PKV 150,000 insured in the debt trap

PKV: More and more people can no longer afford their private health insurance. The industry quantifies the default payments with 300 million euros annually.

03.02.2011

Around 8.8 million people are currently insured with a private health insurance (PKV). According to the associations, these include around 150,000 insured persons who can no longer afford the PKV contributions. The annual sum of all defaulting contributors is estimated at 300 million euros.

Particularly affected: Unsuccessful self-employed
First and foremost in this group are former self-employed who lost their jobs due to a failed business model. The job centers paid those affected only the minimum rate of statutory health insurance (SHI). The difference had to settle the unemployed from the ruleset itself. A recent ruling by the Bundessozialgericht in Kassel now obliged the job centers to pay the full cost of a reasonable base rate. The verdict, however, is criticized in numerous ways, because not only a relief of those affected was created, but also for the private health insurance. Because this refused so far analogous to the GKV to introduce a reduced social tariff in the presence of unemployment.

Change to the GKV not possible
The judgment is also problematic because it is not possible for those affected to change to the statutory health insurance. It is also not possible for private insurance companies to exclude a defaulting payer from health insurance. Since January 1, 2009, there is a health insurance obligation in Germany, after every resident in Germany must have sufficient health insurance coverage. Private health insurance may not refuse a non-insured due to a risk assessment, but must offer at least a basic rate.

Health insurance benefits are reduced for debts
If PKV insured persons can not pay their contributions over a longer period of time completely or not at all, then most providers react with the restriction of the achievement framework (ELP). If, within one year, this restriction does not improve the payment behavior of the debtor, the person concerned will be downgraded to the benefits of a basic rate. The health services are then similar to the statutory health insurance. Insurance companies are currently thinking about further limiting the benefits of months of non-payment. In extreme cases, only emergency services are to be paid. Whether this variant complies with the law, however, may be doubted.

Base fare offers no way out
If insured persons are deported to the basic rate, that does not mean that the debts of the contributor will be reduced. Because most of the time this downgrade only means an improvement for the private health provider. Because the insurance company must then apply less for the benefits of the policyholder, the contributions are mostly similar to „normal“ Rates. The financial burdens are usually not reduced for the person concerned.

PKV Lockangebote are complicit
In this situation, the private health insurance should not be completely innocent. Especially young people are lured in the beginning with sometimes crazy lock offers. Gradually, the contributions and / or the life situation of the insured person is changing. At the end, the insured gets into the debt trap because he can no longer pay the high contributions. The lucky winners of this game are often unscrupulous insurance brokers, who pay horrendous commissions in three- and four-digit amounts when they conclude a contract. If you still want to switch to private health insurance, you should first inform yourself exactly and independently. Corresponding consultations are also carried out by the consumer centers. (Sb)

Also read:
Contributions of private health insurance are increasing
PKV map-Report 2011: Debeka wins the test
PKV: services and quality a change reason?
PKV base fare is increased
Job centers must reimburse contributions for private health insurance

Image: Stephanie Hofschlaeger