Hartz IV Forced change from PKV to GKV?

Should private health insurance in Hartz IV reference to the statutory health insurance "forcibly" resettled?

04/01/2011

Especially former self-employed in Hartz IV relation are often in the private health insurance (PKV) health insurance. However, since the service provider does not pay the full amount of the private health insurance contributions, Hartz IV recipients must themselves finance the coverage gap from the ALG II standard rate. Politicians now propose to forcibly relocate Hartz IV beneficiaries from private health insurance to statutory health insurance (GKV) through a change in the law.

The debate is not new. For some time now Hartz IV sufferers complain that they have to pay for the funding gap not financed by the Jobcenter from the ALG II ruleset. Since the regular benefits but does not provide a contribution financing of private health insurance, most have already accumulated a large amount of debts to the insurance companies. Industry experts put the debt levels of all providers for the last year 2010 with 300 million euros. In addition, there will be around 25 million euros for emergency health care, to which even debtors have a claim. According to health economist Hartz IV, a large part of the debt for emergency services is a beneficiary.

Way back to the GKV is denied
Most affected people are denied the way back to the statutory health insurance. After all, anyone who has ever switched from PKV to GKV will only be resumed in very few exceptional cases. The health insurance companies argue that they are a solidarity community. Those who have left them to switch to private health insurance at better times can not expect to be resumed in financially difficult circumstances. But just those legally anchored bars should now be relaxed by the legislature in terms Hartz IV.

Current regulations for Hartz IV recipients
Unemployment Benefit II Beneficiaries who are insured in private health insurance have the option, if they are unemployed, to switch from the original tariff to a reduced base rate. However, the contribution rate of 290 euros is still significantly higher than the monthly subsidy of the Jobcenter in the amount of 126 euros. This amount is fixed because it reflects the monthly subsidy for a statutory health insurance. This leaves the person affected a difference of 164 euros, which he must pay from the Hartz IV control benefits themselves. The level of Hartz IV control benefits is just € 359 for a single household (excluding the currently discussed € 5 increase). If a Hartz IV recipient lives with a partner in an apartment, the standard rate is once again reduced by 10 percent, because there is a so-called need community. But because only very few can pay the contributions from the regular benefits, many made debts at their private health insurance providers. The PKV quantifies the accumulated debt in the year 2010 with 20 million euros. The number of people affected is currently estimated at 6,000 people.

Federal Social Court will pass judgment
Numerous social courts have already confirmed corresponding complaints of Hartz IV recipients. Now, the Federal Social Court has joined and announced a landmark judgment for the current year. The Federal Ministry of Health and the Federal Ministry of Labor must now quickly find a legal regulation together in order to solve the problem in advance. The health policy spokesman of the CDU, Jens Spahn, therefore calls for a quick and unbureaucratic solution to the problem. He suggests that job centers be required to pay the full cost of a basic rate. This proposed solution achieves the support of the private health insurance association. So said the association's head Volker Leienbach also for a subsidy from taxpayers.

Health insurance companies criticize solution approach
However, this approach causes a clear criticism of the statutory health insurance. Because the health insurance companies minimize the contribution amount of the health insurance to a minimum amount of 126 euros, if the insured Hartz IV benefits. If the contribution gap in private health insurance were closed by the taxpayer, the health insurances would insist on equal treatment and, if necessary, sue the full statutory contribution rate. The costs would thus amount to billions in billions. A majority of ALG II recipients are insured by the statutory health insurances.

The general local health insurance funds (AOK) criticized the proposal of forced change particularly sharply. "The statutory health insurance may not be misused by the policy as a rescue fund for private health insurance," said the deputy chairman of the AOK Federal Association, Jürgen Graalmann. Either the private health insurance should cover the coverage for affected ALG II recipients, or the federal government pays the health insurance, a higher subsidy for Hartz IV recipients, as required by the PKV.

Out of this debate, the proposal of some experts to forcefully forcibly transfer Hartz IV recipients from private health insurance to statutory health insurance by law. Spahn sees in this proposal, however, a problem shift. Even the statutory health insurance companies do not see why they have to pay the debts of private health insurance. Rather, the private health insurance companies should in turn offer a reduced-contribution tariff for Hartz IV recipients.

For its part, politicians should now seek a solution as soon as possible. Because the longer the persons concerned remain in this loophole, the more debts accumulate. In addition, legal experts assume that the Federal Social Court will strengthen the rights of those affected by its ruling and oblige the job centers to fully assume the costs. However, this judgment then calls the statutory health insurance on the plan, which in turn will sue for a full payment of the costs. (Sb)

Also read:
Arge has to pay at Hartz IV PKV contributions
Hartz IV: No GKV claim for ex-self-employed
Study: Fear of Hartz IV makes you sick

Picture: Gerd Altmann