Germany's Federal Social Court (Bundessozialgericht, BSG) has ruled that statutory health insurers are not obliged to pay for sensomotoric insoles, also known as proprioceptive insoles (judgment of 12 June 2025, case reference B 3 KR 12/23 R ). The case concerned a young insured person with a foot malalignment whose insurer had rejected her application for a custom-made device. Two lower courts, and now the BSG, sided with the insurer.
The Actual Reason for the Rejection
First, the good news for supply practice: the court confirms that sensomotoric insoles are, in principle, a medical aid used in the treatment of illness. They are applied as part of a physician-prescribed therapy concept and work differently from conventional, purely supportive insoles. The court acknowledges this explicitly.
Where the claim fails is something else entirely. Sensomotoric insoles are classed as part of a new treatment method. Under German statutory health insurance law, a clear principle applies to new treatment methods: without a positive assessment by the Federal Joint Committee they may not be provided at the expense of the health insurer. No such assessment currently exists. When the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) last revised the German National Association of Statutory Health Insurance Funds (GKV Spitzenverband) 2020 bei der Fortschreibung des German Medical Technical Aids in 2020, it found that the medical benefit of these insoles had not yet been sufficiently proven scientifically. This is precisely what the BSG relies on.
It is worth noting: this has nothing to do with listing in the German Medical Technical Aids Register itself. A product can be listed in the register and still fail at this hurdle, because the underlying method has not received a positive G-BA assessment. Approval within the register and recognition as a treatment method are two separate matters. Anyone who only keeps an eye on one of them is missing the other
What the Ruling Does not Say
One term does not appear anywhere in the judgment: the additional-cost agreement (Mehrkostenvereinbarung). The proceedings dealt exclusively with the question of whether the insurer must cover the full cost. Whether insured persons can instead pay part of the cost themselves and obtain the insole through an additional-cost agreement under Section 33 of the German Social Code Book V (SGB V) was not before the court, and the BSG simply says nothing about it.
This matters because the opposite reading is currently circulating in the industry: that the ruling also closes off this route. The Dortmund-based law firm Hackstein Reuter has publicly disagreed, taking the position that an additional-cost agreement remains possible, provided the overall supply includes a component that would be reimbursable even without the new method, for example a standard soft-foam insole billed under its own applicable HMV code. A reading of the judgment itself reveals no contradiction to that view.
Why the Absence of a G-BA Procedure Does not Lift the Block
A search of the G-BA's procedure register (as at September 2026) returns no result for proprioceptive or sensomotoric insoles: no ongoing, concluded or discontinued method-assessment procedure is recorded there. This suggests that no corresponding application has been filed to date.
At first glance, that might look like a gap in the insurer's favour. If no procedure is under way, one might assume the insurer is free to decide whether to pay. The ruling does not support that conclusion. The BSG makes clear that the blocking effect of Section 135 SGB V does not begin only once a procedure has been opened. It already applies as soon as the question seriously arises whether a method would need to be assessed at all. Whether the G-BA has actually taken the matter up is irrelevant to that preliminary question. This was exactly the situation here: no procedure had ever been initiated, and the BSG still affirmed the blocking effect.
The absence of a procedure changes nothing. As long as the G-BA has not issued a positive assessment, regardless of whether an application even exists, routine reimbursement remains blocked.
What this Means in Practice
For manufacturers and suppliers in the insole sector, the practical consequence is this: routine reimbursement by statutory health insurers for sensomotoric insoles is not currently enforceable, and listing in the German Medical Technical Aids Register does not change that. Whether an additional-cost agreement offers a viable route depends on exactly how the supply is structured. And should the G-BA assess the method in future, or should the GKV-Spitzenverband revise its benefit assessment, the entire picture could shift again. This interplay between the German Medical Technical Aids Register, method assessment and billing routes is exactly the terrain we at BEO BERLIN regularly guide manufacturers through, including in Product Group 08 "Insoles", part of our ongoing register-management portfolio. Anyone with an existing or planned insole supply should now check where their product actually standswithin this framework, to keep reimbursement on solid ground.
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