Consumer advocates warn of low tariffs for private health insurance

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Since the health care reform came into force at the turn of 2011, the switchover conditions to private health insurance (PKV) have been considerably simplified. The self-employed, civil servants and well-earning employees have the choice: either they have statutory health insurance or they take out a private health insurance tariff. In the edition of the "Finanztest" magazine, the Stiftung Warentest warns against rash and premature conclusion of a so-called discount tariff.

Private health insurance tariffs At first glance, the tariffs of some private health insurance providers seem quite attractive. Insurance brokers try to win new customers with dumping prices. It looks like a price undercutting competition has broken out. Hardly any private entry tariff costs more than 100 euros a month. Sometimes the tariffs cost less than 60 euros and still promise adequate health care. If you search on the Internet with the keyword "health insurance", you will find numerous and at first glance inexpensive offers. An insurance broker confirmed to “”: “The less services the tariff offers for the insured, the better the commissions for the broker. That is why many in the industry rely on quick money instead of selling a good performance. ”The broker does not want to have his name mentioned, after all, one does not want to make himself unpopular among colleagues.

High commissions for insurance brokers And indeed, the commissions are breathtakingly high in some cases. The Federal Association of Insurance Consultants in Germany had therefore recently called for a "drastic reduction in commissions". The commissions paid when concluding an insurance contract are now up to 18 monthly premiums for the insured, which is heavily criticized both by politicians and by the Federal Association of Insurance Consultants. In addition, the highest commissions can be obtained for the worst contracts, which means that the advice is sometimes consumed considerably, explained Stefan Albers, President of the Federal Association of Insurance Consultants. For this reason, one pleads to only pay a maximum of seven monthly contributions in order to get the market under control to some extent.

Solid statutory health insurance Self-employed persons who have opted for statutory health insurance pay a minimum rate of currently 340 euros. In return, those who are legally insured voluntarily receive solid health care, long-term care insurance cover and daily sickness benefits from the 43rd day of medically certified incapacity to work. Those who have just started their own business and are start-ups with a low income only have to pay 226 euros per month for statutory health insurance coverage.

Tempting entry-level tariffs for private health insurance For entry-level entrepreneurs and young entrepreneurs, the entry-level tariffs for private health insurance are very attractive. If, after all, you only have to pay 56 euros instead of 226 euros, many will be tempted to switch to private health insurance. At first glance, private health insurance is cheaper, but the benefit restrictions compared to regular private health insurance tariffs are sometimes very high, warns the Stiftung Warentest. The private tariffs are only cheaper if you are not bound, have no children to look after and are significantly younger than 35 years of age.

If you take a closer look at the services of the low-cost tariffs, you will quickly find that hardly any of the alleged high-quality private services can be seen. There is no single occupancy in clinics, no treatment for chief physicians, only a very limited dental prosthesis reimbursement, no subsidies for visual aids, additional payments if original medicines are used instead of generics, no naturopathy treatment with a naturopath and no free choice of doctor. These are not all the benefits you would expect from private health insurance companies.

Tariffs increase with age That would not be a problem if the insured actually only had to pay the low contribution rate. The opposite is often the case, reports the Stiftung Warentest. The discount tariffs are partially concluded with a high deductible. This means that those affected must first pay a certain amount themselves. The PKV only takes over if the deductible is exceeded. If you are still young, this point is still somewhat manageable. But since no one always stays young, health wellbeing also changes. Sooner or later, formerly insured people will have to look around for better alternatives. Since the path to the legal remains vespers forever, the only thing left is to switch to a reasonable tariff with significantly more protection. If you then want to switch to a more powerful tariff, you often have to undergo another health check. And then it turns out that PKV tariffs cost a lot more money than the voluntary statutory health insurance. Werner M. (56) from Hanover reports: "In the past I only paid 254 euros, today it is already 780 euros per month, although I have already deselected numerous services". For comparison: The maximum statutory amount with an above-average income is 575 euros including family insurance.

PKV tariffs are increasing, even if the industry does not like to admit it publicly. Health economists assume that even the best tariffs will increase many times over in the next few years. The tariff contribution may have tripled over the next 30 years. According to one of "Morgen & Morgen"! In May last year, private health insurance premiums increased dramatically in the past ten years. For example, 6 different Deutsche Ring tariffs have increased by an average of 3.4 percent in the last 10 years. In the case of Pax family care, insurance premiums have increased by an average of 6.7 percent over the past ten years and those of Mannheimers by 6.9 percent (including all tariffs). Converted this means that, for example, men have had to spend an average of almost 2,000 euros or more per year on their health insurance since 1985. Above-average increases in premiums for older people are also not uncommon. In some cases, pensioners have had to accept 5 to 10 percent premium increases in the past five years.

Attention for PKV contract clauses The average per capita expenditure of a legally insured person for the health insurers is around 2400 euros. If you, as a privately insured person, accept a deductible of 1000 euros and more per year, you should expect that you will have to pay this amount in addition to the tariff premiums in the course of your life. Experts therefore call for their own provision in the form of reserves.

Against this background, the consumer advocates of the Stiftung Warentest warn against a whole series of unfavorable contractual clauses. Consumers should carefully read and understand all regulations before entering into a private health insurance contract. Basically, you should be aware that medical fees are initially paid out of your own pocket in the current year. The invoices are only submitted to the PKV at the end of the year. For example, uncertainty arises when the doctor's bill is higher than the amount that the insurance actually pays. This can certainly happen because doctors are allowed to charge 3.5 times the statutory fee schedule (GOÄ) for private patients. Discount tariffs often only provide for a reimbursement of a 1.8-fold rate. In numerous cases, insured persons have to pay a maximum of half of the treatment costs themselves. The same applies to dental bills.

Coverage for dentist treatment and remedies Other enticing tariffs cover the cost of dentures and dental treatment. In some cases, the insured must pay between 1,000 and 1,500 euros out of their own pockets. The patient must pay any additional costs themselves. There are even tariffs that do not provide any reimbursement for dentures such as crowns, bridges and dentures or only pay half of them. All costs that go beyond this must be paid by the patient himself. If an expensive jaw operation is due, the affected person can face high costs.

There are no reimbursements for numerous discount tariffs for visual aids, walking aids, hearing aids, wheelchairs or prostheses. Medicinal treatments such as speech therapy, physiotherapy, occupational therapy or medical massages are also gladly removed from the range of services offered by the lure offers. If you suffer a serious accident, heart attack or stroke, the further costs for rehabilitation must be paid for yourself.

Read on this topic:
Beware of PKV lock offers
Basic PKV tariff: Doctors refuse treatment
From 2011: higher health costs
Thousands switch to private health insurance
PKV and children: Change should be well considered

Image: Gerd Altmann / Gerold Meiners /

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