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Social insurance · Germany

Mahnung der Krankenkasse — unpaid contributions and what 'ruhen' means

This is a demand from your statutory health insurer for unpaid contributions plus late surcharges. The key risk for self-payers: at two months' arrears despite a Mahnung, benefits are suspended down to emergency-level care.

How serious: needs actionAlso called: Beitragsrückstand, Säumniszuschlagsmitteilung der Krankenkasse, letters from TK, AOK, Barmer, DAK about 'rückständige Beiträge'

Your gesetzliche Krankenkasse says contributions are unpaid and demands the arrears plus late surcharges. The statutory surcharge is 1% per started month of the arrears, rounded down to €50 (SGB IV §24).

This letter matters most for the self-employed and voluntarily insured, who pay their contributions themselves.

The dangerous mechanism is the 'ruhen' rule: once arrears reach two months' contributions and stay unpaid despite a Mahnung, the benefit entitlement rests. The Kasse then only covers acute illness and pain treatment, early-detection exams, and pregnancy and maternity care (SGB V §16 Abs. 3a).

Who sends it

Your gesetzliche Krankenkasse — a statutory health insurer such as TK, AOK, Barmer, or DAK. It is a public-law corporation that collects health and long-term-care contributions.

Krankenkasse letterhead with your Versichertennummer, words like 'Mahnung', 'Beitragsrückstand', 'Säumniszuschlag', a period and amount of arrears, and often a warning about 'Ruhen des Leistungsanspruchs' or transfer to enforcement.

The deadline

There is no single statutory deadline — the payment date is the one the Kasse prints on the Mahnung. The benefit-suspension sanction has its own threshold: it requires arrears of two months' contributions, unpaid despite a Mahnung (SGB V §16 Abs. 3a).

If you do nothing

Surcharges keep accruing at 1% per started month (SGB IV §24; not charged on arrears under €150 if they would need separate billing). At two months' arrears despite a Mahnung, benefits are suspended except for acute illness and pain treatment, early-detection examinations, and pregnancy and maternity care (SGB V §16 Abs. 3a). The suspension ends immediately upon a valid installment agreement — and it does not apply to those who qualify as needy (hilfebedürftig) under social-welfare law.

How it escalates

  1. 01Monthly Säumniszuschläge accrue (SGB IV §24).
  2. 02Ruhen des Leistungsanspruchs: routine medical care is no longer covered — emergency-level care only (SGB V §16 Abs. 3a).
  3. 03The debt continues to grow and is collected by the Kasse.
  4. 04Membership itself does not end — contributions keep accruing while benefits rest.

Your options, procedurally

  • The arrears listed in the Mahnung can be paid.
  • A Ratenzahlung — an installment plan — can be agreed with the Kasse; benefits are reinstated immediately upon establishing a valid installment plan (SGB V §16 Abs. 3a).
  • Anyone who receives or could receive social benefits can notify the Kasse — the suspension does not apply to members who are hilfebedürftig within the meaning of SGB II/XII.
  • If income fell, the Kasse can be asked to recalculate the contribution basis — a mechanism insurers offer.

Common questions

Does unpaid contribution mean losing the insurance?

No. Membership itself does not end — contributions keep accruing while benefits rest. What is at stake is the suspension ('ruhen') of benefits at two months' arrears despite a Mahnung (SGB V §16 Abs. 3a).

What care is still covered while benefits rest?

Acute illness and pain treatment, early-detection examinations, and pregnancy and maternity care (SGB V §16 Abs. 3a).

How does the suspension end?

Immediately upon a valid installment agreement (SGB V §16 Abs. 3a). It also does not apply to members who qualify as needy (hilfebedürftig) under social-welfare law.

Sources

Facts verified against the sources below on 28 August 2026.