Health insurance withdraws from the optional tariff


Optional tariffs before the end: The Techniker Krankenkasse is ending the tariff TK-Privat-Praxis at the end of the year.

(24.08.2010) The Techniker Krankenkasse (TK) is the first of the statutory health insurance companies to set one of its tariffs. At the end of 2010, the tariff "TK-Privat-Praxis" expired for 7,000 insured persons, which was originally intended to help acquire new customers or to keep better earners.

The “TK-Privat-Praxis” tariff offered the insured the opportunity to bill their doctor's visits in a similar way to private patients and thus enjoy any benefits that the doctors may have. The insured initially paid their bills themselves and then received the money reimbursed from the Techniker Krankenkasse, whereby a maximum of 3.5 times the simple rates of the fee schedule could be charged. With the introduction of optional tariffs for the statutory health insurance companies in 2007, the legislation wanted to provide the statutory health insurance companies with an additional means of competing with private insurance companies. However, it was also stipulated that they must finance themselves. However, since the statutory insurance companies cannot make a similar selection to their customers as private health insurance companies, i. H. The partially very attractive optional tariff is accessible to everyone, sometimes there are considerable costs that cannot be covered by the tariff alone.

Private health insurance (PKV), which faced considerably increased competitive pressure from the statutory health insurers in the course of the introduction of optional tariffs, is very accommodating to the discontinuation of the optional tariffs. "The failure of the 'private patient' tariff of the Techniker Krankenkasse shows that such tariffs are a foreign body in statutory health insurance," emphasized the director of the Association of Private Health Insurance, Volker Leienbach. He further explained that "electoral and additional tariffs (...) are not to be found in a state-subsidized social security system" and "are a regulatory and actuarial error". According to him, the system could not work because the statutory insurance companies are not allowed to demand risk-based premiums from their insured persons.

However, the fact that the competition between private and statutory health insurance funds is developing a little more in favor of private health is problematic for the health system as a whole. In any case, more and more well-insured people are leaving statutory health insurance companies in the direction of private health insurance. This means that the solidarity-based concept on which the health care system is based is practically overridden, since the “strong shoulders” who should bear most of the burden in the statutory insurance system are increasingly turning their backs on it. In addition, the Federal Government's advances to facilitate the switch between statutory and private insurance and to abolish elective tariffs in general have already weakened the statutory health insurance funds.

With the existing optional tariffs, insured models have so far been particularly interested in models with a premium refund. Here, insured persons receive up to a maximum of a monthly contribution if they do not go to the doctor for a whole year or pay their bills there independently. "The insured person has no financial risk here because he does not pay a higher contribution and the health insurer pays the costs in the event of illness," explains the financial expert from the Consumer Advice Center North Rhine-Westphalia, Kai Vogel. However, the model becomes problematic if seriously ill patients refrain from visiting the doctor in order to receive a monthly contribution at the end of the year. (fp)

Also read:
Chief physician treatment only possible at the PKV?
Health insurance additional contributions also in 2011
Health insurance companies criticize the restriction of optional tariffs
Around 1 million refuse to pay an additional contribution

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