Assignments from the health fund lawful

Health insurance funds are not entitled to subsequent allocations from the health fund

05/21/2014

The Federal Social Court has confirmed the legality of the allocations from the health fund for the years 2009 to 2012 and thus rejected the claim of several health insurance companies. These „According to the decision of the 1st Senate of the Federal Social Court (...), they are not entitled to higher allocations from the health fund for the years 2009 to 2012“, so the message of the court.

Federal Social Court judges Assignments from the Health Fund for lawful
Since 2009, statutory health insurance funds have been allocated health insurance funds, mainly financed by health insurance contributions, to cover their expenditure (more than € 170 billion in 2010), reports the Federal Social Court. These „Assignments take account of age, gender and risk-related differences in the insured structure in order to ensure equal opportunities in gaining insured persons and to counteract incentives for risk selection“, the court continues. Against this, among other things, the Techniker Krankenkasse (TK) had sued, because in their view, when setting the allocations legal and data base was insufficient.

With their view, the plaintiff health insurance companies (TK, AOK Bavaria, AOK Northeast, AOK Rhineland-Palatinate / Saarland, pension insurance Knappschaft-Bahn-See, Bosch BKK, BAHN-BKK) could not prevail in ten appeal procedures and remained in the end before the Federal Social Court unsuccessful. This has now decided, „that the compensation procedure is altogether lawful“ and „in particular the legal and data base for the year 2009 sufficient“ is. The allocations determined by the Federal Insurance Office (BVA) are thus not objectionable and the health insurance companies can hope for no additional funds.

Also, the claim made in three other proceedings on higher so-called „convergence assignments“ for the years 2009 and 2010, the court rejected. Here is the „In the opinion of the pending health insurance funds, the morbidity information of the insured persons of the respective country must be taken into account when determining the allocations“, so the message of the Federal Social Court. All in all, the decisions of the Federal Social Court were approved by the BVA President Maximilian Gaßner expressly welcomed. „The decisions confirm the previous allocation practice of the Federal Insurance Office and thus lead to legal certainty for the allocation system“, stressed the President of the Federal Insurance Office. Had the ruling of the court been different, presumably the entire allocation system of the health fund would have had to be revised, which would have brought renewed uncertainties in the coming years. (Fp)