Federal Shell Treaty

A federal shell contract (BMV) is an agreement between the National Association of Statutory Health Insurance Physicians and the National Association of Health Insurance Funds to ensure the statutory medical care of the insured, including the family members who are also insured. The legal basis is Section 82 (1) SGB V.

The federal shell contracts form the general content of the general contracts between the statutory health insurance or statutory health insurance associations and the health insurance and substitute health insurance associations at state level. The federal shell contracts are binding for the health insurance companies and contract doctors or dentists.

The Federal Shell Agreement - Dentists (BMV-Z) came into force on July 1, 2018.

Contract partner

Contractual partners in the field of contract doctors are the National Association of Statutory Health Insurance Physicians (KBV) and, in the field of contract dentists, the National Association of Statutory Health Insurance Dentists (KZBV) on the one hand and, since July 1, 2008, the National Association of Health Insurance Funds (GKV-SV) on the other. Previously, the contracts on the part of the health insurance funds were concluded jointly by the federal associations of primary funds or by the association of substitute funds.

If there is no agreement between the parties, decide to § 89 para. 4 SGB V the Federal Arbitration Office .

Content of the contract

The content of the federal shell contracts are the contractual matters that necessarily require nationwide regulations or are seen by the contracting parties as in need of regulation, without restricting the contracting parties of the overall contracts beyond the general content. In the course of time, the legislature has included more and more requirements in SGB V, which must be implemented through the federal shell contracts. These are essentially:

According to Section 87 (1) SGB V, the uniform assessment criteria for medical and dental services are to be agreed by assessment committees as part of the federal shell contracts.

According to Section 92 (8) SGB V, the guidelines of the Federal Joint Committee (G-BA) are part of the federal shell contracts, insofar as they are passed on the basis of Section 92 SGB V and relate to contract medical or contract dental care.

Agreements on forms and evidence in accordance with Section 87 (1), sentences 2 to 5 SGB V and Section 295 (3) No. 2 SGB V

Agreement on the requirements for the execution and billing of medical examination and treatment methods that require special knowledge, experience or other requirements ( Section 135 (2) sentence 1 SGB V)

Agreement on billing (e.g. billing procedure and data exchange ( Section 295 (3) SGB V))

Agreement on the introduction and design of the health insurance card § 291 Para. 3 SGB V. This has meanwhile been expanded to include the electronic health card according to § 291a SGB V.

The contents of the BMVe in the contract medical and contract dentistry areas differ greatly, in particular the BMV-Ärzte (BMV-Ä) has a considerably higher density of regulations. The BMV-Ä came into force on October 1, 2013 in a version applicable to all health insurance companies.

Federal shell contract dentists (BMV-Z)

In the contract dentistry sector, there were two federal shell contracts. The federal contract for dentists (BMV-Z) applied to the primary health insurance fund and was agreed in 2007 between the KZBV and the top organizations of the primary health insurance funds that existed at the time. The substitute health insurance contract for dentists (EKV-Z) applied to the substitute health insurance scheme and was set by the Federal Arbitration Office on January 1, 2005 in 2004. Both contracts were changed as of April 1, 2014 due to an agreement on the application and approval process for contract dental services and expert assessments.

The federal shell contracts BMV-Z and EKV-Z, previously negotiated separately for primary and substitute funds, have been merged into a uniform federal shell contract - dentists (BMV-Z), which came into force on July 1, 2018.

literature

Herbert Schiller (eds.), Christoph Altmiks, Stefan Hochgesang, Jörg Hofmayer, Gernot Steinhilper, Helga Trieb: Federal Coat Agreement Doctors - Commentary on the joint BMV-Ä , CF Müller, 2014, ISBN 978-3-8114-3334-2

Thomas Rompf, Jürgen Schröder, Thomas Willaschek: Commentary on the federal coat contract for doctors , Deutscher Ärzte-Verlage 2014, ISBN 978-3-7691-3529-9