Consumer advocates warn against PKV low tariffs

17.03.2011

Since the introduction of the health care reform at the turn of the year 2011, the changeover to private health insurance (PKV) has been considerably simplified. Self-employed, civil servants and well-paid employees have the choice: either they can be covered by statutory health insurance or they conclude a PKV tariff. The Stiftung Warentest warns in the issue of the magazine „Finanztest“ before an ill-considered and premature conclusion of a so-called cheap tariff.

Locktarife of private health insurance
At first glance, the tariffs of some private health insurance providers seem quite tempting. Almost with dumping prices insurance brokers try to win new customers. It seems that there has been competition for price undercutting. Hardly a PKV entry-level tariff costs more than 100 euros a month. Some of the tariffs cost less than 60 euros and still promise sufficient health care. You search the internet with the keyword „Health insurance“, so you can count on numerous and at first glance cost-effective offers. This was confirmed by an insurance broker „Heilpraxisnet.de“: „The less benefits the tariff provides for the insured, the better the commissions for the brokers. That's why many in the industry rely on quick money instead of selling well.“ The broker does not want to let his name be known, after all, one does not want to make himself unpopular with colleagues.

High commissions for insurance brokers
And indeed, the commissions are sometimes breathtakingly high. The Federal Association of Insurance Advisers in Germany was therefore recently for a „drastic reduction of commissions“ pronounced. The paid commissions on the conclusion of an insurance contract are now up to 18 monthly contributions of the insured, which is criticized by both the policy and the Federal Association of insurance advisors massive. In addition, the highest commissions are to be fetched in the worst contracts, whereby the advice is sometimes consumed considerably considerably, said Stefan Albers, President of the Federal Association of Insurance Advisors. For this reason, one pleads for paying only a maximum of seven monthly contributions, in order to get the market reasonably well under control again.

Solid statutory health insurance
Self-employed who have opted for a statutory health insurance, pay a minimum rate of currently 340 euros. For this purpose, statutory insured persons receive solid health care, long-term care insurance and daily sickness allowance from the 43rd day of the legally certified inability to work. Anyone who has just become self-employed and entrepreneur with a low income, even has to pay only 226 euros per month for the statutory health insurance.

Enticing introductory tariffs of private health insurance
For many start-up entrepreneurs and young entrepreneurs, the introductory rates of private health insurance are very tempting. After all, if you only have to pay 56 euros instead of 226 euros, many people are tempted to switch to private health insurance. Although the private health insurance is cheaper at first glance, but the performance restrictions compared to the regular private health insurance tariffs are sometimes very high, warns the Stiftung Warentest. The private tariffs are only cheaper if you are free, have no children and is clearly younger than 35 years of life.

Anyone who takes a closer look at the benefits of the low-cost tariffs will quickly realize that there is hardly anything to be detected about the alleged high-quality private services. There is no single occupancy in clinics, no chief physician treatment, a very limited dentures reimbursement, no subsidies for visual aids, co-payments, if instead of generic original medicines are used, no naturopathy treatment with naturopaths and no free choice of doctor. These are not necessarily benefits that you would expect from private health insurance companies.

Rates increase with age
That would not be bad if the insured actually only had to pay the low contribution rate. Often the opposite is the case, reports Stiftung Warentest. The low rates are partially completed with a high deductible. This means that a certain amount must first be paid by the person concerned. Only if the deductible exceeds the PKV. If you are still young, then this point is still somewhat to cope with. But since no one always stays young, the well-being of health changes as well. Sooner or later formerly young people have to look for better alternatives. Since the way to the legal remains vespert forever, just remains the change in a reasonable rate with much more hedges. Who then wants to switch to a higher-performance tariff, must often undergo a renewed health check. And then it turns out, most of the time, that PKV fares cost far more money than the voluntary statutory health insurance. As reported by Werner M. (56) from Hannover: „I used to pay only 254 euros, today it is already 780 euros per month, although I have already voted off numerous benefits“. For comparison: The maximum amount of legal with an above-average income is 575 euros including family co-insurance.

The PKV tariffs rise, even if the industry does not like to admit that publicly. Health economists believe that even the best fares will increase many times over the next few years. In the next 30 years, the tariff contribution could have already tripled. According to one of „Tomorrow morning“! In May of last year, the contributions of the private health insurance companies in the last ten years have increased drastically. For example, six different tariffs of the German Ring have risen on average by 3.4 percent in the last 10 years. In the Pax family welfare insurance premiums of the last ten years have risen by an average of 6.7 percent and the Mannheim's by 6.9 percent (including all tariffs). Converted this means that, for example, men have spent an average of nearly € 2,000 per year since 1985 on their health insurance. Also not uncommon are above-average increases in premiums for the elderly. For example, some retirees had to accept 5 to 10 percent premium increases in the last five years.

Attention to PKV contract clauses
The average per capita expenditure of a legally insured person amounts to approximately 2400 euro for the cashes. If you take a deductible of € 1,000 and more per year as a private insurance, you should expect that in the course of life you have to pay this amount in addition to the tariff premiums. Experts therefore call for their own provision in the form of reserves.

Against this background, the consumer advocates of Stiftung Warentest warn against a whole series of unfavorable contractual clauses. Consumers should read and understand all regulations before signing a PKV contract. Basically, you should be aware that doctor's fees are initially paid out of pocket this year. Only at the end of the year, the bills are submitted to the private health insurance. Uncertainty arises, for example, when the medical bill is higher than the amount actually covered by the insurance. This can certainly happen because physicians in private patients are allowed to charge 3.5 times the statutory fee schedule (GOÄ). Cheap fares but often provide only a reimbursement of 1.8 times the rate. In many cases, insured persons have to pay a maximum of half of the treatment costs themselves. The same applies to dental bills.

Cover for dentist treatment and remedies
Other Locktarife cover the costs of dentures and dentist treatments. For example, insured persons sometimes have to pay between € 1,000 and € 1,500 out of their own pocket. Any additional costs must be paid by the patient himself. There are even rates that do not provide any reimbursement for dentures such as crowns, bridges and prostheses or settle only half. Any additional costs must be paid by the patient. If a complicated jaw surgery is due, high costs can be incurred on the affected person.

There are no reimbursements at many low rates for vision aids, walkers, hearing aids, wheelchairs or prostheses. Even remedial treatments such as speech therapy, physiotherapy, occupational therapy or medical massages are gladly deleted from the catalog of services of the lock offers. If one suffers a serious accident, heart attack or stroke, the additional costs for the rehabilitation itself have to be paid.

Read on this topic:
Beware of PKV lock offers
PKV basic rate: Doctors refuse treatment
From 2011: Higher health costs
Thousands change to private health insurance
PKV and children: change should be well considered

Picture: Gerd Altmann / Gerold Meiners