cream (see Frerichs, op. cit., Section 3 AsylbLG, as of April 8, 2025, marginal note 100). The applicant was and remains unavoidably subject to the obligation to pay contributions; in particular, he could not declare his withdrawal from the mandatory follow-up insurance within two weeks of the end of the compulsory insurance period, since – unlike the case of receiving analogous benefits under Section 2 of the Asylum Seekers' Benefits Act (see Federal Social Court, judgment of March 10, 2022 – B 1 KR 30/20 R –, BSGE 134, 6-13, SozR 4-2500 § 188 No. 4, SozR 4-2500 § 5 No. 31, SozR 4-3520 § 3 No. 6, juris para. 23) – he had no other entitlement to corresponding health insurance coverage (see Section 188 para. 4 sentences 1 and 2 of the German Social Code, Book V). In particular, the reduced benefit entitlement under Section 4 AsylbLG is not sufficient for this purpose (see BSG, judgment of March 10, 2022, loc. cit.).

The contribution demands of €223.88 per month also threaten the applicant's basic subsistence level, as he currently receives benefits based on a standard allowance of €397. This threat is not eliminated by the fact that the AOK (health insurance fund) referred to its standard procedure in cases of need for assistance in a letter dated March 28, 2025, and stated that the contribution demand was "currently" not being collected from the applicant. Nor does the fact that the applicant subsequently – after the issuance of the decision of December 4, 2024 – took up marginal employment, which therefore does not require mandatory statutory health and long-term care insurance, alter this situation.

The atypical nature of the need required under Section 6 of the Asylum Seekers' Benefits Act (AsylbLG) arises from the fact that, although the applicant, as a beneficiary of benefits under the AsylbLG, may be subject to mandatory follow-up insurance, the AsylbLG – unlike the Social Codes II and XII (SGB II and XII), which also serve to secure the constitutionally protected minimum subsistence level – does not contain any provision for considering unavoidable mandatory contributions to statutory health and long-term care insurance as separate needs (Section 26 SGB II or Sections 32, 32a SGB XII; cf. Social Court Freiburg (Breisgau), judgment of March 17, 2025 – S 7 AY 3255/24 –, juris para. 36).„

The decision can be found here:

Update 22.09.2025: The 20th Chamber of the Dresden Social Court, in a decision dated 28.08.2025 under file number S 20 AY 63/25 ER, also issued an interim injunction in expedited proceedings, ordering the City of Dresden to assume the health and long-term care insurance contributions for the mandatory follow-up insurance pursuant to Section 6 of the Asylum Seekers' Benefits Act (AsylbLG). The decision can be found here:

Affected group of people:

All recipients of basic benefits who are covered by statutory health insurance, who again receive basic benefits under Sections 3 and 3a of the Asylum Seekers' Benefits Act (AsylbLG), and whose monthly health and long-term care insurance contributions are not covered by the social welfare office. Currently, to our knowledge, this primarily affects AsylbLG recipients within the local jurisdiction of social welfare offices in Baden-Württemberg and Thuringia.

Practical approach:

We advise all recipients of basic benefits whose monthly health and long-term care insurance contributions are not covered by the social welfare office to file an objection and a lawsuit against the non-coverage.

Even if the objection period has already expired, legal action can be taken by submitting so-called review applications!