PKV tariffs have massive performance gaps

Private insured persons are often less well protected than cash patients, according to a study

10/06/2012

According to a recent study, many private health insurance (PKV) full insurance companies have in some cases substantial exclusions of health care benefits. In case of illness, private patients have to adjust to additional financial burdens. In many cases, benefits that are stipulated by the statutory health insurances in the benefits catalog are not included.

The private insurance companies advertise with their comprehensive services and yet are under constant fire of public criticism. A joint study by the Kiel health economist Thomas Drabinski and the Frankfurt consulting firm „Premium Circle“ has shown that many private insured have completed tariffs, some of which have significant benefit exclusions. In the event of illness, the insured persons face renewed costs, some of which are quite high. Often affected are so-called follow-up therapy, which are not available in many tariffs, such as the magazine „The mirror“ reported in his current issue. The approximately 10 million private insured in Germany are partly with „existential disability benefits ", the report said.

More than 80 percent of the private health insurance rates pay less than the law
The result of the evaluation is sobering. Thus, according to the „Premium Circle“ Chairman Claus-Dieter Gorr „More than 80 percent of the tariff systems of private health insurance make less than the statutory health insurance“. In particular, it is about services that are standard with the statutory health insurance, such as the „Home care“ or „the so-called aid declarations without restrictions“. The charge is heavy because many insurers do not orient their tariffs according to the needs of the customer, but rather „how they perform in price comparisons with other providers“, so the summary of the study.

According to study authors, it is critical that many private health insurance providers only offer limited final treatment and that they do not pay for psychotherapy or medical aids at all or only partially. In case of need private patients sometimes incur high costs, even though full insurance has been taken out. In the course of reporting, the health spokesman for the CDU, Jens Spahn, expressed concern. The politician demands from the insurance companies a speedy „Agreement on a minimum insurance cover.“ A similar claim also comes from the insurance itself. For example, the chairman of the German health insurance (DKV) Clemens Muth admonishes with regard to the elderly insured „a minimum standard in areas that are often relevant to people only at an advanced age.“

Many low rates without adequate power protection
Especially in old age private insurance will be more expensive without the possibility of a change. If, for example, important aids are not fully taken over, the customers are stuck in a cost trap. Muth calls for the industry to fundamentally rethink. „Too long, too often, products have been sold only by price, not quality“. That led to that „Low tariffs with some drastic foreclosures in the market are. "

The chairman of the Bundesverband der Privatkassen, Volker Leienbach, in a statement pointed out that „Insured persons should make sure that they do not exclude any personally important benefits“. But the basic requirement for this is good advice, says Leienbach. If the contract came about, the insured would have „a legal claim to agreed services“.

The economists have selected for their study exactly 85 components for tariffs, which are based on the statutory benefit catalog of health insurance companies. They also included offers such as eyeglasses, contact lenses or private medical care, which are not or will not be taken over by the health insurances. A total of 32 renowned private providers were selected for the analysis.

In the final report they criticize the lack of influence of politics. In contrast to the GKV, the politicians can do little, according to the authors. In addition, there is often a lack of transparency for the customer to find their way around the different tariff offers. Without expertise, it is difficult to find the right full insurance. (Sb)

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Picture: Ronny Richert