Government wants to strengthen rights of private health insurance

The rights of private insured persons should be strengthened

02/02/2012

As emerges from a bill of the Federal Ministry of Justice, the rights of private insured persons (PKV) should be strengthened in the future. According to this, a claim to information against the insurer should be introduced, according to which the latter is obliged to inform the insured party whether or not the costs for treatment are taken over. In addition, private insured persons should get two months to cancel after a contribution increase.

Request for information against insurers
Federal Minister of Justice Sabine Leutheusser-Schnarrenberger (FDP) wants to strengthen the rights of privately insured persons with the new bill. These are to receive a claim to information against their insurer regarding the assumption of treatment costs. The insurer is obliged to respond within a maximum of 14 days. In urgent cases, the private insured must receive a response immediately. Prerequisite are treatment costs of at least 3000 euros. The insurer's answer is binding if it is granted on the basis of a treatment and cost plan.

Privately insured often do not know when starting a treatment, whether the costs are covered by their insurance. Although you can theoretically start therapy on your own account, many private individuals can not afford it. In addition, doctors and hospitals usually start treatment only when the cost is cleared, unless life-threatening situations are at stake.

The man suffered irreparable damage because the insurance took too much time
In the past, therefore, tragic individual fates have come. In one case, an insured had even suffered irreparable damage because the private health insurance of the man took too long to commit to taking care of the treatment costs. When the Petition Committee of the Bundestag heard about the case, the latter asked the Ministry of Justice to examine whether there was any concrete need for action. The Ministry then sent to countries and associations on Tuesday, the new bill and announced that with the new law „increased transparency in the assumption and settlement of insurance claims“ becomes.

Reimbursement must be based on defined criteria
Only recently had an insured before the Palatine Higher Regional Court (OLG) Zweibrücken complained (file number: 1 U 78/11), because the private health insurance refused the cost of an artificial insemination.

The judges decided in favor of the plaintiff and thus stated that even private health insurance can not decide at will on cost assumptions. If, as in the current case, no comprehensible, unambiguous criteria for checking the reimbursement of costs are presented, this uncertainty will be borne by the insurance company and it will have to bear the costs of the treatment, the district court of Zweibrücken ruled. The rights of the private insured will be significantly strengthened by this verdict.

Termination possible two months after contribution increase
In addition to the right to information, the bill also provides for the extension of the period of notice for increases in contributions. While private insured have had time to cancel their private health insurance just one month after the premium has been increased, the deadline has been extended by another month. Accordingly, the termination may take up to two months after an increase in contributions.

If a private insured person has decided on the base rate for the self-payer tariff, the latter is to be able to cancel the deductible at any time, provided that this tariff does not lead to a reduction in the premium. (Ag)

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Picture: Ronny Richert