City BKK What now insured must pay attention

The health insurance City BKK concludes: What must insured now have to consider

11.05.2011

CITY BKK closes on July 1, 2011 due to financial difficulties. The fund closes because it may become insolvent in the long run, the expected income will not cover the required expenses, and sufficient assets are not available to offset revenue / expenditure fluctuations , If a health insurance fund is insolvent, if insolvency threatens or if it is over-indebted, the board of directors must inform the health insurance fund. Even the already estimated additional contribution of 15 euros per month could not save the City BKK. On the contrary, more and more members turned their back on the cash register. The cashier came increasingly in the financial off. Many insured are now wondering what happens with their insurances and whether certain health services continue with other funds. We have put together some questions and answers about the closure of City BKK.

Who decides on the closure of a health insurance?
A closure is decided by the respective supervision of the fund. This is the Federal Insurance Office (BVA) at City BKK. The supervisor consults intensively with the fund and the competent Kassenartenverband about possible solutions (merger, closure, insolvency). Before deciding on the closure, the supervisor must consult the national association and the GKV-Spitzenverband. In addition to an assessment of existing or non-existent long-term economic performance of the fund, the question of the closing date is the subject of this hearing.

What happens to receivables or payables at a cash register closing?
Unlike in the private sector, there are no pre-existing or subordinated claims of creditors in the closure of a health insurance. In order to record the claims and obligations, the board must publicize the closure. With the closure of a cash register, it automatically enters a settlement stage, i. H. towards all creditors, the health insurance continues until it is settled. This refers to the day-to-day business, the remuneration of the service providers, the obligation to the contract partners, such as the Association of Statutory Health Insurance Physicians, as well as the relationship with the members and the employers.

The principle applies: If medical services have been provided, these will be reimbursed to physicians, hospitals and all other contracting parties for medical care - this also applies to all statements after the closing date. That is what the community of all company health insurance funds stands for.

In which health insurance can be changed?
You can always switch to one of the statutory health insurance companies. Each health fund must take out the ex-insured City BKK. There are other company health insurance funds (BKK), guild health insurance funds (IKK), substitute health insurance funds or the general local health insurance funds (AOK). You can choose which fund is best for you. The service catalog of the individual funds is about the same. There are only minor differences in service, additional benefits and additional contributions. The majority of health insurance companies assure that they will not make an additional contribution in 2011.

What if the cashier wants to drain a new member
In the last days it became known that apparently some cash registers try to block member inquiries already on the telephone. Among other things, it is said that the cash register would already be "full". Other employees claim that the service catalog would be better for a company health insurance fund. However, all these arguments are advanced and at least legally questionable. Each health fund must have a compulsory insured. Nevertheless refuses a health insurance, so should be reimbursed at the Federal Insurance Office an ad. It is important to note down the name of the employee, the time and day as well as the content of the conversation.

Health insurances, to which insured persons of the City BKK want to change „rauszuholen the application for admission and not more“, said Thorsten Nowak, spokesman for City BKK. Nowak appealed to those affected to note the interlocutors with their statements and the respective date. This could be "horse and rider" locate.

How are the members informed about the closure??
All members will be informed by a personal letter. The first letters have already been sent according to the health insurance.

How long is the CITY BKK still available??
The City BKK can still be reached by phone throughout 2011. All local phone numbers can be found on the letterhead. Questions about closure will also be answered via a hotline (030) 88 95-1200, (040) 29 808-1200, (0711) 933 44-1200.

Where are the disputed cases resolved??
All cases that have led to a need for clarification through our actions are primarily handled by CITY BKK. In some cases, it may happen that these cases are coordinated with your new health insurance.

Who handles CITY BKK? How long does this process take??
There is a resolution board and an employee circle, from which all open points after closure are processed. This concerns, for example, all invoices and refunds as well as information on insurance periods.

What happens to my data (history of services etc.)?
The data of the insured will continue to be archived by CITY BKK. For this purpose, the health fund is required by law, for example, to inform the new health insurance fund of the pre-existing medical conditions necessary for the calculation of sickness benefit or to provide insured persons with information about insurance periods.

If you need a notice of termination § 175 para. 4 sentence 3 SGB V ?
The letter you receive from CITY BKK as information about the closure replaces the notice of cancellation. The letter must be forwarded to the new fund office.

If the insurance protection remains intact?
Membership of a new health insurance fund begins without interruption following the membership in the closed CITY BKK, so also retroactively if required. She and the family members who are co-insured with a change of contributions are insured in the new statutory health insurance fund from the first day (first July 2011) on the entire benefits catalog, without waiting or waiting periods and without prior health check-up. Unlike in private health insurance, there are no benefit exclusions or higher contributions z. B. because of possible pre-existing conditions or disabilities.

During its execution, CITY BKK will continue for the time being (§ 155 Abs. 1 SGB V) and has to fulfill the claims arising from the insurance before the closure and to collect any outstanding claims for contributions. However, new entitlements to the closed health insurance can no longer arise, because the membership ends with the date of the effectiveness of the closure.

Within which period the new cash register has to be chosen?
The members of the CITY BKK can exercise their special right to vote until 14 July 2011 (2 weeks after the closing date). The two-week period begins on the day the checkout closes. Voluntary members must declare their change no later than 3 months after closure, ie until 30 September 2011.

What happens if a member does not choose a new fund in time??
If in doubt, the insured gets a new health insurance. As a general rule, the employer re-registers an employee with the health insurance fund where he was a member before joining CITY BKK. If this can not be determined, the employer selects a new health insurance (§ 175 para. 3 sentence 2 SGB V).

The same applies to recipients of unemployment benefits or unemployment benefits II (Hartz IV) and pensioners. Here, either the Federal Employment Agency or the pension insurance institution selects the new health insurance. This ensures that no gaps in insurance coverage arise even if deadlines are missed

Voluntary members (eg self-employed, housewives, voluntarily insured welfare recipients) must explain their own change. A 3-month notification period has to be observed. If the deadline is missed and there is no other cover for the person in case of illness, a subordinate obligation to insure in the statutory health insurance usually applies. Thus, even in these cases provides for a seamless insurance coverage. Such persons must contact the health insurance company where they were last insured against CITY BKK. A voluntary member receives on 15.6. the information that his health insurance at 30.6. must close. Registration with a new health insurance must be done by the end of September. Membership of the new fund starts retroactively from 1.7.

What must be considered when changing the health insurance, if an insured person „nursing case“ is or is not capable of acting?
With this insured group, for example, the pension insurance institution is required to select a new health insurance. As a precaution, the relatives of the person in need of care should also take care of entering a new health insurance. If the person in need of care is single, the nursing home or an officially appointed caregiver can make an effort to change the health insurance fund of a person who is not able to work.

What happens if the insured person stays abroad for a longer period of time, failing to choose a new health insurance??
If the insured fails to exercise the cash-in-hand option without being liable to pay, he or she may make good his or her right after the abolition of the grounds for prevention (here after returning from abroad). Such circumstances must be examined in a single case by the new health insurance companies.

Can you switch to a new health insurance earlier??
No, you can not before the 1.7. switch to new health insurance. The cash-in-hand option generally requires a two-month change period (if you had canceled your membership in April, you would not have been able to choose a new fund until the 1st of July). Due to the closure of the CITY BKK you can also until 14.7. retroactive to 1.7. choose a new box office. (pm, sb)

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