Tariff change
The tariff change is the entitlement according to § 204 Insurance Contract Act (VVG) of the insured against his or her private health insurance to change the health insurance tariff . This can be a change to a cheaper or higher quality, but then more expensive tariff, taking into account the previously saved aging reserve . The insurance company may only reserve a health check and risk surcharges when changing to a higher-quality tariff. Motive for the tariff change can be the desire for
- Improved benefits: especially for younger policyholders who want to switch from a low-cost tariff to a fully equipped, more expensive tariff with increased income
- Premium savings: especially for older policyholders who are economically overwhelmed by the increased premiums as a result of improved medical progress or a higher damage rate in the older age groups.
Tariff change
In the case of a tariff change according to § 204 VVG, a distinction must be made between a tariff change without changing the insurer and with a change to another insurer.
Without changing the insurer
Change to a higher-quality tariff
The policyholder can change to a higher-quality, but usually more expensive tariff by taking his / her retirement provision with him. According to Section 204 (1) No. 1 VVG, the insurer can request an exclusion of benefits or an appropriate risk surcharge and a waiting period for the additional service.
Change to a cheaper tariff
According to Section 204 (1) No. 1 VVG, a change to a cheaper tariff, for example by increasing the deductible, deselecting the single room in the hospital, etc. without a new health examination and risk surcharges with the same insurer is always permissible. This is often indicated when the premiums increase. Very few insurers actually comply with the obligation of the insurance company to propose cheaper tariffs to the policyholder at the same time as premium increases that offer a similar scope of benefits.
Basic tariff, emergency tariff
Under certain conditions it is still possible to switch to the basic tariff (see below) and to the emergency tariff (see below).
With a change of insurer
According to Section 205 (1) VVG, a policyholder can terminate the insurance contract at the end of a calendar year with a 3-month notice period. It is then possible to switch to another insurer. Outside of the basic tariff, the new insurer is not obliged to enter into a contract . A (partial) transfer of the aging provision to the new insurer is only possible if the previous health insurance contract was concluded after January 1, 2009. Further details are described in the following section.
Carrying out the aging reserve
Since 2009 , a change in the law has made it possible to keep your aging reserve or take it with you to a new insurer when you change tariffs . The changes that became legally effective in 2009 were necessary because for a large number of policyholders switching to another, mostly cheaper insurance company, due to the loss of the aging reserve, increased premiums enormously in old age. In many cases, a change was not possible for this reason and the policyholders were effectively tied to their insurance company . In order to create a better competitive situation here, the transfer of the aging provision was anchored in law and its exact scope was determined. In the case of so-called old contracts that were concluded before 2009, the policyholder has no legal right to take the aging reserve with him. In the case of old contracts, there is still a form of buffering for the contributions for policyholders: Retirement provisions are not used on a personal basis, but are applied to an entire group of policyholders. For those over 50, the total sum of all retirement provisions is used to cushion the contributions of all policyholders in this class. The effect of the cushioning is thus slightly worsened for the individual policyholder, which leads to increasing insurance premiums with older age despite old-age provisions.
Practice of changing tariffs
Various media reports time and again that insurers are trying to torpedo a tariff change. According to this, quite a few insurers would not pay adequate attention to clearly expressed tariff change requests of their customers , treat them as subordinate or even block them. Another approach is to use unattractive suggestions to dissuade the insured from their plan to change the tariff. These include For example, the option of increasing the deductible in favor of lower monthly premiums or the tactic of only offering policies that are only marginally lower in costs and at the same time with a lower scope of benefits.
As a reaction to the repeated criticism of the action of the insurance companies, the Association of Private Insurance agreed on the “ Guidelines for private health insurance for a transparent and customer-oriented tariff change ” that came into force on January 1, 2016 . In it, the 25 largest private insurance companies in Germany undertake to adopt a more customer-friendly approach with regard to the possibility of changing tariffs within private health insurance. The policyholder's right to change tariffs is recognized and, at the same time, the customer is assured that he will be supported by competent and transparent advice and by showing adequate alternatives to his previous insurance coverage when changing tariffs.
As a result of the legislative resolution of 2009, various companies also positioned themselves on the German market, most of which offer advice and help on changing tariffs within society on a fee basis. Advice on changing private health insurance tariffs is also offered free of charge; the costs for advice are then calculated in accordance with the so-called brokerage practices borne by the private health insurance.
Tariff change options for premium savings
The insured person has the following options.
Change to a cheaper tariff
According to Section 204 (1) No. 1 VVG, a change to a cheaper tariff without a new health check and risk surcharges with the same insurer is always permissible (see above).
Change to the basic tariff
A change to the basic tariff is possible according to §§ 204 Abs. 1 Nr. 1 VVG, 12 Abs. 1b Nr. 4 VAG without a new health check and risk surcharges, especially if the existing insurance was taken out after January 1, 2009 or if the The insured person has reached the age of 55 or is receiving a pension from the GRV. The basic tariff corresponds to the scope of services of the statutory health insurance. The contribution for the basic tariff may not exceed the maximum contribution of the statutory health insurance, in 2015 a maximum of € 639.38 per month in accordance with Section 12 (1c) VAG. If someone becomes in need of social assistance through the payment of this contribution , the contribution is halved for the duration of the need for assistance .
Change to the emergency tariff
A change to the emergency tariff is mandatory for those policyholders who do not pay their insurance premiums despite repeated reminders - Section 193 (6) VVG. The insurance contract is then suspended. The contract will not be suspended or will end if the policyholder is in need of social assistance. As long as the contract is suspended, the policyholder is insured in accordance with Section 193 (7) VVG in the emergency tariff in accordance with Section 12h VAG. The emergency tariff only provides for the reimbursement of costs for the treatment of acute illnesses and pain conditions as well as pregnancy and maternity.
Change to another insurer
According to Section 205 Paragraph 1 VVG, a person insured in private health insurance can terminate the insurance contract at the end of a calendar year with a 3-month notice period. If the previous substitutive health insurance was taken out after January 1, 2009, it is possible to switch to another insurer while (partially) taking the aging provisions with you. Outside of the basic tariff, the new insurer is not obliged to enter into a contract.
Change to statutory health insurance - GKV
A return of those who were previously privately insured to statutory health insurance , especially those who are older, is not desired by either the legislature or the statutory health insurance funds, as this would damage the solidarity community of statutory health insurance providers. For this reason, switching to statutory health insurance is only possible under very limited circumstances. If the policyholder over 54 years of age, there is practically only a return chance when the conditions for a family insurance met according to § 10 SGB V because with a family insurance, the insurance freedom not in accordance with § 6 para. 3 SGB V for 54-year-old people applies. Those younger than 55 years of age return to the GKV if they are again required to be insured as an employee in accordance with Section 5 (1) No. 1 SGB V. This is the case if his salary as a contractor is expected to drop below the mandatory insurance limit for 1 year . In 2015 this amounts to € 54,900.00 annually = € 4575.00 per month. For employees who were already privately insured on December 31, 2002, the compulsory insurance limit is € 48,600.00 per year = € 4050.00 per month. Even those who become unemployed and receive unemployment benefit are , according to Section 5 (1) No. 2 SGB V in compulsorily insured by the GKV, provided that according to § 8 Abs. 1 Nr. 1a SGB V he waives to be exempted from the health insurance obligation.
Pursuant to Section 9 (3) SGB V, young professionals who take up employment in Germany for the first time and whose regular annual wages as blue-collar workers exceed the annual wage limit can voluntarily take out statutory health insurance , even if they were previously covered by private health insurance as a student. "Employment" stands for employment ; However, taking up self-employed or freelance work immediately after completing your studies does not entitle you to voluntarily join the GKV according to Section 9 (3) SGB V. The statutory health insurance company must be notified of joining within three months of commencing employment.
According to Section 9 (1) No. 4 SGB V, severely disabled people also have the option of returning to the GKV under certain conditions .
Self-employed persons can only return to GKV if they give up self-employment and enter into an employment relationship that is subject to compulsory insurance . Even with an income of less than € 405.00 per month, self-employed persons can be re-insured with the GKV via family insurance after giving up self-employment in accordance with Section 10 SGB V
If you are insured with private health insurance and have family insurance for the duration of parental leave, you can secure a right to seamless further insurance in private health insurance after the end of parental leave through entitlement to private health insurance. Depending on the terms of the contract, this can then be carried out without a health check and, if necessary, under the same conditions, including the retirement provisions.
Individual evidence
- ↑ Obstruction of the change of private health insurance tariff SPIEGEL from June 18, 2013
- ↑ jwegner: Association of Private Health Insurance eV: change of tariff guidelines of private health insurance. Retrieved February 10, 2017 .
- ↑ a b c d e f g h i Health insurance - possibility of returning from private to statutory health insurance: Otto Friedrich University Bamberg
- ↑ Thomas Schmitt: The stony way back to health insurance. In: www.handelsblatt.com. February 22, 2012, accessed July 11, 2019 .
- ↑ Exemption from compulsory insurance. In: www.studentische-versicherungen.de. Retrieved July 12, 2019 .
