Additional contribution for the individual cash register
The additional contribution for individual health insurance providers ( § 242 SGB V 2009–2014) was introduced by the grand coalition with the GKV Competition Strengthening Act in the course of the health reform in Germany in 2007 . In essence, it has two functions: On the one hand, it is intended to provide the health insurance companies with an additional means of compensating for financial bottlenecks. On the other hand, it should promote competition in statutory health insurance and ensure cost awareness.
concept
Health insurance companies that no longer manage with their membership fees and the funds allocated from the health fund can or must cover the missing funds from their insured persons through increased contributions. This so-called additional contribution was until December 31, 2010 according to § 242 SGB V a. F. to 1% of pensionable earnings and the income threshold thus limited to a maximum of 37.50 euros per month. Alternatively, until the end of 2010, the health insurances had the option of demanding additional contributions of up to EUR 8.00 from their members, independent of income, which meant that the aforementioned limit of 1% could be circumvented. Since 2011 there has only been an additional contribution that is independent of income and is no longer directly capped; However, there is a social compensation, see paragraph Social compensation. Well-managed health insurance companies also have the option of paying out surpluses to their members in the form of premiums. Payment of premiums and additional contributions both had to be approved by the Federal Insurance Office.
Special right of termination
If the health insurance company levies an additional contribution for each individual health insurance company, if it increases an additional contribution for an individual health insurance company, or if it reduces or ends a premium payment, members have according to Section 175 (4) and (4a) SGB V a. F. a special right of termination and, with reference to this, can give extraordinary notice up to the first due date of the premium collection, increase, premium reduction or elimination . The health insurance company must point this out to you, otherwise this deadline will be postponed by the delayed period. If a contractually agreed waiver of termination was agreed for a certain membership period through an optional tariff, there was no right to extraordinary termination until December 31, 2010.
Change shaft
For the first time, individual health insurances levied additional contributions from their members in 2009, but the public debate only took greater notice of the additional contributions at the beginning of 2010, after several health insurance companies, some of which had a large number of members, demanded mostly eight euros per month from their members. The term “change wave” quickly came up in the media after various estimates indicate that between 300,000 and 500,000 insured persons made use of their extraordinary right of termination in the first quarter of 2010 alone . The main beneficiaries were health insurances, which excluded additional contributions for 2010. Statistically, it appears that younger policyholders are more likely to make use of their extraordinary right of termination. In 2010, the number of members of the German salaried health insurance (substitute fund) fell by 460,000 to 5.8 million, and in the KKH-Allianz by 190,000 to 1.86 million. Both funds had raised an additional contribution of 8 euros.
Competitive spirit
The additional contributions represent a novelty in the German health system in that they are paid directly by the member to his health insurance company for the first time and are not processed in advance via the payroll of an employer. This means, on the one hand, that the insured become self-payers (debtors) of their health insurance and, on the other hand, that the health insurances must realize this contribution for each individual insured. So if the sum of all contributions was previously collected automatically from a debtor (e.g. the employer or the pension insurance company), today this means that every fund announces the individual additional contribution to each individual insured and also monitor his payment, if necessary also enforce it in the event of non-payment , must, which is naturally associated with costs.
Consumers, so the argument goes, are much more sensitive to the cost development in the healthcare sector than to automated billing processes. However, this only sheds light on the income side of the cash registers. However, the development of costs is more on the expenditure side. Therefore develop z. B. Efforts to ensure that patients receive the bills of their treatments for their knowledge (as is common practice with private patients) and thus learn what specific costs are incurred. It should be noted here that the health system is still based on the principle of solidarity : "Everyone what they need and everyone what they can do".
Additional contributions are generally to be paid by all insured persons in order to generate as many potential participants as possible in the competition between the insurance companies. However, the simple contribution rate of the respective health insurance company would be more transparent and practicable, be it with an employer's share set by the legislator.
Exceptions
The following groups have been exempt from the additional contribution since the 2011 health reform: Unemployment benefit II recipients, recipients of social assistance , military and community service providers , trainees (if earnings are below EUR 325 per month), mini jobbers and people with a disability.
Social compensation
With the GKV Financing Act , social compensation was introduced for the additional contributions (insertion of Section 242b SGB V). The Federal Cabinet approved the relevant ministerial draft of the Federal Ministry of Health on September 22, 2010. The law was passed by the Bundestag on November 12, 2010 and came into force on January 1, 2011.
The basis for calculating the social compensation is the so-called average additional contribution . In the future, the average additional contribution is to be set anew every autumn for the following year by a committee of experts, the appraisal group at the Federal Insurance Office . The difference between the expected costs in the health sector and the corresponding coverage through membership fees of the health insurance companies is calculated. An expected shortfall is passed on to all insured persons and thus results in the average additional contribution per insured person. For the transition year 2011, the additional contribution will be zero.
The social compensation is calculated for each employee as part of the payroll. The employer checks whether the average additional contribution amounts to more than two percent of the income subject to contributions. The actual amount of the additional contribution that the employee's health insurance may collect is insignificant. A calculated difference is offset by reducing the employee's share of the health insurance contribution by the difference. The wages paid are correspondingly higher.
example
Assume that the average additional contribution was set at 35 euros per month. For an employee who receives gross wages of EUR 1500, the employer calculates as follows:
| Average additional contribution | 35 € |
| - Load limit (2% of 1500 euros) | 30 € |
| = Social compensation | 5 € |
| Employee contribution GKV (8.2% of 1500 euros) | 123 € |
| - social compensation | 5 € |
| = AN contribution to GKV after social compensation | 118 € |
criticism
The criticism of the additional contributions is aimed primarily in two directions. On the one hand, it is criticized that the concept only helps in the short term to compensate for structural funding deficits of the health insurance funds, so that a fundamental reform is required. On the other hand, reference is made to social hardship and it is feared that the additional contribution represents a “hidden” entry into the flat rate per capita. Ultimately, it should be mentioned that the so-called social compensation, which is reflected in the income as a percentage, forms a fund-specific contribution rate of the income subject to contributions on balance.
Another point of criticism is the practical implementation of the currently planned social compensation (maximum 2% of the income): The explanatory statement for the law shows that this can easily be implemented by employers and pension funds using the accounting programs that are already in place. However, this overlooks the fact that there are also groups of insured persons who generate additional income from other paying agencies (e.g. multiple employees, recipients of several pensions / benefits, voluntary members, for whom the entire income is part of their livelihood). However, the total income that is subject to contributions must be taken into account, the assessment ceiling must be observed. This in turn means that all those affected should be aware of the respective other income and that it should be regulated in which order the various types of income up to the contribution assessment ceiling would be used so that this is not exceeded in the overall statement from the perspective of the insured.
It is also criticized that the Federal Ministry of Finance is intended to influence the average additional contribution according to the draft law. In the draft it says: "On the basis of the appraisal group, the BMG, in agreement with the BMF, determines the average additional contribution and announces it." It is therefore possible that not only health policy but also financial policy issues are taken into account when determining the average additional contribution .
Footnotes
- ↑ Justifications and process flow for the Statutory Health Insurance Competition Strengthening Act in the DIP
- ↑ More and more customers are changing checkouts . In: Handelsblatt , April 20, 2010.
- ↑ Direct debit authorization motivates you to switch . Zusatzbeitrag.com, April 27, 2010.
- ↑ Additional contributions are to be blamed: Funds alienate members . n-tv.de, January 26, 2011.
- ↑ Coalition Agreement 2005, page 88 (PDF; 634 kB) ( Memento of the original from November 22, 2009 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ As of 2011 no additional contribution for recipients of Hartz IV , zuatzbeitrag.com, 23 May 2010.
- ↑ a b Reasons and process sequence of the statutory health insurance financing law in the DIP
- ↑ The world. The price of health. Guest contribution by Philipp Rösler (FDP) and Hermann Gröhe (CDU), April 11, 2010
- ↑ Inquiry from the Greens. April 6, 2010 (PDF; 100 kB)
- ↑ Entry into flat rate per capita via additional contribution Zusatzbeitrag.com, April 23, 2010.
