Health insurance Staggered discounts illegal

Statutory health insurance funds (GKV) may no longer award a graduated discount.

(22.06.2010) Staggered premiums of the statutory health insurance (GKV) are unlawful, as decided today by the Supreme Social Court. A GKV health insurances wanted to introduce staggered premiums for their insured persons, if they do not make much use of the health insurance benefits during the course of the year. This offer should now no longer be allowed to take place, as the Federal Social Court (BSG) today ruled. Only GKV´s Allow discounts only if the insured person has not taken any insurance benefits in a full year. However, this does not include the following benefits: prevention and education, pregnancy support and services for underage members.

The Daimler company health insurance fund (BKK Daimler) had planned to change the statutes and grant a premium if the insured go to the doctor only once or twice a year. This should create a staggered premium. But the Federal Insurance Office denied the fund the right to create such a scheme. On the other hand, the health insurance company complained, but the Federal Insurance Office got today by the Federal Social Court right granted. A "tiered bonus" violates the law. It applies the "all or nothing" principle. According to the Kassler Richter, bonuses may only be granted in the case of "complete non-use all year round". (BSG, Az. B 1 A 1/09 R). (Sb)

Picture: Rainer Sturm