Many private individuals return to the GKV

Private insured use opportunities to escape from the PKV

10/01/2012

The media reports about a massive influx of private insured towards the statutory health insurance, cause controversial reactions in the insurance associations. While the GKV-Spitzenverband claims to be happy to win new insureds, the spokesperson of the PKV-Verband emphasized: „The fact is that every year many more insured persons change into private health insurance than the other way round.“

In view of the fact that legislators do not intend to provide for repatriation when leaving SHI, the influx of insured persons from private to statutory health insurance seems highly questionable. Certainly, the statutory health insurance may look forward to the profit of insured, but it must be questioned whether at this point not only the abuse of the system has increased. Because it is possible that more people are now using the option of cheaper insurance in private health insurance at a high income and making use of one of the few exceptional options that will allow them to return to GKV later in life, with rising contribution rates. In other words, in the years of good health and low treatment costs those affected are favorably insured in the PKV, in old age (at high cost of service), they return to relatively low contribution rates in the statutory health insurance.

Nearly 30,000 private persons return to the GKV
In order to avoid such a misuse of the system, the legislature has collected numerous regulatory hurdles, which are to prevent a return from private health insurance to the statutory health insurance. But the few existing loopholes seem to use more and more privately insured to be back in the GKV yet. As the CEO of the AOK Rheinland / Hamburg opposite the news magazine „The mirror“ explained, piling up „the telephone inquiries of private insured who want to come to the AOK.“ Further reports „The mirror“, that in the past year around 27,600 insured changed from the private health insurance to the largest statutory health insurance Barmer GEK, which corresponded to an increase in the change of insurance by nine percent compared to the previous year. An influx of insured, the statutory health insurance, according to the speaker of the GKV-Spitzenverband, Florian Lanz, welcome.

Member inflows are not necessarily a competitive advantage for the SHI
For Lanz, the cause of the increased insurance change is obvious: „It seems slow to get around that the beautiful advertising image of PKV Always better and cheaper! does not correspond to reality.“ According to the GKV association spokesman is at the statutory health insurance „everyone is welcome within the scope of legal requirements.“ After the bankruptcy of the City BKK last year, some public health insurance but rather attracted by a contrary attitude unpleasant - even if the insured did not come from a private but a statutory health insurance. In addition, although the statutory health insurance may interpret the inflow of members from private health insurance as a competitive advantage, but in fact this can also bring significant night parts with it. Especially with the older insured, the risk that the expenditure on benefits exceeds the amount of additional premium income increases. The insured would also be cared for at the expense of the solidarity community, even though they had withdrawn from the solidarity community at a young age, with a high income and good health.

PKV Association criticized „dubious“ presentation
In a statement on the current media report, the association of private health insurance companies contradicted Florian Lanz's statement and emphasized that the private insurance companies were by no means in the background. The attempt here to give a different impression, explained the spokesman of the PKV Association, Stefan Reker, compared to the „Stuttgarter Nachrichten“ when „untrustworthy“ and stressed that the statutory health insurance would have to increase their contributions immediately by ten percent if they „not 15 billion a year grant at the expense of taxpayers“ would receive - „,not to mention practice fees, co-payments and benefit cuts.“ However, Reker forgets to mention at this point that the statutory health insurance funds have neither the opportunity to choose their insured nor to determine their contribution rate itself - as in the case of private health insurance. Furthermore, the PKV spokesman said it would stay „The fact that every year many more insured persons change into private health insurance than vice versa.“ However, it must be mentioned that a return from private health insurance to statutory health insurance is expressly not desired by the legislator and is complicated by numerous corresponding regulations.

High contribution rates Main reason for health insurance changes
As a major reason for the increased change from PKV towards GKV called the health expert of the magazine „Finanztest“, Ulrike Steckkönig, the high costs for private individuals with increasing age. For example, people who expect private health insurance at the age of 30 should expect their contributions to triple at least until retirement age, Steckkönig explained. Here, contributions quickly come together in old age, in which the victims yearn for a return to the GKV. However, the willing to change only a few loopholes and some questionable tricks to get back but again in the GKV. Many of these options are highly controversial and at least a legal gray area - some are simply banned. Therefore, consumer advocates urgently warn of cheating. Anyone who wants to return to the SHI should therefore be honest. Because „Getting a bill of exchange with tricks is dangerous“, emphasized Thorsten Rudnik of the Confederation of Insured. In case of doubt, those affected would have to leave the SHI again, take out private insurance again (probably on significantly worse terms) and expect compensation claims.

Loopholes to return to the GKV
However, there are a few exceptions that make it possible to return to statutory health insurance within the legal framework. For example, employees are put under an annual income „50,850 Euro grossly compulsorily insured again in the statutory health insurance ", Thorsten Rudnik explained.In addition, there is a possibility to return to the GKV even when unemployed I. Unemployment Benefit I recipients can cancel their private insurance and are compulsorily insured by a provider of their choice at ALG I. The recipients „Unemployment Benefit II must remain in private health insurance“, said the expert from the Federation of insured. A return to the GKV is also excluded for persons over the age of 55 years. In the case of the more questionable tricks, for example, the expert mentions a deliberately lower setting of the starting salary for new hires - with the salary only being raised to the level originally envisaged after the change of policy. Another option is to temporarily reduce working hours so that the salary falls below the compulsory insurance limit. However, such tricks move in a legal gray area and violate the actual intuition of the legislature. (Fp)

Also read:
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Health insurance: additional contributions come again
Complaints about increase in PKV contributions
Health insurance: What will change in 2012?
Private health insurance may terminate
New PKV tariff for non-payers
Contributor: PKV increases massively tariffs

Picture credits: Ronny Richert