Which health insurance actually fits

PKV unisex rates in insurance choice

14.02.2012

Due to the rapid changes in the health insurance system in the past year, many insureds are currently wondering whether the principle of a private or a statutory health insurance is suitable for them. However, gender-specific differences are unlikely to play a role here in the future, since as of December 2012, so-called unisex tariffs will also apply in private health insurance. The previous differentiation of contributions to men and women is from then on away.

When choosing health insurance, you should take into account a number of key factors that can have a significant impact on whether private health insurance (PKV) or rather statutory health insurance (SHI) is recommended. For example, at a young age, with good health and high incomes, insured persons may pay higher contributions in statutory health insurance and receive fewer benefits than in private health insurance. Over the entire life course, however, the private health insurance can quickly become a cost trap for many insured, since the contributions usually increase massively with age. Insured persons can no longer pay their PKV contribution, threatens the so-called base rate, in which the hedge usually fails worse than the GKV.

Better benefits in private health insurance
Since a return to the statutory health insurance is normally excluded, insured should think well about the change in the private health insurance. Although the conditions under which insured persons can switch to private health insurance have been greatly facilitated by the legislature, so that the decision is open to considerably more people today than it was just over a year ago. However, such a change is not always the most sensible option for the insured. Although the total private health insurance is clearly ahead of the statutory health insurance scheme in terms of benefits, on the other hand there are massively increasing contributions in the course of the life course. In addition, legally insured persons generally have the option of taking out additional insurance with the private insurance companies in order to benefit from more comprehensive benefits as a GKV member. However, this additional insurance then also cause corresponding costs. The private patients put together their insurance package individually, so that this can anyway be adapted to their exact needs anyway. The level of performance is usually much higher than for the SHI. The basic tariff, which was introduced with the compulsory insurance in 2009 under the then Minister of Health Ulla Schmidt (SPD) to ensure the insurance coverage of the private insured, but here is the exception. This tariff is based on the performance targets of the GKV, but in practice even remains behind in some places. The basic rate has been set up for all private patients who are unable to cope with the premium increases in private health insurance in the long term but can not return to SHI.

Different costs and development of contributions
In terms of costs or contribution levels, the benefits are more likely to be in private health insurance, especially at a young age, with high incomes and good health. This is due, among other things, to the fact that the contribution rate in the GKV - according to the principle of solidarity - also increases with rising income, up to a maximum value of just under 600 euros. In private health insurance, however, the contributions are not based on income, but on the insurance risk that can be deduced from factors such as the age or health of the insured. The contributions are therefore at a young age in good health is particularly low and accordingly attractive seems the change. But with increasing age and individual disease risk also increase the premiums in the PKV. According to media reports, some private health insurance companies increased their premiums by up to 40 percent at the beginning of the year. The contributions often reach much higher rates over the life course than the approximately 600 euros maximum rate of SHI. As private insurance companies are well aware of the problem of massive increases in old-age contributions, some of them offer the opportunity to create old-age provision in order to keep contribution rates as constant as possible in old age. However, contributions to statutory health insurance usually remain relatively constant over the course of life, or in some cases even decrease as a result of declines in income. Only amendments adopted by the legislator to levy the GKV contributions could under certain circumstances lead to a significant increase, but for the time being further adjustment seems out of the question. Especially since the contribution rate for employees was only increased last year from 14.9 to 15.5 percent

Unisex tariffs prevent gender-specific differentiation
An essential aspect in deriving contribution rates in private health insurance has always been the gender of those insured. But as of December 2012, this criterion will no longer have any influence on the level of private health insurance rates. Because of the EU Equality Directives from 2004, so-called unisex tariffs will be introduced from 21 December, which will no longer allow gender differentiation. For women, therefore, the contributions are likely to decrease slightly, while men from the end of December have to pay significantly more. Excluded are contracts that currently exist or have been completed by the balance sheet date. A change in the private health insurance could possibly be even more worthwhile for men now, while women would rather wait until December. Previously, women had to pay higher premiums in private health insurance because they have a statistically higher life expectancy, perform significantly more check-ups, consult a doctor more frequently than men and incur significant costs in the event of pregnancy.

Consider family planning in the insurance choice
An important criterion when choosing the right health insurance is generally the individual family planning. Because in private health insurance each family member must be individually secured, while in the GKV there is the possibility of family insurance. If children are insured, the statutory health insurance is usually much cheaper than the private health insurance due to the free family insurance. Although these offer reduced cost tariffs for adolescents, but with the supply of SHI private individuals can not compete at this point. Childless families and singles can safely ignore this point of view, but all insured who are planning a family should not disregard the benefits of a free family insurance with the GKV.

Different billing of the treatment costs
Finally, the method of payment for many insured persons also plays a significant role in the choice of insurance. For in private health insurance, patients must first pay for their services themselves or receive the bill for this and submit them later to their health insurance. While with the legally insured the handling of the accruing treatment costs is taken over directly by the insurance. The insured persons do not have to make any advance payments here, which can bring significant benefits in the event of personal liquidity bottlenecks.

Facilitated change in the PKV
A change in the PKV is possible since the beginning of 2012 for employees and employees with a one-time annual income of 50,850, - €. Students, civil servants, the self-employed and freelancers are basically free to choose their health insurance. But those who have once decided to switch to private health insurance can not normally return to SHI. Thus, the choice of insurance is sometimes a decision for life - a thorough consideration of the advantages and disadvantages is therefore urgently required. (Fp)

Also read:
PKV Unisex fares hardly cheaper
Switch to statutory health insurance for private persons easier
Complaints about increase in PKV contributions
Health insurance: What will change in 2012?

Picture: Gerd Altmann / Gerold Meiners