Reduction of the aid in the PKV base rate prohibited

Federal Administrative Court: Aid reduction for insured in the base rate is inadmissible

04/22/2014

The allowance for civil servants who are insured in the basic rate of private health insurance (PHI) may not be reduced or limited, according to the current decision of the Federal Administrative Court in Leipzig. Discrimination against the officials insured in the basic tariff violates the law „constitutional equality“. There is no factual justification for limiting the entitlement to basic benefits for insured persons. BVerwG 5 C 16.13, BVerwG 5 C 40.13)

In two cases, the Federal Administrative Court ruled in favor of the pending eligible pensioners. One used to work for the state of Berlin, the other for the Federal Republic of Germany. In the first instance, they had already enforced their request for full benefits for medical services which they or their spouse had used. Now, the Federal Administrative Court confirmed that, in principle, there should be no discrimination in the aid for insured persons in the basic rates.

Lower subsidy for policyholders paid in base rates
The aid provides for a reimbursement of 70 percent of the expenses and for the remaining 30 percent, the plaintiffs had a private health insurance in the basic rate, the Federal Administrative Court. The medical services are „charged mainly with 2.3 times the fee rate of the fee scale for doctors“ as is customary with private insured persons in regular rates. However, the aid authorities had reduced the amounts applied for, „by using a lower rate of increase than that of 2.3 times the fees for medical services“, the Federal Administrative Court continues. The State Aid Regulations of the Federal State of Berlin and the Federal Government show identical regulations which, referring to a regulation of the statutory health insurance, stipulate that only significantly lower rates of increase can be applied to medical benefits for policyholders at basic rates.

Violation of the constitutional principle of equality
The basic tariffs were originally set up in PKV as basic insurance for insured persons who can no longer afford their contributions but can not return to the statutory health insurance. The private insurance companies are required by law to offer a base rate. However, this covers a much lower scope of services than the private health insurance rates. Therefore, the state aid regulations of the federal state of Berlin and the federal government have also estimated lower rates of increase (1.1 times to 1.8 times) for the medical services. A provision that, according to the decision of the Federal Administrative Court, violates the general principle of equality. „Civil servants and their eligible dependents, who are insured in the absence of an alternative in the basic tariff, are thereby penalized in comparison to the standard rate of sickness-entitled beneficiaries“, reports the Federal Administrative Court. A factual justification for this is not apparent.

Although the amount in dispute was in the current procedures in a very manageable framework (in the Berlin retired civil servants was about 40.01 €), but could be for the federal government and for the state of Berlin in the future quite more extensive additional payments. Depending on how many retired civil servants are insured here in a basic rate. A timely revision of the state aid regulations seems urgently needed now that the basic clause clauses have proved to be legally inadmissible. The Land Berlin had held to last to the regulation, as this one „expressly authorized maximum amount“, the „the maximum amount of aid to the level of the statutory health insurance“ limiting. In case of illness „ensures adequate protection“, so the reasoning of the state in court. However, the Federal Administrative Court recognized a clear violation of the constitutional principle of equality with regard to the insured persons in a PKV regulation tariff. (Fp)