Health care reform and health insurance: Voluntary rates in the GKV



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In addition to the statutory elective rates, there are a number of voluntary health insurance rates. A minimum binding period of three years applies to all tariffs which the fund can voluntarily offer. In other words, the insured persons are subject to such a tariff against their health insurance for this period.

Health reform and health insurance: Voluntary tariffs in the GKV Health care reform and health insurance: Voluntary tariffs in the GKV

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This entry contains content and information that may be out of date, eg due to legal or statistical changes. Because it can still be helpful to get an overview of the topic, you can still find it here.

When may you change?

Overview

The health insurance can be changed before the end of this time only in hardship cases. The premium payments to insured persons are limited in amount. In principle, they may not exceed 20 percent of the contributions contributed by the member in one year, but not more than 600 Euro. This is necessary to prevent abuse - for example, for insured who pay only small contributions.

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At the same time, the limitation means that deductible tariffs and tariffs which provide for premium payments for non-use of benefits are only possible to a limited extent. The deductible must therefore be commensurate with the premium reimbursement. Overall, a cap was introduced that prevents premium payments in the accumulation from being disproportionate to the contributions paid.

You can offer the following voluntary tariffs:

Overview

  • Deductible rates: Each insured person can also settle a deductible with his / her cash register: the health insurance company grants a more favorable tariff; in return, the insured undertakes to pay a certain amount from his / her own pocket when using health services. In a comparable way, insured persons may choose special tariffs which provide for premium payments in the event of non-use of benefits. For example, you may agree that in the event of an illness, you will pay the first 100 Euro yourself and pay a lower contribution. If you do not get sick, it is cheaper. However, bear the risk yourself.
  • Tariffs for non-use of benefits: The member and his family members do not take any benefits from the fund for one year. Also in these tariffs the member receives a premium. This is limited to one twelfth of his annual contribution.
  • Tariffs for special therapy directions: So far, the health insurances have not or only very limited the costs for alternative therapies, for example for homeopathic remedies, taken over. Who wants to take such services in the future, can choose a special tariff, if it offers his cash. An additional premium will then be due for this extension of the entitlement to benefits.
  • Reimbursement: The cost reimbursement tariff is aimed at legally insured persons who wish to benefit from benefits such as privately insured persons: When claiming, the insured person receives an invoice, which he initially pays himself. The services charged by the doctor or the hospital are - depending on the tariff - calculated at a higher rate than for the statutory health insurance; possible is an 2,3-fold higher fee rate. The insured person will be reimbursed by his health insurance. The scope of reimbursement is contractually agreed in the tariff. This premium is payable in addition to the monthly contribution rate.

Individual sick pay claim

Overview

Statutory insured persons who are not entitled to sickness benefit pay a reduced contribution rate. The health insurance companies have to pay these insurance members, as far as they are unable to work incomes, from 1. January 2009 to offer an elective tariff on the sick pay, which also individually determines the start of the sickness benefit. This means that the members decide independently on their financial protection in case of illness and the time when it should take effect. Self-employed persons, who often have no interest in sickness benefit benefits, as well as short-term employees who are not entitled to six-week paid continued pay in the event of illness, benefit from this rule.

Beware of the special tariffs

Overview

Experts currently advise against getting involved in differentiated tariffs. The long-term commitment to new, unproven tariffs with simultaneously expected tariff fluctuations speaks against it. These voluntary election tariffs are particularly attractive for the health insurances because they are accompanied by a three-year customer loyalty. This three-year customer loyalty extends into the phase in which nationwide a uniform contribution rate applies. The calculus of the health insurances: With the same contribution rates, the willingness to change of the insured could come to a standstill. The insurance company, which succeeds in retaining the insured in the meantime, should benefit in the long term.

Above all, the tariffs serve to keep young, healthy insured persons happy. Most coffers only go along because they fear that those customers will otherwise migrate to a competitor who has the savings models in the program. In addition, many offers are not yet mature: With 250 cash registers and at least as many tariff variants, it is almost impossible to keep track. Also comes from the coffers themselves Criticism, Anyone who decides for a special tariff should take a closer look: Not every tariff fits every insured person. Choosing the wrong model can be expensive. It is therefore advisable to have comprehensive advice from its cash office beforehand.

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Little equality of opportunity

Overview

Another annoyance in the electoral tariffs: Although the funds of each of their offers must be approved by their supervisory authority, there is little evidence of equal opportunities. For example, the general local health insurance funds (AOK) are - unlike most of their competitors - not subject to the Federal Insurance Office (BVA), but are supervised by the state authorities. The result: While most health insurances must cover the cost of a doctor's visit one-to-one with their customers as part of a deductible tariff, the AOK can take a different approach. With her, the patients do not pay the actual costs, but a flat rate, which is below the real price. This gives the local health insurance companies a competitive advantage over their competitors.

Criticism finally comes from the private health insurance companies: With the election tariffs, the possibility would be created to obtain a state-approved access to the market of supplementary insurance. In the Klartext: The health insurance funds could provide private services as legal entities. Understandably, private health insurance is seen as an unjustified intervention in its functioning market.


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  1. Andrea Acklin

    What a successful preparation of this important topic. Thanks a lot for this!#

  2. Simone Janson

    Hello Marion, thanks for the hint. Did you have experiences there. In the link you have linked, unfortunately, there is no more information to be found than in the article above.

  3. marion

    Unfortunately not everybody gets the election tariff: http://www.pkv-infos.net/gkv-wahltarif.php

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