Tariff change at PKV health insurance

PKV tariff change easier

Federal Administrative Court: The change of tariffs within the private health insurance company was facilitated. A surcharge may not be charged in the event of a change of fare.

(24.06.2010) Today, the Federal Administrative Court in Leipzig strengthened the rights of private health insured persons. In future, the tariff change to a cheaper tariff within the private health insurance company is facilitated. Thus, the insured may not be expected to pay a mark-up, as the Supreme Administrative Court ruled on Wednesday. With the judgment, the Federal Administrative Court of the Federal Financial Supervisory Authority, which was in a lawsuit with the "Allianz Private Krankenversicherungs-AG". The judgment: file number: 8 C 42.09. A previous ruling by the Frankfurt Administrative Court was overturned.

With this judgment could be slowed the trick with which private health insurance companies can attract new customers into low-cost insurance rates, while older members in closed tariffs must pay high contributions. Private health insurance companies bring new tariffs on the market to attract new customers. This is done by changing tariffs in short time intervals and recalculating them. The old tariffs are "closed" and no longer offered on the insurance market. New, mostly young insured persons, get into the new tariffs, while the old members remain in the closed tariffs and pay high contributions. The closed tariffs are usually much more expensive than the new tariffs, since the costs increase with the age of the PKV insured.

According to the Insurance Contract Act, lump-sum structural surcharges are not allowed for tariff changes within the same insurance company. The procedure was concerned with whether PKV insurance providers should be able to circumvent this by changing and re-calculating the tariff. In the disputed case, the "Allianz Private Krankenversicherungs-AG" with the "Aktimed tariff" had made a healthy offer to very healthy members. The threshold for sickness-related risk premiums was significantly lower than previously. Anyone who wanted to switch to the "Aktimed rate" within the alliance had to pay a surcharge of 20 percent. The insurer argued that the tariff was calculated completely differently. Therefore, a surcharge must be paid.

However, private health insurance companies are not allowed to levy such a supplement in the future because this flat rate tariff surcharge of 20 percent violates insurance contract law. The classification of a new tariff is based solely on the health of the insured, which existed at the time of the insurance. It follows that insured persons who were previously completely healthy and ranked "Best Risk" have the right to change their tariffs. It is not decisive how the state of health of the insured today. A surcharge for the rate change within the same private health insurance provider may not be charged in future by the insured. Thus, the rights of consumers were significantly strengthened. (Sb)

Also read:
The health insurance change or stay?
Member loss at the health insurance companies