Tariff change with PKV health insurance

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PKV tariff change made easier

Federal Administrative Court: The tariff change within the PKV insurance company has been made easier. A surcharge may not be charged when changing tariffs.

(24.06.2010) Today, the Federal Administrative Court in Leipzig strengthened the rights of people with private health insurance. In the future, changing tariffs to a cheaper tariff within the PKV insurance company will be easier. Thus, the insured may not be expected to pay a bill, as the highest administrative court ruled on Wednesday. With the judgment, the Federal Administrative Court approved the Federal Financial Supervisory Authority, which was in a legal dispute with "Allianz Private Krankenversicherungs-AG". The verdict: Case number: 8 C 42.09. A previous judgment of the Frankfurt Administrative Court was set aside.

With this judgment, the trick was stopped that private health insurance companies can lure new customers into low-cost insurance tariffs, while older members have to pay high premiums in closed tariffs. PKV insurance companies bring new tariffs to the market to attract new customers. This is done by slightly changing and recalculating tariffs at short intervals. The old tariffs are "closed" and no longer offered on the insurance market. New, mostly young, insured persons join the new tariffs, while the old members remain in the closed tariffs and pay high premiums. The closed tariffs are usually much more expensive than the new tariffs, since the costs increase with the age of the insured persons.

According to the Insurance Contract Act, flat-rate structural supplements are not permitted when changing tariffs within the same insurance company. The procedure was about whether private health insurance providers were allowed to avoid this by changing and recalculating the tariff. In the controversial case, the "Allianz Private Krankenversicherungs-AG" made very affordable members with the "Aktimed tariff" to very healthy members. The threshold for illness-related risk premiums was significantly lower than before. Anyone wishing to switch to the "Aktimed tariff" within the alliance had to pay a surcharge of 20 percent. The insurer argued that the tariff was calculated completely differently. Therefore a surcharge had to be paid.

However, private health insurance companies may not levy such a surcharge in the future, since this flat rate surcharge of 20 percent violates insurance contract law. For the classification for a new tariff, only the state of health of the insured is decisive, which existed when the insurance started. It follows that insured persons who were previously completely healthy and were rated "best risk" have the right to switch to a different tariff. It is not important what the insured person's state of health is today. A surcharge for changing tariffs within the same private health insurance provider may not be charged by the insured in the future. This significantly strengthened consumer rights. (sb)

Also read:
Change health insurance or stay?
Membership loss in health insurance

Author and source information

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