Cost trap PKV How affected can fight back

Cost trap PKV: How can private persons protected from it?

02/04/2012

The private health insurance (PKV) are in crisis. The members feel this in the form of drastic increases in contributions. More and more private insured are simply overwhelmed financially in view of the massive increase in their insurance premiums, reports the consumer center of Rhineland-Palatinate on the basis of a nationwide sample of contribution development in private health insurance. But there are ways to escape the cost trap.

Consumer advocates also noted that private health insurance often makes it far more difficult for members to change their plans. So the insured would indeed after § 204 of the Insurance Contract Act (VVG) theoretically the possibility to change in a contribution increase in a lower-cost tariff, but in practice they would be massive obstacles in the way, criticized the consumer center Rhineland-Palatinate. Together with the Verbraucherzentrale Bundesverband, the consumer centers of the federal states therefore demanded that the Federal Government not only simplify the switch between individual private health insurance tariffs, but also facilitate a smooth transition between the various providers. Beyond that, too „a fundamental reform of private health insurance overdue“, said the consumer center Rhineland-Palatinate in a statement on Thursday last week.

PKV contributions of over € 1,000 a month
Many private health insurance companies attract new customers with particularly attractive offers, which at first glance promise more performance than in the statutory health insurance for less money. After conclusion of the contract, the insured, however, often expect massive increases in contributions in the coming years, which can be a hardly bearable financial burden for some. For elderly insured persons with increased health problems, the contributions may reach more than € 1,000 a month. The former financial advantage turns into a disadvantage in later life, devouring much of the monthly pension income. Many private individuals can not afford such insurance premiums and so the proportion of non-payer private health insurance has increased significantly in recent years. However, the affected private insured theoretically still have some options to pull the cost-emergency brake. The most important options are in the § 204 of the VVG.

Aggravated change to a cheaper health insurance plan
For example, the law guarantees private insureds the change to a cheaper tariff within private insurance. But the private health insurers have drawn here a number of bureaucratic and financial hurdles that complicate the change, so the charge of consumer centers. The consumer centers have in the past three months nationwide 144 complaints from private individuals on contribution and switching problems in the PKV evaluated, with the insurance premiums at the turn of the year increased, according to the Verbraucherzentrale Rheinland-Pfalz on average by 23.9 percent. Especially negative „Central Health Insurance and Gothaer Versicherung with an average increase of 28.4 percent and 26.4 percent, respectively“ noticed the message of the consumer center Rhineland-Palatinate. The highest premium increase was a staggering 60 percent. In particular „longstanding existing customers and older insured persons“ According to the Verbraucherzentrale Rheinland-Pfalz, they were affected by the massive contribution explosions.

Private health insurance undermines the right to change tariffs
Most of the complaints investigated by the Consumer Centers related to contracts that were concluded more than ten years ago, with insured persons usually being over 45 years of age. The insurance premiums, which in some cases cost more than 1,000 euros a month, would be a massive problem for those affected and many would not be able to pay their contributions even after retirement, according to the Consumer Information Center. Since a return to the statutory health insurance is usually excluded, the private insured have few opportunities to escape the cost trap. This also includes the right of exchange in a cheaper rate, which of the private health insurance, however „is often subverted“, explained the consumer center Rhineland-Palatinate. Only in four out of 144 cases was „to recognize in the documents that the change could be carried out easily“, report the consumer advocates.

Opportunities for cost-emergency brake for private insured
In addition to the theoretically existing option of exchange, private insured persons may also have the option of agreeing with their insurer on a reduction in benefits and, as a result, a reduction in the premiums. After all, single rooms or chief consultants in the hospital may be dispensable, if this means the monthly contributions can be reduced back to a tolerable level. In addition, private individuals may also agree to participate in treatment costs or medicines to reduce their contributions. However, in the case of severe, long-term illnesses, this entails a considerable risk, since rapidly horrendous amounts come together, which have to be paid out of pocket. Whether a reduction in the current contributions justifies this risk is difficult to say. A termination in the previous insurance also makes sense only in exceptional cases, because it threatens a loss of pension provisions, which are built from the contributions.

If insured persons have been in private health insurance for more than five years and have passed the age of 40, it is therefore not advisable to change providers. In general, there is also the possibility to switch to the basic rate of private health insurance, but this includes a much stripped-down range of services and often remains disputable, which measures the insurance. Since the insured pay for their treatment and medicines for the time being out of pocket and then settle with their insurance a particular problem. Because under certain circumstances they will end up sitting on the costs.

Change options must be improved
In the opinion of the consumer centers, the current survey makes it clear that, in a first step, it is above all the change possibilities that have to be improved in the interests of private insured persons. For this, the legislature should ensure that the private health insurance „Neutarife is designed in such a way that a tariff change without health examination is possible, tariffs are not charged or premium increases justified and the basis for calculation for contribution increases can be verified“, so the demand of the consumer centers. In addition, should „the possibility to change his provider to all insured in the private health insurance“ be extended. Until now, this option only applies to insured persons who have signed their contract after January 1, 2009.

Comprehensive reform of private health insurance required
When „key points for a consumer-friendly reform of private health insurance“ Furthermore, the Consumer Centers and the Federation of German Consumer Organizations also called for the introduction of the principle of benefits in kind, whereby the insured no longer have to pay in advance for their medical care, but the service providers and insurance companies charge the costs directly. Also, in the case of the tariffs whose services correspond to those of the statutory health insurance, the contributions should be adjusted to the level of the statutory health insurance. In addition, the consumer centers demanded the introduction of a „Income component in the premium calculation“, so that no longer exclusively the risk of illness decides on the contributions. The here achievable additional revenue should be in a kind „Hardship Fund“ from which, in case of doubt, the contributions of other members which are no longer The fund would grab, „if the contributions exceed the financial standing of the consumers“, so the explanation of the consumer centers. Thus, the social hardships within the private health insurance system could be compensated and would not be passed on to society as a whole, emphasized the consumer advocates.

Politics with growing doubts about the bipartite health insurance system
In politics too, given the current trend in private insurance, doubts about the two-tier insurance system are increasing. Thus, the spokesman for health policy of the CDU / CSU parliamentary group, Jens Spahn, publicly took a stand in March and emphasized the separation of statutory and private health insurance „not up to date anymore“. A statement that meets the ears of the opposition. For example, Alliance 90 / The Greens has long been demanding the abolition of private health insurance. As more and more private insured due to the increasing contributions in a financial predicament, an intervention of the policy seems urgently needed. Whether in the end the two-tier health insurance system will last will only be of secondary importance. The decisive factor is the timely reduction of private health insurance premiums to a tolerable level, whereby the compensation should be provided by the private health insurance system itself, as required by the consumer advice centers. (Fp)

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Picture credits: Ronny Richert