PKV cost trap: How affected people can defend themselves

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PKV cost trap: How can privately insured persons protect themselves against this?

Private health insurance (PKV) is in crisis. Members feel this in the form of drastic increases in contributions. An increasing number of privately insured people are simply financially overwhelmed in view of the massive increase in their insurance premiums, reports the Consumer Advice Center Rhineland-Palatinate based on a nationwide sample of the contribution development in private health insurance. But there are ways to escape the cost trap.

Consumer advocates also found that private health insurance often made it significantly more difficult for members to change tariffs. According to Section 204 of the Insurance Contract Act (VVG), the insured would theoretically have the option to switch to a cheaper tariff if the premium was increased, but in practice massive obstacles would be put in their way, criticized the Consumer Advice Center Rhineland-Palatinate. Together with the Federal Consumer Centers, the federal consumer centers therefore asked the federal government not only to simplify the switch between the individual PKV tariffs, but also to enable a smooth switch between the various providers. In addition, “a fundamental reform of private health insurance is overdue,” said the Rhineland-Palatinate Consumer Agency in a statement last Thursday.

Private health insurance contributions of more than 1,000 euros per month
Many private health insurance companies attract new customers with particularly cheap offers, which at first glance promise more benefits than statutory health insurance for less money. After the contract has been concluded, however, the insured often expect massive increases in premiums in the coming years, which for some may become an unacceptable financial burden. In the case of older insured persons with increased health problems, the contributions may reach more than 1,000 euros a month. The former financial advantage turns into a disadvantage in old age, which devours a large part of the monthly pension income. Many privately insured cannot afford such insurance premiums, and the proportion of non-payers in private health insurance has increased significantly in recent years. However, theoretically, the privately insured affected have a few options to pull the emergency brake on costs. The most important options are summarized in Section 204 of the VVG.

It is difficult to switch to a cheaper health insurance tariff
For example, the law guarantees the private insured to switch to a cheaper tariff within a private insurance. However, the private health insurers have put in place a number of bureaucratic and financial hurdles that make it difficult to switch, according to the accusations by the consumer advice centers. In the past three months, the consumer advice centers nationwide evaluated 144 complaints from privately insured people about contribution and exchange problems in private health insurance, whereby insurance premiums rose by an average of 23.9 percent at the turn of the year, according to the Rhineland-Palatinate consumer advice center. “Central health insurance and Gothaer Versicherung with an average increase of 28.4 percent and 26.4 percent, respectively, were particularly negative,” according to the Rhineland-Palatinate Consumer Agency. The highest premium increase was a proud 60 percent. According to the Consumer Advice Center in Rhineland-Palatinate, "long-standing existing customers and older insured persons" were particularly affected by the massive explosion in premiums.

Private health insurance companies are subject to the right to change tariffs
The complaints investigated by the consumer advice centers mainly related to contracts that were concluded more than ten years ago, with the insured persons generally being older than 45 years. The insurance premiums, which in some cases cost more than EUR 1,000 per month, would become a massive problem for those affected and many are unable to pay their premiums even after retirement, according to the consumer advice center. Since a return to the statutory health insurance is usually excluded, the privately insured have only a few options to escape the cost trap. This also includes the right to change to a cheaper tariff, which is, however, "often undermined by private health insurance companies", explained the Consumer Advice Center in Rhineland-Palatinate. Only in four out of 144 cases "can it be seen in the documents that the change could be carried out without any problems", report the consumer advocates.

Opportunities for cost-emergency brakes for privately insured
In addition to the theoretically existing possibility of switching, the privately insured sometimes also have the option with their insurer to reduce the benefits and thus to arrange a discount on the premiums. After all, single rooms or treatments by senior physicians in the hospital may be dispensable if the monthly contributions can be reduced to a tolerable level. In addition, the privately insured can possibly agree to a share of the treatment costs or the medication in order to reduce their premiums. However, in the case of serious, lengthy illnesses, this poses a considerable risk, since horrendous amounts that have to be paid out of one's own pocket quickly accumulate. It is difficult to say whether a reduction in current contributions justifies this risk. Cancellation by the previous insurance company also only makes sense in exceptional cases, as there is a risk of losing the retirement provisions that are built up from the contributions.

If insured persons have been in the PKV for more than five years and have exceeded the age of 40, it is therefore not advisable to change providers. In general, there is also the option to switch to the basic tariff of private health insurance, although this includes a significantly slimmer range of services and often remains controversial as to which measures the insurance company will take on. Because the insured initially pay for their treatment and medication out of their own pocket and then settle with their insurance company, this is a particular problem. Because in the end, they may remain at the expense.

Change opportunities need to be improved
In the opinion of the consumer advice centers, the current survey makes it clear that, in a first step, it is above all the exchange options that have to be improved in the interests of the private insured. To this end, the legislator should ensure that private health insurance “decides on the tariff change no later than two weeks after receipt of the application, that new tariffs are designed in such a way that tariff changes are possible without a health check, no fees are charged or premium increases are justified when changing tariffs, and the calculation bases are based on Contribution increases are verifiable, ”so the consumer advice centers. In addition, “the possibility of changing its provider should be extended to all those insured in private health insurance”. So far, this option has only been available to insured persons who signed their contract after January 1, 2009.

Comprehensive reform of the private health insurance system is required
The consumer advice centers and the consumer advice center federal association also named the introduction of the benefit in kind principle as "essential cornerstones for consumer-friendly reform of private health insurance", whereby insured persons no longer have to make advance payments for their medical care, but service providers and insurance companies bill the costs directly . In the case of the tariffs whose range of services corresponds to that of the statutory health insurance, the contributions should also be adjusted to the level of the SHI. In addition, the consumer advice centers called for the introduction of an "income component in the premium calculation", so that it is no longer solely the risk of illness that decides on the contributions. The additional income that can be achieved here should be paid into a kind of “hardship fund” from which, in case of doubt, the contributions of other members that can no longer be financed can be offset. The fund would take effect "if the premiums exceeded the financial capacity of the consumers," explained the consumer advice centers. This would compensate for the social hardship within the private health insurance system and would not be passed on to society as a whole, the consumer advocates emphasized.

Politics with growing doubts about the two-tier health insurance system
Politicians are also increasingly concerned about the two-tier insurance system, given the current development in private insurance. The health policy spokesman for the CDU / CSU parliamentary group, Jens Spahn, had taken a public stand in March and emphasized that the separation of statutory and private health insurance was “no longer appropriate”. A statement that meets with open ears in the opposition. For example, Alliance 90 / The Greens has long called for the abolition of private health insurance. As more and more privately insured people find themselves in a financial predicament as a result of rising premiums, political intervention seems urgently necessary. Whether the two-tier health insurance system will endure is of secondary importance. The decisive factor is the prompt reduction of the private health insurance contributions to an acceptable level, whereby the compensation should be provided by the private health insurance system itself, as required by the consumer centers. (fp)

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