Statutory health insurance

from Wikipedia, the free encyclopedia

The statutory health insurance ( SHI ) is an essential part of the German health care system . Together with the pension , unemployment , accident and long-term care insurance , it forms the German social security system . The GKV is basically a compulsory insurance for all persons in Germany who are classified as not exempt from insurance and who have no other claim to cover in the event of illness. Membership can also be acquired voluntarily under certain conditions.

Law regarding the health insurance of workers in the Reichsgesetzblatt of June 21, 1883

history

Statutory health insurance was introduced in Germany by the law on health insurance for workers of June 15, 1883 as the first social insurance benefit from Otto von Bismarck as part of the German social insurance solidarity system in order to win the workers over to the state. It came into force on December 1, 1884. At this point in time, the municipal health insurance in Bavaria was already in place through the law of April 29, 1869. These were the very first laws that regulated social security for the lower income groups in the event of illness. The group of people was limited to dependent employees with an annual income of no more than 2000 Reichsmarks in the branches of mining, industry, railways, inland steam navigation, crafts and trades and granted medical and pharmaceutical costs for a maximum of thirteen weeks in the event of illness, sickness benefit amounting to half of the then usual Daily wages, weekly benefits and death grants. Two thirds of the funding came from the workers and one third from the employer. Initially consisting compulsory insurance in the health insurance only for this population with mostly low income. In 1911 the Insurance Act for Salaried Employees was passed. This expanded the membership base.

Based on the German model, Austria also passed a health insurance law on March 30, 1888, which Hungary followed on April 9, 1891.

tasks

The task of the statutory health insurance is to maintain the health of the insured, to restore it or to improve their state of health ( § 1 SGB ​​V ). This also includes alleviating symptoms of illness ( Section 27 SGB ​​V).

In principle, all insured persons have the same entitlement to benefits, the scope of which is laid down in Book V of the Social Code (SGB V) and which is limited by Section 12 (1) SGB V. According to this, the services must be sufficient, appropriate and economical and must not exceed what is necessary. Against this background, a health insurance company can also provide additional services by way of a respective statutory regulation, provided that they are based on a legal authorization. These include B. (Supplementary) benefits relating to the prevention of diseases (prevention), home nursing, domestic help or rehabilitation.

In accordance with the solidarity principle , the assessment of contributions in statutory health insurance - unlike in private health insurance - is not based on the personal risk of illness, such as age, gender, health status, but on a fixed contribution rate that depends on the income that is subject to contributions. The aim of statutory health insurance is to largely cover a general life risk of the insured against unacceptable medical costs that would overburden him financially.

People with compulsory insurance are insured by law. You can therefore, in principle, already claim benefits if you meet the criteria of compulsory insurance, for example taking up employment subject to compulsory insurance. Entitlement to benefits does not depend on whether the employer has actually paid contributions.

Services

The benefits of the statutory health insurance in Germany are laid down in Book Five of the Social Security Code and are provided by the health insurance companies according to the principle of benefits in kind . They can be divided into:

The scope of services is determined on the one hand by the principles of public health insurance for the provision of services apply ( § 2 para. 1 and § 12 SGB V), on the other hand, in accordance with the guidelines of the Joint Federal Committee to § 92 decides SGB V . In principle, approved service providers are used ( contract doctors , dentists , psychotherapists ). Cash benefits are paid out directly to the insured by the health insurance company.

In addition to the services mentioned and legally stipulated for all health insurance companies, many health insurance companies also offer additional services that are specified in the statutes of the respective health insurance company. Some health insurance companies also offer optional tariffs for which the insured person has to pay a separate contribution.

Health insurance

Of the health insurance (including statutory health insurance the duties of statutory health insurance are called) in accordance with the SGB V perceived.

A health insurance company as a public corporation with self-administration regulates its budget independently. It must meet statutory performance requirements (mandatory services) and in some cases may go beyond them (statutory services). According to Section 260 (2) SGB V, your operating resources should not exceed a monthly expenditure. This must be regulated accordingly by adjusting additional contributions.

Cash register types

A distinction is made between the following types of cash register:

The distinction between primary providers (so-called primary funds ) and substitute funds is no longer relevant from the perspective of the insured, because according to § 175 SGB ​​V there is a right to choose from the insurance .

Statutory health insurance membership statistics 2008
Health insurance companies in December 2016
number
open nationwide		 regionally
open		 not
open		 Members
(with retirees)		 Insured
all health insurance companies 117 42 46 29 55.8 million 71.9 million
General local health insurance companies 11 0 11 0 19.9 million 25.6 million
Company health insurance funds 92 32 32 28 8.9 million 11.9 million
Guild health insurance funds 6th 3 3 0 4.0 million 5.3 million
Agricultural health insurance 1 0 0 1 0.5 million 0.7 million
Miners 1 1 0 0 1.4 million 1.7 million
Replacement funds 6th 6th 0 0 21.0 million 26.9 million

Choice of health insurance and change of health insurance

The earlier automatic allocation to a health insurance company according to the employer or the option to choose depending on the occupation no longer existed since 1996. Since then, there has been extensive freedom of choice in statutory health insurance. The only exception is currently still for the agricultural health insurance , which is reserved for farmers . According to their statutes, every health insurance company is approved nationwide, for one state or several states; Company and guild health insurance funds can also be company-related and then require an employment relationship in the respective company.

Insured can to § 173 SGB V choose between the local Ortskrankenkasse , a local competent insurance fund and an operating or Innungskrankenkasse if the insured person is engaged in a corresponding operation or health insurance is generally open to all insured. The local jurisdiction depends either on the place of residence or the place of employment, for students additionally on the place of the university. Furthermore, the insured person can choose the health insurance company in which he was last member or family insured, as well as the health insurance company of the spouse. A member has the freedom of choice as soon as he is able to act , i.e. from the age of 15. Family insured persons and recipients of social assistance , if they are not themselves a member of a health insurance company ("contracted service from the social welfare office"), have no freedom of choice. According to Section 175 (1) SGB V, the responsible health insurance companies are obliged to enter into a contract ;

The Deutsche Rentenversicherung Knappschaft-Bahn-See has also been open to all insured persons since April 1, 2007, but the special services of the miners' supply are only available to old members.

Insured persons who become members of a health insurance company are bound to this health insurance company for a period of 18 months in accordance with Section 175 (4) SGB V. This does not affect the insured's special right of termination if the health insurance company charges or increases an additional contribution for the first time . This also applies to a merger of two health insurance companies. An interruption of membership in the statutory health insurance for at least one calendar day triggers a new right to choose even if the period of 18 months with the previous health insurance company had not yet expired. The notice period is two full calendar months. If the insured person quits with the intention of switching to family insurance, the statutes of the respective health insurance company can stipulate a shorter period of notice. In the event of a change in the compulsory insurance (e.g. change of employer), the insured person can change health insurance without prior notice.

If there is an optional tariff for the insured person, the binding period according to Section 53 SGB ​​V is one or three years, depending on the type of optional tariff.

Quantitative development of health insurance companies

Number of health insurance companies

In 1931 there were 6985 health insurance companies in Germany.

In 1991 there were 1209 health insurances, in 1993 a total of 1367 and on January 1, 2019 a total of 109 health insurances, of which 84 were company health insurances.

According to the Federal Government's announcement in June 2006, the number of health insurance companies should be further reduced as part of the health reform and should be dependent on certain minimum sizes of the membership. The number of health insurance companies over time (information on the reference date January 1 of the respective year) has since been reduced due to the closure of health insurance companies (e.g. BKK Airbus and City-BKK) and mergers.

Merger progresses on January 1st
year 1970 1980 1990 1995 2000 2005 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Number of health insurance companies 1815 1319 1147 960 420 267 221 202 169 156 146 134 132 124 118 113 110 109
Number of health insurance companies by type of insurance company
Cash register type 1/1994 1/1997 1/2000 1/2003 1/2004 1/2005 1/2006 1/2007 1/2008 1/2009 1/2010 7/2011 9/2012 1/2013
AOK 236 18th 17th 17th 17th 17th 17th 16 15th 15th 14th 12 11 11
BKK 706 457 337 255 229 210 199 189 171 155 131 119 112 109
IKK 165 43 32 24 19th 19th 17th 17th 15th 14th 8th 7th 6th 6th
Replacement funds 15th 14th 12 12 11 10 10 8th 8th 8th 6th 6th 6th 6th
(LKK) SVLFG 21st 20th 20th 10 9 9 9 9 9 9 9 9 9 1
Knappschaft / Sk 2 2 2 2 2 2 2 2 1 1 1 1 1 1
Number of health insurance companies by type of insurance company (continued)
Cash register type 1/2014 1/2015 3/2016 1/2017 1/2018 1/2019 1/2020
AOK 11 11 11 11 11 11 11
BKK 107 99 93 88 85 84 80
IKK 6th 6th 6th 6th 6th 6th 6th
Replacement funds 6th 6th 6th 6th 6th 6th 6th
(LKK) SVLFG 1 1 1 1 1 1 1
Knappschaft / Sk 1 1 1 1 1 1 1


The graphic shows the reduction in the number of German statutory health insurance funds from 2008 to today.


Number of health insurance companies according to the number of members

Number of health insurance companies according to the number of members
Number of members 1/2003 8/2005 1/2006 1/2007 1/2008 1/2009 1/2010 7/2011 7/2016
> 1,000,000 12 12 13 13 13 13 14th 15th 18th
500,000-999,999 10 10 10 10 11 11 7th 7th 8th
250,000-499,999 8th 9 10 9 10 10 12 10 8th
100,000-249,999 24 29 31 28 29 27 18th 14th 13
50,000-99,999 32 33 28 34 27 26th 21st 18th 15th
25,000-49,999 36 32 38 31 23 19th 19th 19th 16
<25,000 205 134 123 116 106 96 78 71 39
total 327 259 253 241 219 202 169 154 117

Prominent examples of cross-fund mergers are those of TK with IKK-Direkt , DAK with several company health insurance funds or, conversely, the company health insurance company Mobil Oil with KEH replacement insurance company . TK is the health insurance company with the largest number of members in Germany (as of 12/2018).

Former Federal Health Minister Ulla Schmidt considers 30 to 50 health insurers to be sufficient in the long term. If you consider that only 64 health insurance companies have more than 50,000 members, the goal was already achieved in 2011: Of the 90 smaller insurance companies with fewer than 50,000 members, 32 were "closed" company health insurance funds and more or less did not participate in the market. It was in this size class that the greatest decline occurred in the 2000s.

The future expenses for pensions of the service staff at the general local health insurance funds and the guild health insurance funds require the build-up of provisions of more than 10 billion euros, because since 2010 all health insurance companies can go bankrupt and must therefore provide for this case. An ordinance specifies the calculation of the allocations for the formation of these provisions up to the year 2049.

Establishing a health insurance company

The establishment of a health insurance company is based on the provisions of the fifth book of the Social Security Code (SGB V). In the case of a company health insurance fund according to Section 148 SGB ​​V and in the case of a guild health insurance fund according to Section 157 SGB ​​V. The employer can set up a company health insurance fund for one or more companies if

  1. at least 1000 persons subject to insurance are regularly employed in these companies and
  2. their performance is guaranteed in the long term.

The main requirement for the establishment is therefore the number of employees, not the number of insured persons. After the establishment of the health insurance, the employees are not obliged to switch from their health insurance to the newly established company or guild health insurance.

According to § 148 SGB V, the establishment of the company health insurance fund requires the approval of the supervisory authority responsible after the establishment. The respective Ministry of Health is responsible , in the case of health insurance companies that are open nationwide, the Federal Social Security Office . Approval may only be refused if one of the requirements specified in Section 147 of the Book V of the Social Code is not met or if the health insurance company does not have 1,000 members at the time of establishment. The construction requires the approval of the majority of the employees in the company.

Insolvency of the health insurance companies

In the past, only funds under federal supervision were capable of bankruptcy. Since January 2010, this regulation has also applied to health insurance companies under state supervision . Since then, all cash registers have had to keep their books according to uniform and identical regulations. An adjustment to the Commercial Code is intended to increase transparency.

The distribution and assertion of liability amounts in the event of bankruptcy or the closure of a health insurance company are regulated in a corresponding ordinance.

membership

Membership structure

The health insurance coverage in the GKV can exist within the framework of a compulsory membership (especially employees and pensioners), through a family insurance or as voluntary insurance. The insured are distributed among these types of insurance as follows (as of 2018):

Beginning and end of membership

When the membership of the individual insured begins and ends is  regulated in § § 186 ff. SGB V. Membership of employees subject to compulsory insurance begins on the day they enter the employment relationship and, except for the death of the member, ends above all at the end of the day on which the employment relationship ends again. With the end of membership, the entitlement to benefits generally ends ( Section 19 (1) SGB V). According to Section 19 (2) SGB V, however, there is a subsequent entitlement to benefits for a maximum of one month after the end of mandatory membership, as long as no new gainful employment is exercised and no family insurance is established. The subsequent entitlement to benefits applies accordingly to family insured relatives if membership ends due to death (Section 19 (3) SGB V).

Compulsory insurance

The group of insured persons is determined by law ( § 5 SGB ​​V or § 2 KVLG 1989). The persons named there have insurance cover by virtue of compulsory insurance . You can only be exempted from insurance in the statutory health insurance under the restricted conditions of § 8 SGB ​​V or § 4 KVLG 1989. The persons named in § 6 SGB ​​V are exempt from insurance . These include u. a. Civil servants and employees whose regular annual wages exceed the annual wage limit.

Since April 1, 2007, people who are not otherwise insured against illness, who are not self-employed or who are not insured, have been required to take out insurance (Section 5 (1) No. 13 SGB V or Section 2 (1) No. 7 KVLG 1989), provided that Last but not least, they had private health insurance. People who did not register with a health insurance company of their choice had to pay all outstanding contributions plus a late payment surcharge of five percent per month. With the law on the elimination of excessive social demands in the case of premium debts in health insurance , there was the possibility of debt relief from August 1 to December 31, 2013, provided that uninsured persons registered with a health insurance company during this time. Since 2014, the back payment of missed contributions is due in a reduced amount. Anyone who is late for statutory health insurance must pay around 55 euros per month (as of 2018; including long-term care insurance). The late payment surcharge was reduced to one percent per month.

Since 2013, people whose compulsory insurance or family insurance ends and who do not have a subsequent insurance against illness have automatically entered voluntary insurance in accordance with Section 188 (4) SGB V. The mandatory supplementary insurance therefore only comes into consideration for people who were not previously insured in the statutory health insurance.

Freelance artists and journalists can obtain a grant to the GKV through the Artists ' Social Insurance Fund (KSK), similar to employees. Like employees, you are then compulsorily insured by law. In principle, students are required to take out health insurance for students (KVdS). Pensioners are generally obliged to take out health insurance for pensioners (KVdR).

Voluntary insurance

Statutory health insurance also offers the option of taking out voluntary insurance ( Section 9 SGB ​​V or Section 6 KVLG 1989). This is done for people who have withdrawn from compulsory insurance or family insurance without an application ( Section 188 (4) SGB V). For special persons (e.g. returnees from abroad) a period of three months applies for the application. Although the contribution rate corresponds to that of statutory health insurance, it is paid in full (100%), as the employer's share (50%) is not applicable. The minimum income is currently € 1038.33 (as of 2019). With a contribution rate of 17.6% (example TK total of 14% KV + 3.05% PV + 0.7% additional contribution), the minimum contribution is € 184.31. This also applies if you have no income.

Family insurance

According to § 10 SGB ​​V, the uninsured spouses, life partners and children of members of a health insurance company living in Germany can be family insured free of charge.

Family insurance is ruled out if the family member is self-employed or exempt from insurance under Section 6 SGB ​​V or if he has a regular monthly total income that exceeds one seventh of the reference figure (2019: 445 euros). With a mini job , the income can be up to 450 euros.

Children or stepchildren, grandchildren and foster children treated as equivalent according to Section 10 (4) of the Social Code Book V can be covered by family insurance up to the age of 18. The age limit is at the completion of the 23rd year of life if the child is not gainfully employed, at the completion of the 25th year of life if the child is a pupil or student. There is no age limit for disabled children whose disability coincided with family insurance.

Children are not covered by family insurance if the member's spouse or partner, who is related to the children, is not a member of a health insurance company and their total monthly income regularly exceeds one twelfth of the annual income limit and is regularly higher than the member's total income.

Health insurance after returning from abroad

This article or section needs to be revised: Although the individual record still exists as a membership in the statutory health insurance after returning abroad ( memento of April 18, 2012 in the Internet Archive ), it may no longer be up-to-date. In addition, at least one statement ("Anyone who was insured in the statutory health insurance scheme there in the EU / EEA abroad can join a German health insurance company when they return. There is an option") in this generality is not covered by this individual record.
Please help to improve it , and then remove this flag.

When someone returns to Germany from abroad, special regulations sometimes apply:

  • If insurance is compulsory in Germany (e.g. as an employee or student), you can choose a statutory health insurance provider within 14 days.
  • Anyone who was insured with a health insurance company in Germany before their stay abroad and is not required to be insured in Germany will also return to statutory health insurance. He is insured in the last health insurance company. There is no option.
  • Anyone who was insured with the statutory health insurance scheme in other EU / EEA countries can join a German health insurance company when they return. There is an option.
  • If you have not yet had health insurance in Germany, your professional career will determine the type of insurance: If you were an employee abroad and you had to take out statutory health insurance after returning to Germany. Self-employed people who have not yet been a member of a statutory health insurance must, however, take out private health insurance.
  • Anyone who was previously privately insured in Germany must take out private health insurance again. He has the right to be taken back from his previous private health insurance. It must at least offer him basic tariff insurance.
  • An entitlement insurance in the GKV can be useful if the member has their domicile or habitual residence temporarily outside the EU / EEA countries, then returns to Germany and wants to become a member of a health insurance again. The entitlement to benefits in accordance with Section 16 SGB ​​V is suspended during the entitlement period ; however, the right to return remains. Periods of entitlement insurance are also taken into account in the 9/10 rule for pensioners' health insurance (KVdR).

Uninsured people

According to the Federal Statistical Office, 188,000 German citizens (uninsured self-employed persons not recorded) were without any health insurance in 2003 . The number had thus doubled since 1995. For 2005 an increase to 300,000 uninsured citizens was expected. For 2007 the number was estimated at 400,000. One reason for this is often given as economic pressure, i.e. not taking out health insurance as a cost-saving measure. Until January 1, 2009, there was the group of high-earning, deliberately uninsured. They bore their own risk of illness and saved the costs of administration and redistribution components of a health insurance company or private health insurance. In 2011, according to the Federal Statistical Office, only 137,000 people in Germany were not insured and had no other right to health care. This corresponded to a share of 0.2% of the total population. After the number of uninsured people fell to 79,000 in 2015, it rose by almost 79% to 143,000 by 2019.

financing

Premium income and federal subsidy

Since January 1, 2009, the health insurance funds have been financed in accordance with Section 220 SGB ​​V from allocations from the health fund and other income, which includes the additional contribution made by the individual health insurance company . Borrowing is expressly prohibited. The health fund mainly includes contributions from the main group of working insured persons, employees and their employers .

In addition, in accordance with Section 221 (1) SGB V , the federal government makes a subsidy to the health fund for flat-rate compensation for non-insurance benefits . The grant is currently (2018) 14.5 billion euros.

Assessment and payment of contributions

The contributions are based on the income of the members that are subject to contributions ( § 226 SGB ​​V). Amounts above the income threshold are not taken into account. The payment and assessment of the contributions depends on the type of membership.

Contribution calculation according to groups of insured persons

The calculation of contributions differs depending on the group of insured persons.

Compulsorily insured

Employees subject to compulsory insurance

For employees, the contribution to the gross - wage sized ( § 226 SGB V), if it is not the income threshold exceeds ( § 223 SGB V). What is to be understood by wages is defined in § 14 SGB ​​IV. Early retirement benefits and training allowances are equal to wages (Section 226 SGB V). In the case of employees subject to compulsory insurance, the employer pays half of the contribution (since January 1, 2019, half of the additional contribution for the individual health insurance fund). The other half of the contributions are paid by the employees ( Section 249 (1) SGB V). The employer pays the contribution for employees only, insofar as contributions are to be paid for short-time work benefits (Section 249 (2) SGB V).

For employees who are more than marginally employed for a monthly wage up to the upper limit of the sliding zone (Section 20 (2) SGB IV), separate regulations apply (Section 249 (4) SGB V).

Pensioners subject to compulsory insurance

In addition to the remuneration of employees subject to compulsory insurance, pensions or pension payments are also subject to the obligation to contribute ( Section 226 SGB ​​V) - pension payments insofar as they are achieved due to a restriction of earning capacity or for old-age or surviving dependents' benefits ( Section 229 SGB ​​V).

The contributions are based on the amount of the respective gross pension. For recipients of statutory pensions, the pension insurance and the pensioner each pay half of the contributions. The pensioners alone bear the contributions from foreign pensions ( Section 249 of the Book V of the Social Code).

Marginally employed

The employer of marginal part-time employees has to pay a contribution of 13% of the remuneration of this employment for insured persons who are exempt from insurance or not subject to insurance in this employment. For employees in private households, the employer has to pay a contribution of 5% of the wages for this employment ( Section 249b SGB ​​V).

Voluntarily insured

Voluntarily insured persons generally bear the contribution to statutory health insurance alone ( Section 250 (2) SGB V). If, however, voluntarily insured persons are exempt from insurance simply because they exceed the annual wage limit, they are entitled to a contribution from the employer that corresponds to the employer's contribution to the health insurance of a comparable person with compulsory insurance ( Section 257 (1) SGB V).

Since January 1, 2009, the exact regulations on the amount of contributions have been based on Section 240 SGB ​​V and the contribution procedure principles for self-payers issued by the National Association of Statutory Health Insurance Funds . In principle, all income that serves the general livelihood must be taken into account, i.e. wages, interest, rental income, pensions and other income, for the self-employed also the start-up subsidy above a certain tax exemption. If the spouse is not insured with a statutory health insurance company, their income is also included in the contribution calculation using a special procedure.

Other insured

For participants in benefits for participation in working life, career development or work trials as well as the contributions to be paid due to the receipt of transitional allowance, injury allowance or sickness benefit, the responsible rehabilitation provider ( § 251 SGB ​​V).

For people who are to be enabled to work in youth welfare institutions, as well as for employees in workshops for disabled people or in workshops for the blind and for disabled people who regularly provide a service in institutions, homes or similar institutions that is one fifth of the Performance of a fully employable employee in the same job, the provider of the respective institution bears the contributions alone. For the last two groups mentioned, the contributions are reimbursed by the responsible service providers ( § 250 SGB ​​V).

Contribution rate and additional contribution

Contribution rates in the GKV
Period Contribution rate distribution
average AG ON
1970 08.2% 4.1% each
1975 10.5% 5.25% each
1980 11.4% each 5.7%
1985 11.8% 5.9% each
1990 12.5% 6.25% each
1995 13.2% 6.6% each
2000 13.5% 6.75% each
2001 13.6% 6.8% each
2002 14.0% 7.0% each
2003 14.3% 7.15% each
2004 14.3% 7.15% each
Jan. to Jun. 2005 13.8% 6.9% each
July to December 2005 13.8% 6.45% 7.35%
2006 13.4% 6.25% 7.15%
2007 14.0% 6.55% 7.45%
2008 14.0% 6.55% 7.45%
Period
Uniform contribution rate		 distribution
general reduced AG AN 1
Jan to Jun. 2009 15.5% 14.9% 7.3% 8.2%
Jul. 2009 to 2010 14.9% 14.3% 7.0% 7.9%
2011 to 2014 15.5% 14.9% 7.3% 8.2%
2015 14.6% 14.0% 7.3% 8.2%
2016 14.6% 14.0% 7.3% 8.4%
2017 14.6% 14.0% 7.3% 8.4%
2018 14.6% 14.0% 7.3% 8.3%
since 2019 14.6% 14.0% 7.85% each
1from 2015 including the average additional contribution

The general contribution rate according to § 241 SGB V and the reduced contribution rate according to § 243 SGB V since the enactment of the Health Fund uniformly on January 1, 2009 for all health insurance and paying members. An adjustment can only be made by changing the law to a possibly increasing financial requirement of the health insurance companies.

The reduced contribution rate applies to members who are not entitled to sick pay . The latter does not apply to compulsorily insured pensioners , even if the calculation of contributions is based exclusively on pensions, pension payments and, if applicable, any earned income from self-employment.

Voluntarily insured self-employed persons and those insured through the artists' social insurance fund who voluntarily pay the general contribution rate instead of the reduced rate are entitled to sick pay from the 43rd day of incapacity for work. The non-artists are only offered the general contribution rate within the framework of an optional tariff, which results in a three-year commitment to the health insurance company.

From July 1, 2005 to December 31, 2018, the contribution burden was no longer shared equally between employees and employers. Until 2014, employers had to pay half of the general or reduced contribution rate, which was reduced by 0.9 percentage points, in accordance with Section 249 of the old version of SGB V. In return, well-performing health insurance funds were allowed to distribute allocations from the fund that exceeded their financial requirements in the form of a premium payment to their members from 2009 to 2014. Since 2015, employers have paid half of the member's contributions from wages according to the general or reduced contribution rate in accordance with Section 249 (1) SGB V, new version. The remaining part of the contribution was borne by the employees. The income-related funds individual additional contribution from 2009 to 2014 or the income-related additional contribution since 2015, statutory pensions for recipients and / or pensions wearing only since March 1, 2015, had members alone. Since January 1, 2019, the additional contribution has been financed on an equal footing again.

Both the introduction or increase of an additional contribution and the cancellation of a premium entitle the holder to terminate the contract. Membership then ends at the end of the month after the next month after receipt of termination.

The assessment ceiling up to which the health insurance contribution is levied is EUR 4,537.50 in 2019.

Own contribution

Co-payment

As a rule, the insured have to contribute to some benefits through their own contributions and additional payments ( deductible ). A distinction is made between the following types:

  • For the supply of medicines, bandages and remedies, the additional payment is generally ten percent of the costs, but at least five euros, a maximum of ten euros and in no case more than the cost of the agent.
  • When providing dental prostheses , the person with statutory health insurance has to bear an own contribution of an average of 35% to 50% of the costs of standard care , as well as the additional costs for similar and different types of care .
  • For medicinal products, the additional payment is ten percent of the costs and ten euros per prescription.
  • In the case of inpatient measures such as hospital treatment and follow-up rehabilitation measures, an insured person has to contribute to the costs with ten euros per calendar day for a maximum of 28 calendar days per year. In the latter case, the additional payments for previous hospital treatment are taken into account.
  • Rehabilitation measures that do not constitute follow-up rehabilitation in terms of the concept are subject to an additional payment of ten euros per day for their entire duration.
  • In the case of home care, the co-payment is ten percent of the costs plus a fee of ten euros per prescription (for a maximum of 28 days per calendar year).
  • The additional payment of 10 euros per quarter in medical practices ( practice fee ) no longer applies as of December 31, 2012.

Relief in cases of hardship

According to Section 62 of the Book V of the Social Code, the health insurance company must assume the additional payments incurred by the insured person during a calendar year, insofar as they exceed a load limit to be individually determined for the insured person - possibly taking into account his relatives. This amounts to two percent of the gross annual income for living expenses; for chronically ill people who have been receiving continuous treatment for at least one year for the same serious illness, it amounts to one percent of the gross annual income for living expenses.

The costs are only covered upon request. If the application is made early, an exemption from future co-payments for an entire calendar year or for the remainder of a calendar year will be granted under certain circumstances. For those with statutory health insurance, this means that they will never be burdened with more costs than legally expected of them in view of their financial situation.

Social assistance recipients in fully inpatient facilities can take a so-called co-payment loan due to their limited ability to pay and repay it in monthly even installments ( Section 37 (2) SGB XII). For this group of people as well as for recipients of assistance for livelihood or basic security in old age and in the case of reduced earning capacity, only the standard rate of the head of the household according to Section 28 (2) SGB XII is decisive as gross income for livelihood for the entire community of need . In the case of insured persons who receive benefits to secure their livelihood in accordance with SGB II, only the standard benefit according to Section 20 (2) SGB II is decisive as gross income for livelihood for the entire community of needs .

According to § 55 SGB V, people with statutory health insurance are largely exempted from their own contributions for dentures if this would place an unreasonable burden on them. See hardship regulations for dentures .

Deductibles in optional tariffs

According to Section 53, Paragraph 1 of Book V of the Social Code, health insurance companies can provide so-called optional tariffs in their statutes , in which the members can bear part of the costs otherwise to be borne by the health insurance company themselves. As part of the deductible, the insured bear their individual risk of illness themselves, not the community of statutory health insurance insured persons.

expenditure

Rough outline

Note: This is not a complete list!

Activity type Expenses per year
2013 2014 2015 2016 2017
in billions of euros Share 1 in billions of euros Share * 1 in billions of euros Share 1 in billions of euros Share 1 in billions of euros Share 1
Medical treatment 35.96 18.74% 37.50 18.41% 39.09 18.39% 40.723 18.40% 42.641 18.64%
Dental treatment 9.46 4.93% 9.86 4.84% 10.21 4.80% 10.615 4.80% 10,821 4.73%
dentures 3.11 1.62% 3.21 1.58% 3.27 1.54% 3.262 1.47% 3,296 1.44%
drug 32.21 16.79% 35.35 17.36% 37.02 17.41% 38,464 17.38% 39.882 17.43%
Tools 7.20 3.75% 7.86 3.86% 8.0 3.76% 8.269 3.74% 8.523 3.73%
Remedies 5.54 2.89% 5.94 2.92% 6.37 3.00% 6,799 3.07% 7.123 3.11%
Hospital treatment 64.91 33.83% 68.55 33.66% 71.1 33.44% 73.702 33.30% 75.579 33.04%
Sick pay 9.75 5.08% 10.62 5.21% 11.23 5.28% 11.672 5.27% 12.276 5.37%
Travel expenses 4.38 2.28% 4.54 2.23% 4.98 2.34% 5.261 2.38% 5,584 2.44%
Preventive and rehabilitation measures 2.56 1.33% 3.21 1.58% 3.3 1.55% 3.435 1.55% 3.516 1.54%
Vaccinations 1.43 0.75% 1.01 0.50% 1.11 0.52% 1.116 0.50% 1.125 0.49%
Pregnancy / maternity
(without statutory delivery ) 		1.15 0.60% 1.21 0.59% 1.26 0.59% 1.330 0.60% 1.395 0.61%
Home care 4.33 2.26% 4.83 2.37% 5.3 2.49% 5.771 2.61% 6.133 2.68%
Net administrative costs 9.88 5.15% 9.97 4.90% 10.35 4.87% 10,924 4.94% 10,877 4.75%
Total 2 191.87 100% 203.66 100% 3 212.59 100% 3 221,343 100% 3 228.771 100%

Notes:
1 This is the proportion of the costs in the total amount listed here.
2 The sum listed here is only made up of the expenses shown here.
3 Rounding results in differences.

Development until 2040

A study by the Institute for Health and Social Research (IGES) on behalf of the non-profit Bertelsmann Foundation predicts that statutory health insurance expenditure will rise to around 426 billion euros in 2040. With a constant contribution rate of 15.5 percent and income of 377 billion euros in 2040, this would result in a deficit of up to 50 billion euros. A contribution rate covering expenses would have to be 16.9 percent in 2040. According to the researchers, this increase is less due to the aging of the population than to the development of the amount and price of available medical services. Systemic factors that cannot be directly influenced by health policy have been shown to have the greatest influence on the financing of statutory health insurance. This includes, for example, the development of wages. In order to mitigate the forecast increase in contribution rates, the authors of the study recommend two central measures: on the one hand, a cost-containment policy and, on the other, a higher tax subsidy from the federal government.

psychotherapy

Every year around 900 million euros are distributed to psychological psychotherapists via the statutory KV system . In the reference, however, there is no indication of the amount of money distributed to the medical psychotherapists. The above-mentioned contribution to the costs of mental illnesses was criticized from various sides due to the misinformation and misinterpretations presented.

In Germany, psychotherapy is used by a considerable number of the 27,000 licensed psychologists and 23,000 specialists and general practitioners with further training in psychotherapy. The 250 German university professorships in the “P” subjects cost around 60 million euros a year. Inpatient psychiatry costs four billion euros - which also includes a lot of psychotherapy , 0.5 billion euros for inpatient medical rehabilitation , 0.2 billion euros for psychosomatic hospital treatment, 0.5 billion euros for outpatient psychiatric treatment and about 1, 5 billion guideline psychotherapy, together around six billion euros.

administrative expenses

Administrative costs in health insurance
GKV PKV
year Total
expenditure		 administrative
expenses		 proportion of per member year Total
expenditure		 administrative
expenses		 proportion of
2004 € 140.2 billion € 8.1 billion 5.8% € 160.28 2004 € 32.2 billion € 3.1 billion 9.6%
2005 € 143.8 billion € 8.2 billion 5.7% € 161.84 2005 € 37.4 billion € 3.1 billion 8.3%
2006 € 143.8 billion € 8.2 billion 5.7% € 161.78 2006 € 35.6 billion € 3.2 billion 9.0%
2007 € 153.9 billion € 8.2 billion 5.3% € 161.21 2007 € 36.9 billion € 3.2 billion 8.7%
2008 € 160.9 billion € 8.3 billion 5.2% € 117.94 2008 € 36.8 billion € 3.3 billion 9.0%
2009 € 170.8 billion € 8.9 billion 5.5% € 127.24 2009 € 39.4 billion € 3.5 billion 8.9%
2010 € 176.5 billion € 9.5 billion 5.4% € 136.24 2010 € 43.0 billion € 3.5 billion 8.1%
2011 € 179.6 billion 9.4 billion euros 5.2% € 135.57 2011 € 43.1 billion € 3.6 billion 8.4%
2012 € 184.2 billion € 9.7 billion 5.3% € 138.66 2012 € 44.2 billion € 3.5 billion 7.9%
2013 € 194.5 billion € 9.9 billion 5.1% € 142.17 2013 € 46.0 billion € 3.3 billion 7.2%
2014 € 205.54 billion € 10.01 billion 4.87% € 142.46 2014 € 46.3 billion € 3.2 billion 6.9%
2015 € 213.67 billion € 10.43 billion 4.88% € 147.47 2015 € 48.7 billion € 3.2 billion 6.6%
2016 € 222.73 billion € 10.98 billion 4.93% € 153.78 2016

In 2003 it was stipulated by law that the administrative costs of the individual health insurance funds may not increase compared to 2002.

The proportion of administrative costs in relation to health expenditure by statutory health insurers in Germany fell by 0.9 percentage points from 2004 to 2016. Of the total expenditure of the statutory health insurance in 2015 of 213.7 billion euros, 10.4 billion euros (4.9%) are accounted for by administrative costs. In 2004 there were 140.2 billion euros in health expenditure and 8.1 billion euros in administrative costs.

For the private health insurances, the administrative costs were 6.6% in 2015 and 9.6% in 2004.

The administrative expenses of the statutory health insurance funds were distributed as follows in 2008: The personnel costs of around 140,000 employees accounted for 5.3 billion euros, 569 million euros for pensions, supplementary pensions and old-age provision, 545 million euros for contributions to health insurance associations and clubs, 131 Million euros for advertising, 77 million euros for travel expenses, 23 million euros for company cars; The coffers spent 5.7 million euros on staff to combat misconduct in the healthcare system.

According to published figures for 2009, the head of TK received an annual base salary of 271,000 euros, DAK boss Rebscher around 235,000 euros, Barmer boss Fischer around 203,000 euros and the GKV top association board chairwoman Pfeiffer 226,250 euros. KBV CEO Köhler received 260,000 euros in the same period. The old-age pensions are added.

The distribution of administrative costs for 2015 can be found in the 2015 results of the Federal Ministry of Health. From page 14, these are shown in detail as a total and broken down into the individual types of cash register.

In the case of private health insurance companies, the 2015 financial report for private health insurance only breaks down administrative costs into acquisition costs and administrative costs. It is noticeable that the costs for closing expenses are significantly higher than the administrative expenses.

Differences between GKV and PKV

Statutory health insurance has a fundamentally different structure than private health insurance (PKV). Statutory health insurance and private health insurance also differ fundamentally in terms of contributions and benefits.

structure

  • Relevant legal regulations for the GKV result from the fifth book of the Social Security Code (SGB V), for the PKV the insurance contract - and the insurance supervision law (VVG and VAG) are important.
  • The group of people insured is regulated by law in the GKV. A distinction must be made between insurance by law, voluntary insurance and family insurance. In principle, there is a statutory compulsory membership for employees who have a gross income below the annual income limit. Voluntary membership is possible, whereby the maximum contribution must be paid for income above the wage limit. Family members of the members without their own income are insured in the GKV free of charge. In the private health insurance scheme, the persons named in Section 193 (3) VVG are also obliged to be insured. With private health insurance, however, a separate insurance premium is due for each insured person.
  • In contrast to the statutory health insurance, a health check takes place before acceptance into the private health insurance scheme, which can affect the amount of the premium or lead to the rejection of the insurance application.
  • If the individual insurance risk is low, the PKV can offer cheaper tariffs with a higher range of services compared to the GKV. This applies in particular to young insured persons and single people. With increasing age and change in marital status, this benefit can turn into a disadvantage.
  • Switching between the systems is subject to legal restrictions. In order to be able to switch from statutory health insurance to private health insurance, a certain income limit ( annual income limit ) must generally be exceeded. In order to get back into the GKV , there must be an offense according to § 5 SGB ​​V, from which the compulsory insurance in the GKV results, for example the income must have permanently fallen below the annual income limit. For example, those who were previously self-employed have to receive unemployment benefits or start a full-time job. Persons who are 55 years of age or older are barred from access to statutory health insurance according to Section 6 (3a) SGB V if they were not insured in statutory health insurance in the last five years before the occurrence of the insurance and if they or their spouse or registered life partner of which were either exempt from insurance, exempted from compulsory insurance or not subject to compulsory insurance due to a full-time self-employed activity for at least 2.5 years.
  • Lawsuits against a statutory health insurance fund are public-law disputes free of charge and assigned to the social courts (§§ 9, 55 SGG). Prior to this, free objection procedures are prescribed by an objection committee of the respective health insurance company made up of volunteers. Complaints to the Federal Social Security Office or a state supervisory authority are possible. Lawsuits against a private health insurance company are civil litigation. The civil courts are responsible for this (Section 23 GVG). If there are differences of opinion with their company, those insured with private health insurance can contact the neutral ombudsman at the private health insurance company or the Federal Financial Supervisory Authority based in Bonn (BaFin) free of charge .

Contributions

  • At the statutory health insurance scheme, the contributions are based on the wages (wages, salaries, commission, etc.) up to the income threshold . You will be collected in accordance with the tax law principle of assessment based on performance. With private health insurance, the initial premium is calculated according to the personal risk of illness (age, occupation, health status) and the desired scope of insurance. In the GKV, the contributions increase or decrease automatically with the wage up to a maximum of the contribution assessment ceiling (this is usually increased annually) and by the statutory contribution rate. Single people without previous illnesses usually pay more favorable contributions to private health insurance than to statutory health insurance if they are early. However, the contribution often increases with age and can later be well above the contribution of the statutory health insurance, as the Stiftung Warentest 2003 and 2004 determined.
  • In the case of dependent employees, the employer pays a share of the health insurance for the private health insurance, analogous to the statutory health insurance, by paying the employee a private health insurance subsidy free of tax and social security contributions with the payroll. The insured pays the private insurance premium directly to his insurer. For those with statutory health insurance, the employer's share is half of the general contribution rate of 14.6% and, since 2019, half of the additional contribution of the health insurance concerned. In the case of privately insured persons, the employer pays exactly half of the private health insurance contribution, but no more than the same amount as for an insured person in the GKV ( Section 257 (2) SGB V).
  • The self-employed always pay the full contributions alone. Since the contributions that are advertised by the health insurance companies only indicate the portion to be paid by the employee himself (without the employer's contribution), the contributions in the statutory health insurance scheme for self-employed are about twice as high as those given for employees. However, the contributions are not higher for the self-employed, as the division into employee and employer share only hides the actual costs of health insurance in the statutory health insurance.
  • Those who are compulsorily insured and those who are co-insured with their families are free of charge during parental leave. Anyone who has voluntary statutory health insurance or private health insurance must continue to pay contributions during parental leave. Privately insured persons also pay the employer's share, as the employer's allowance does not apply. If you are privately insured and work part-time during parental leave, you are required to take out insurance if your income falls below the compulsory insurance limit, but you may be exempt from compulsory insurance. With a private health insurance entitlement insurance , parents can, before they switch to statutory health insurance during part-time work on parental leave, have the opportunity to re- enter private health insurance later without a new health check, with the retirement provisions and, if applicable, under the same conditions; otherwise the previous private health insurance contract expires.
  • Individuals insured with private health insurance can influence the amount of their contribution by adjusting their benefit entitlements and the amount of any deductible . For GKV-insured persons, the health insurances can offer optional tariffs which provide for annual bonus payments (premiums) or co-payment reductions when assuming a certain deductible.
  • The private health insurance creates a provision for old age in order to alleviate the premium burden that increases with age. The GKV does not have any old-age provisions because it operates according to the pay-as-you-go system .
  • In the event of premium increases, those with statutory health insurance have the option of changing their health insurer quite easily. The contribution amount does not change depending on your income. Privately insured persons can also change the insurance provider. In contrast to statutory health insurance, however, this can be associated with considerable financial disadvantages depending on age and medical history, for example due to surcharges on the contribution or exclusions from previous illnesses. In the case of contracts that were concluded after January 1, 2009, however, the previous insurer will check how much retirement provisions have been set up and will offset these against the new premium (portability of retirement provisions).
  • The media are critical of the fact that private health insurance contributions rise even when income falls and that people would therefore try to “save” themselves back into the solidarity system as soon as things “get financially tight”. This is not based on solidarity and is not always possible. The private health insurance represents a financial risk today in "times in which continuous employment histories are no longer the rule". At the time of the conclusion of the contract, the soundness of the insurance is difficult to assess for the customer.

Services

  • The services of the GKV must be “sufficient, appropriate and economical”. You must not exceed what is necessary. Services that are not necessary or uneconomical cannot be claimed by the insured, the service providers are not allowed to provide them and the health insurance companies are not allowed to approve them ( Section 12 (1) SGB V). Such services can be used as individual health services (IGeL) by the insured on their own account. In the private health insurance, however, the insured event is the “medically necessary treatment”. There is no profitability requirement in private health insurance in this form. However, private insurers are legally obliged to offer certain people insurance at the basic tariff with the mandatory benefits of the statutory health insurance.
  • The services of the GKV as well as the indirect services of the PKV in the standard and basic tariff are in the Social Code Book V (SGB V) and according to §§ 91, 92 SGB V in the guidelines of the Joint Federal Committee (G-BA) and in the statutes of the respective health insurance fixed, in the PKV however by private law contract. The committees of the joint self-administration in the area of ​​statutory health care can limit or expand services in the statutory health insurance and private health insurance basic / standard tariff at any time within the scope of their authorization. In contrast, services agreed in the private law contract apply for the entire term of the contract. So medical innovations are u. It may not be covered by an existing private health insurance contract.
  • In accordance with the benefits in kind principle applicable in the statutory health insurance , the member receives benefits in kind if necessary (outpatient or inpatient medical treatment, medication, etc.). Payment is made through the health insurance companies to the "service providers" (resident doctors, hospitals, pharmacies). The health insurance companies manage the collected contributions to it since 1 January 2009 to the additionally financed with tax revenues Health Fund , which then in turn distributes its funds to the health insurance companies. The service providers are then reimbursed via the statutory health insurance associations . Under certain conditions, those with statutory health insurance can choose to be reimbursed . The PKV always provides its services to the insured according to the cost reimbursement principle and does not receive any subsidies from tax revenues. It provides its benefits solely from the premium income of its insured.
  • In the GKV, the insured must expressly request a patient receipt in order to find out about billing details. In the PKV, the insured receive an invoice from the service provider. The amount will be reimbursed in full or in part by the PKV. Privately insured patients pay bills themselves and can later have the bills reimbursed by the insurer. In certain cases you can also have the service provider settle directly with your insurer; However, this requires an assignment of the insured's benefit claims , which insurers usually only accept in the case of inpatient treatment in a hospital.
  • The reimbursable services of the PKV usually include the remuneration that is chargeable according to the GOÄ and the GOZ . However, the individually agreed insurance contract is decisive. The type and amount of benefits therefore differ both according to the insurer and tariff as well as from the statutory health insurance benefits. The benefits of private health insurance are often higher for non-prescription drugs, visual aids and dentures. Depending on the tariff and the exclusion of benefits, they can also be lower than in the statutory health insurance, for example for psychotherapy, speech therapy , rehabilitation and palliative care. A domestic help is u. U. paid by the statutory health insurance, but not by the private health insurance depending on the tariff.
  • In principle, those insured with private health insurance do not receive any sick pay or allowances for health cures . These benefits can be insured through a daily sickness allowance insurance. In the case of gradual reintegration, the GKV usually continues to pay sick pay; In the PKV, no daily sickness allowance is usually paid in the event of partial incapacity for work.
  • If there is also a claim to benefits from statutory accident insurance or statutory pension insurance, statutory health care or accident insurance, the private health insurance insurer is only liable for expenses that remain necessary despite statutory benefits, without prejudice to the policyholder's claims for daily hospital benefits.
  • In the case of fertility treatment, the PKV applies the polluter pays principle (the polluter's insurance reimburses the total costs), while the GKV applies the body principle (the insurance only reimburses the treatment of its respective policyholder). There is an insurance gap if an ( infertile ) man is legally insured, but his (healthy) partner is privately insured.
  • It is said that statutory health insurance patients are sometimes treated significantly worse than private patients: only one third of all patients (in Germany) had good blood pressure, and that of private patients was significantly better than that of statutory health insurance patients.

See also

literature

  • Martin Albrecht, Wilhelm F. Schräder, Stephanie Sehlen (eds.): Models of an integrated health insurance. Financing effects, distribution effects, implementation. Edition Sigma, Berlin 2006, ISBN 3-8360-8673-5 .
  • Gerhard Bäcker u. a .: Social policy and social situation in Germany. 3rd edition, Volume 2, Westdeutscher Verlag, Wiesbaden 2000, ISBN 3-531-13334-9 .
  • Kay Bourcarde: Social reforms since 1989 - The reform of the statutory health insurance. In: Journal for Growth Studies 1 (2005), pp. 19–27, wachstumsstudien.de (PDF; 394 kB)
  • Mattias G. Fischer: The principle of benefits in kind of the statutory health insurance: origin, functions, future. In: H.-J. Blanke (Ed.), The reform of the welfare state between freedom and solidarity, Mohr Siebeck, Tübingen 2007.
  • Ingrid Füller: Statutory health insurance: the benefits of the health insurance companies - your claims as a patient. Consumer advice center North Rhine-Westphalia, Düsseldorf 2005, ISBN 3-933705-66-5 .
  • Stefan Muckel: Social law. 2nd edition, Verlag C. H. Beck, Munich 2007, ISBN 3-406-52632-2 .
  • Anita Pfaff: Financing alternatives for statutory health insurance. Influencing factors and options for further development , Edition Sigma , Berlin 2006, ISBN 3-8360-8676-X .
  • Raimund Waltermann: Social law. 8th edition, C. F. Müller Verlag, Heidelberg 2009, ISBN 3-8114-8103-7 .
  • Guido W. Weber: Marketing in statutory health insurance - customer loyalty in a regulated competition. Shaker Verlag, Aachen 2012, ISBN 978-3-8440-1098-5 (content and reading sample) .

Web links

Wikisource: Health Insurance  - Sources and Full Texts

Individual evidence

  1. ↑ Cf. § 5 and § 6 SGB V .
  2. ^ Law on the health insurance of workers, RGBl. 1883, 73-104.
  3. ↑ On the emergence of the Health Insurance Act of 1883 and on health insurance in the 19th century, cf. Collection of sources on the history of German social policy from 1867 to 1914 , Department I: From the time when the Reich was founded to the Imperial Social Message (1867–1881), Volume 5: Commercial support funds , edited by Florian Tennstedt and Heidi Winter, Darmstadt 1999; Collection of sources on the history of German social policy from 1867 to 1914, Section II: From the Imperial Social Message to the February Decrees of Wilhelm II (1881–1890), Volume 5: The statutory health insurance and the registered auxiliary funds , edited by Andreas Hänlein, Florian Tennstedt and Heidi Winter, Darmstadt 2009; Collection of sources on the history of German social policy from 1867 to 1914, III. Department: Expansion and differentiation of social policy since the beginning of the New Course (1890–1904), Volume 5, Statutory Health Insurance , edited by Wolfgang Ayaß , Florian Tennstedt and Heidi Winter, Darmstadt 2012.
  4. ^ Michael Stolleis : History of social law in Germany. A floor plan . Lucius & Lucius. Stuttgart. 2003. ISBN 3-8252-2426-0 , p. 78.
  5. ↑ Benefits of the statutory health insurance .
  6. ^ Current reform: debt relief . ( Memento from May 10, 2013 in the Internet Archive ) Allgemeine Ortskrankenkasse # The AOK Federal Association , accessed on April 23, 2010.
  7. ↑ Graphic created on October 21, 2008.
  8. ↑ Information from the Federal Ministry of Health about members and insured persons of the GKV January to December 2016 (PDF file; 810 kB), accessed on January 2, 2017.
  9. ↑ BSG, March 8, 2016, AZ B 1 KR 26/15 R
  10. ↑ Federal Social Court , December 2, 2004, AZ B 12 KR 23/04 R.
  11. ↑ BSG, judgment of June 13, 2007, AZ B 12 KR 19/06 R
  12. ↑ BSG, judgment of September 11, 2018, AZ B 1 KR 10/18 R
  13. ^ Walter Schuhmann , Ludwig Brucker: Social policy in the new state . W. Rink et al. B. Krause, Berlin 1934, p. 356.
  14. ↑ According to the National Association of Health Insurance Funds .
  15. ↑ gkv-spitzenverband.de on January 1st.
  16. ↑ Mergers of statutory health insurance funds 2011 ( Memento from June 1, 2011 in the Internet Archive )
  17. ↑ Health insurance companies have to fill the billion-hole . In: Welt Online . January 18, 2008 ( welt.de [accessed February 4, 2016]).
  18. ↑ Printed matter 283/11. (PDF) Federal Council, May 20, 2011, accessed on February 4, 2016 .
  19. ↑ KK-AltRückV - Ordinance on the formation of retirement provisions by the statutory health insurance companies and their associations. In: www.gesetze-im-internet.de. Retrieved February 4, 2016 .
  20. ↑ Ordinance on the distribution and assertion of liability amounts by the Central Association of Health Insurance Funds in the event of insolvency or closure of a health insurance fund of January 4, 2010 ( Federal Law Gazette I p. 2 ), which is amended by Article 14 of the law of December 22, 2011 ( Federal Law Gazette I p . 2983 ) has been changed.
  21. ↑ Graphic on Sozialpolitik-aktuell.de
  22. ↑ In detail: Krug: In: Social security in agriculture . Issue 3/2007, pp. 203 ff. (PDF) .
  23. ^ TK: Contributions for voluntarily insured persons. TK, 2017, accessed August 25, 2017 .
  24. ^ Federal Ministry of Health, membership in the statutory health insurance after returning abroad.
  25. ↑ Questions and answers on the 9/10 rule. In: New Osnabrück Newspaper. April 18, 2016. Retrieved September 28, 2018 .
  26. ↑ 400,000 without insurance - a doctor's visit a luxury? n-tv.de, July 24, 2007.
  27. ↑ Fewer people without health insurance coverage . ( Memento from August 29, 2014 in the Internet Archive )
  28. ↑ More and more people without health insurance. In: Tagesschau.de. August 14, 2020, accessed on August 14, 2020 .
  29. ↑ More and more people in Germany without health insurance. In: Deutsches Ärzteblatt . August 14, 2020, accessed on August 14, 2020 .
  30. ↑ in the version of the Household Accompanying Act 2013 of December 20, 2012 valid from January 1, 2013 ( Federal Law Gazette I p. 2781 ).
  31. ↑ GKW Spitzenverband: Uniform principles for the assessment of contributions of voluntary members of the statutory health insurance and other member groups as well as for the payment and due dates of the contributions to be paid by members themselves ( contribution procedure principles self-payer ) of October 27, 2008, last changed on November 28, 2018.
  32. ↑ Development of the contribution rates and the assessment limits in the social insurance ( Memento from June 15, 2013 in the Internet Archive ) Statistics Baden-Württemberg
  33. ↑ New version of § 241 SGB ​​V as of January 1, 2011 through Article 1 No. 17 GKV Financing Act of December 22, 2010 ( BGBl. I p. 2309, 2313 ).
  34. ↑ § 242 SGB V in the version valid from January 1, 2015, Article 1 No. 18 GKV-FQWG
  35. ↑ Susanne Plettner: Contract competition in the GKV under competition law aspects Frankfurt (Main): Peter Lang, 2010, ISBN 3-631-60339-8
  36. ↑ Statutory health insurance achieved a surplus in 2013 . In: aok-bv.de . Retrieved November 24, 2017.
  37. ↑ GKV financial result 2014: first minus since 2010 . In: aok-bv.de . Retrieved November 24, 2017.
  38. ↑ GKV financial result 2015: For the second time in a row in the red . In: aok-bv.de . Retrieved November 24, 2017.
  39. ↑ Health insurance companies closed 2016 with a surplus . In: aok-bv.de . Retrieved November 24, 2017.
  40. ↑ 2017 closes with a stable cash position . In: aok-bv.de . Retrieved November 25, 2018.
  41. ^ Gregor Waschinski: Health care: The statutory health insurance companies are threatened with a deficit of 50 billion euros. In: Handelsblatt . October 9, 2019 ( handelsblatt.com [accessed October 10, 2019]).
  42. ↑ Study: Fund deficit increases until 2040. In: Bonner General-Anzeiger . October 9, 2010, p. 6 .
  43. ↑ Richard Ochmann, Martin Albrecht: Future development of statutory health insurance financing . Ed .: Bertelsmann Foundation . Gütersloh 2019 ( bertelsmann-stiftung.de [PDF; accessed on October 10, 2019]).
  44. ↑ Helmut Laschet: Far away from the sick mind . In: Doctors newspaper . July 3, 2008, p. 5 ( online [accessed November 6, 2013]).
  45. ↑ Loew, Psychodynamische Psychotherapie (PDP) 2009; 8:57
  46. ↑ Financial results of the GKV - Federal Ministry of Health . In: www.bundesgesundheitsministerium.de . Retrieved November 24, 2017.
  47. ↑ PKV reports from 1997/98 . In: www.pkv.de . Retrieved November 25, 2017.
  48. ↑ Final calculation results of the statutory health insurance according to the statistics KJ 1 - 2004. (PDF; 1.6 MB) Federal Ministry for Health and Social Security , July 15, 2005, accessed on November 24, 2017 .
  49. ^ The private health insurance figures report 2004/2005. (PDF; 635 kB) Association of Private Health Insurance , October 4, 2005, accessed on November 25, 2017 .
  50. ↑ Final calculation results of the statutory health insurance according to the statistics KJ 1 - 2005. (PDF; 967 kB) Federal Ministry of Health, September 4, 2006, accessed on November 24, 2017 .
  51. ↑ Figures report of the private health insurance 2005/2006. (PDF; 2.0 MB) Association of Private Health Insurance, October 24, 2006, accessed on November 25, 2017 .
  52. ^ Final result of the calculation of the statutory health insurance (2006). (PDF; 967 kB) Federal Ministry of Health, September 4, 2006, accessed on November 24, 2017 .
  53. ↑ Figures report of the private health insurance 2006/2007. (PDF; 1.9 MB) Association of Private Health Insurance, November 5, 2007, accessed on November 25, 2017 .
  54. ↑ Final 2007 results (PDF; 2.1 MB) Federal Ministry of Health, January 6, 2009, accessed on November 24, 2017 .
  55. ↑ Figures report of the private health insurance 2007/2008. (PDF; 2.4 MB) Association of Private Health Insurance, November 6, 2008, accessed on November 25, 2017 .
  56. ↑ Statutory health insurance final invoice results 2008. (PDF; 1 MB) Federal Ministry of Health, July 7, 2009, accessed on November 24, 2017 .
  57. ↑ Figures report from private health insurance 2008/2009. (PDF; 2.7 MB) Association of Private Health Insurance, November 19, 2009, accessed on November 25, 2017 .
  58. ↑ Statutory health insurance final invoice results 2009. (PDF; 284 kB) Federal Ministry of Health, July 16, 2012, accessed on November 24, 2017 .
  59. ↑ Figures report for private health insurance 2009/2010. (PDF; 2.6 MB) Association of Private Health Insurance, November 18, 2010, accessed on November 25, 2017 .
  60. ↑ Statutory health insurance final invoice results 2010. (PDF; 96.96 kB) Federal Ministry of Health, June 30, 2011, accessed on November 24, 2017 .
  61. ↑ Figures report from private health insurance 2010/2011. (PDF; 2.6 MB) Association of Private Health Insurance, November 17, 2011, accessed on November 25, 2017 .
  62. ↑ Statutory health insurance final calculation results 2011 (PDF; 147 kB) Federal Ministry of Health, July 12, 2012, accessed on November 24, 2017 .
  63. ↑ Figures report from private health insurance 2011/2012. (PDF; 3.5 MB) Association of Private Health Insurance, November 17, 2011, accessed on November 25, 2017 .
  64. ↑ Statutory health insurance final calculation results 2012. (PDF; 108 kB) Federal Ministry of Health, June 19, 2013, accessed on November 24, 2017 .
  65. ↑ Numerical report of private health insurance 2012 (PDF; 3 MB) Association of private health insurance, December 2013, accessed on November 25, 2017 .
  66. ↑ Statutory health insurance final invoice results 2013 (PDF; 100 kB) Federal Ministry of Health, June 25, 2014, accessed on November 24, 2017 .
  67. ↑ Figures report for private health insurance 2013 (PDF; 3.4 MB) Association of private health insurance, November 2014, accessed on November 25, 2017 .
  68. ↑ Statutory health insurance final invoice results 2014 (PDF; 87 kB) Federal Ministry of Health, June 23, 2015, accessed on November 24, 2017 .
  69. ↑ Figures report of private health insurance 2014 (PDF; 2.6 MB) Association of private health insurance, November 2015, accessed on November 25, 2017 .
  70. ↑ a b Statutory health insurance final invoice results 2015 (PDF; 1.2 MB) Federal Ministry of Health, June 23, 2016, accessed on November 24, 2017 .
  71. ↑ a b Figures report of private health insurance 2015 (PDF; 3.1 MB) Association of private health insurance, December 2016, accessed on November 25, 2017 .
  72. ↑ Statutory health insurance final invoice results 2016 (PDF; 1.2 MB) Federal Ministry of Health, July 12, 2017, accessed on November 24, 2017 .
  73. ↑ BILD, February 6, 2010, p. 2
  74. ↑ Doctors newspaper, March 10, 2010, p. 6
  75. ^ Stiftung Warentest: Private health insurance: Magic of numbers , in: Finanztest 1/2003
  76. ^ Stiftung Warentest: Private health insurance: Cost trap , in: test 6/2004
  77. ↑ PKV during parental leave - tips on costs and subsidies. Retrieved April 4, 2019 .
  78. ↑ Ursula Rieder: There is no employer's allowance for privately insured persons. In: Finanztip. January 31, 2019, accessed April 4, 2019 .
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  84. ↑ Section 1 (2) of the model conditions for private medical expenses and daily hospital allowance insurance ( MB / KK 2009) on pkv.de (PDF)
  85. ↑ § 6 of the model conditions for private health insurance and daily hospital allowance insurance ( MB / KK 2009) on pkv.de (PDF)
  86. ↑ Quoted from Also cardiologist messes up with hypertension. In: Medical Tribune. January 26, 2007, p. 11.