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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.

How to respond

Response types

  • File the objectionWiderspruch gegen den Beitragsbescheid / Säumniszuschlagsbescheid · § 84 SGG
  • Ask for instalmentsAntrag auf Stundung oder Ratenzahlung der Beitragsrückstände · § 76 Abs. 2 SGB IV
  • Ask for clarificationMitteilung der Hilfebedürftigkeit / Antrag auf Neufestsetzung der Beitragshöhe · § 16 Abs. 3a SGB V
  • Confirm paymentZahlungsnachweis / Klärung des Beitragskontos

Where and how

  • Brief an die Stelle, die den Bescheid erlassen hat
  • Einschreiben (Übergabe-Einschreiben / Einschreiben mit Rückschein)
  • Telefax
  • Widerspruch zur Niederschrift bei der zuständigen Stelle
  • Elektronische Form nach §36a Abs. 2 SGB I / Nutzerkonto nach §9a Abs. 5 OZG
  • Einfache E-Mail
  • Telefon

What makes it count

A response is in time only when it has reached the body that issued the Bescheid — with one widening: §84(2) SGG also preserves the period where the Widerspruch reaches another German authority, a Versicherungsträger, a German consulate or a Seemannsamt in time. §84(1) SGG gives one month from Bekanntgabe, three months where the Bescheid was given abroad, and admits the Widerspruch in writing, in the electronic form of §36a(2) SGB I, in the form-replacing routes of §36a(2a) SGB I and §9a(5) OZG, or zur Niederschrift at the competent body. The date of posting preserves nothing. A missed period can be cured by Wiedereinsetzung under §67 SGG: the application runs one month from the day the obstacle falls away and the missed act is performed inside it.

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.