/dpa
Berlin – The Union faction in the Bundestag calls for a reform of the financing of private health insurance (PKV). Among other things, more constant price adjustments are needed to protect policyholders from unnecessarily high jumps in premiums.
The legislator has not changed the legal basis of the tariff structure of private health insurance for more than 15 years, they criticize CDU and CSU in an application. Contribution adjustments are therefore “carried out exclusively on the basis of long-standing laws and regulations”, it states.
Due to the current legal situation, policyholders would normally receive irregular premium adjustments, which could sometimes be in the double-digit range, especially for those who are not entitled to benefits.
The reason is so-called “trigger factors”: premium adjustments can only be made if the actual probability of death deviates from the calculated probability of death by more than five percent or if it is proven that the insurance benefits at a rate are higher than originally calculated by a percentage defined according to contractual conditions.
Because the prescribed percentages are very high, the threshold values sometimes take years to reach. When the time comes, premium increases will suddenly have a significant impact, as cost increases accumulated in previous years will have to be absorbed.
“Years with strong increases are less predictable and more difficult to plan for policyholders with regard to their personal financial planning,” writes the Union. “Such significant fluctuations in contributions are more psychologically impactful than more frequent, but generally smaller, adjustments.”
Continuing contributions would therefore lead to a more equitable distribution of contributions and therefore better planning for the benefit of policyholders, but not to further increases in contributions.
The CDU and CSU therefore ask that the contributions become permanent. Limit values would have to be reduced and price adjustments in private health insurance would have to be possible sooner. These would then have a lower recovery factor, meaning that price adjustments – as in GKV – would be more frequent, but also significantly more consistent and smaller.
Furthermore, a prolonged low interest rate environment, as has been the case in recent years, means that declining returns in the capital market can only be subsequently and delayed reflected in premiums as part of premium adjustments, which are triggered by other factors and relatively late.
Therefore, an additional trigger factor “interest” is needed to react more quickly to changes in the capital market situation and, thus, allow possible changes in interest rates to be promptly incorporated into the evolution of premiums.
The federal government must also create a legal framework so that when a rate changes within an insurance company, all old provisions are no longer completely exhausted and contributions are reduced.
Instead, for example, a certain portion of old reserve funds that become available could be used to mitigate future premium increases and thus contribute to premium stabilization.
The statutory ten percent surcharge on contributions for comprehensive health insurance has not been adjusted for the increase in life expectancy and the increase in the retirement age to 23 years. The Union proposes to make it variable, for example in terms of payment period, value and depending on the age of the insured. The funds thus generated would make it possible to contain increases in contributions earlier and extend this effect for a longer period, even into old age.
Finally, there is also an urgent need to update the design of existing social tariffs. The current regulation of access to standard or social tariffs means that insured people who are in financial difficulties and who are not considered to be in need of help under social law and who only signed up for private health insurance after 1 January 2009 , don’t do it. do not have the opportunity to switch to those that are generally cheaper for them. Switch to standard fare.
Instead, they would have to choose the basic fare and would often find themselves in a worse situation than before. “In the opinion of the applicants, its role as a social tariff is sometimes reduced to the point of absurdity in the case of the basic tariff”, it states in the application.
The Union therefore calls for the reopening of the normal tariff for everyone – including those who have become members of the PKV since 2009 and do not need help in the sense of social entitlement – and thus provide real relief to policyholders in difficult financial situations of life. © lau/aerzteblatt.de