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How does the system work?
The Confederation shall pay four billion euros to the health fund for a flat-rate compensation for the expenses of the health insurance funds for non-insurance benefits for the year 2009. From the year 2010 increase the federal benefits by annually 1,5 billion euros up to a total of 14 billion euros.
Each health insurance company receives a flat-rate allocation per insured as well as additional allowances and deductions depending on the age, sex and illness of its insured persons. Due to the special consideration of serious and cost-intensive chronic diseases, the risk structure compensation (RSA) takes into account the different need for care of the insured persons of a health insurance company. The uniform contribution rate for all members of the fund is determined by the Federal Government. The funds may, if they do not come out with the money distributed from the funds, with the insured additional contributions amounting to a maximum of one percent of the gross income demand, as soon as this is above 800 Euro.
How is the contribution collection organized?
Up to the 31. December 2010, the organization of the contribution contribution is retained in its current form. However, the coffers should set the course for common facilities to relieve employers of unnecessary administrative burdens. From the 1. January 2011, employers who wish to do so will also be given the option of paying their contributions, contributions and notifications to a forwarding agency. It will pass on the contributions to all social insurance funds. The new top-level federation of the health insurance funds ensures a uniform immigration practice throughout Germany.
The new financing system of the health fund should make the services of the health insurance funds more transparent in terms of service and cost management and reduce bureaucracy in the health system. A health insurance company that does better can grant its insured financial benefits or a premium payment. A health insurance company that does worse has to make an additional contribution to its members. In order not to overwhelm its members, the additional contribution may not exceed one percent of the contributory income. In addition, the health insurance company must point out to its members the possibility of a cash change. At the same time, the contractual freedom of the statutory health insurance funds increases, that is, the scope of the health insurance funds for contracts with individual doctors, hospitals and other health care providers as well as in the integrated care is considerably expanded.
A general citizens insurance on uniform conditions is currently not provided. So the health fund - should it come - will not bring a truly uniform tariff for all:
- Persons who have left the insurance and can not be insured privately, have no option to return to an insurance.
- A general duty to insure is introduced. In the future, all uninsured people will receive health insurance coverage.
- In the case of preventive care and rehabilitation, the principle that the health fund chooses the facility is up to now. She can prove her own contract. It should take into account the wishes of the insured person.
- Insured persons can choose limited reimbursement instead of benefits in kind. The funds have to provide appropriate statutes.
- Voluntarily insured persons can, under certain conditions, choose rates with a deductible or premium refund.
- The insured receives a genuine right to vote for a preventive and rehabilitation facility that is approved and appropriately certified. If costs are incurred which exceed those of the contractual institutions, the additional costs must be borne by the insured person.
- The possibilities of the insured to choose the reimbursement are bureaucratised and made more flexible.
- The options are made more flexible. In the future, the health insurances will be able to offer all members deductibles and premium payments.
- The funds must then offer optional rates for special forms of care and special sickness benefit plans and may provide for premium payments to or through the insured persons. Among other things, they can offer tariffs in which the services for certain persons are limited.
- Comprehensive service catalog with the medically necessary.
- Domestic nursing services are only provided in the insured person's household.
- Recommended vaccinations are statutory benefits that the health insurances do not necessarily have to provide.
- Mother / father-child cures are regular benefits that the health insurance companies do not necessarily have to provide.
- Outpatient and inpatient rehabilitation services are also regular benefits. No fact
- Performance restriction with self-inflicted treatment need.
- The services of medical treatment care for people in need of full-time inpatient facilities is
- until the 30. June 2007 not benefit of the SHI, but the social care insurance.
- In the future, additional benefits will be offered: geriatric rehabilitation as a compulsory service and improved palliative care.
- The household term is extended. In the future, home health care will also be provided in new residential communities or living arrangements, and in special cases also in homes.
- Recommended vaccinations become compulsory. All coffers have to offer them.
- Mother / father-child cures are also compulsory.
- Outpatient and inpatient rehabilitation services are also compulsory.
- In cases of self-inflicted need for treatment in special cases, such as complications from cosmetic surgery, piercing, tattooing, etc., greater use must be made of recourse to restrict performance.
- The previous rule, according to the health insurance companies do not have to assume any costs for self-debt, is specified.
- The medical treatment care is permanently assigned to the social care insurance.
Special forms of care
- Insured can choose family doctor model of his cash register.
- For a limited circle of insureds there are possibilities of integrated care.
- The contract design options and the quality requirements are specified.
- Integrated care will be further expanded. The long-term care insurance can also be integrated. The
- Startup financing will be extended. Unnecessary bureaucracy is reduced.
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