The shock for many members of private health insurance (PKV) comes every three to six years. In between there is silence. Then the insurers increase the contributions again mightily. A twenty percent increase or more, that’s what indignant victims report.
With the current increase, the private health insurance association is trying to calm down: On average, the increase for 2022, about which customers have now been informed, is 4.1 percent. And three quarters of the 8.7 million insured are not affected at all. Conversely, this only means that customers in the remaining quarter experience all the steeper increases. Anyway: the average adjustments are tough too. The average increase for 2021 was 8.1 percent and for 2020 2.8 percent. And there are insured persons who are affected by an increase for several years in a row – like an SZ reader from Erding who reported three increases in a row, namely by 25 percent, 21 percent and 19 percent.
Even the insurers do not like the usually usual change from rest periods and blatant increases – but it is due to the law. For years, the industry has been calling for rule changes in order to be able to implement the increases more evenly – in vain. The SPD stonewalled the grand coalition. Maybe something will change under the traffic lights. Because now a prominent consumer advocate has sided with the insurers, at least on this issue.
“Those with private insurance are not second-class citizens,” says the Association of Insureds
“It’s time to do something,” says Axel Kleinlein, spokesman for the board of the Association of Insured Persons (BdV), in a joint interview with Roland Weber, board member of the largest private health insurer Debeka. The association of insured persons also has privately insured members who must be treated sensibly. “But they won’t always,” says Kleinlein. This is not only due to the insurers, but also to the fact that their hands are tied by legal regulations. “Those with private insurance are not second-class citizens, but should be treated just as fairly and cleanly as everyone else,” Kleinlein clarifies.
Debeka board member Weber also sees it this way: There are constant legal adjustments in the health insurance companies, in the private health insurance there are none. “After two legislative periods of standstill, sitting out further reform options for private health insurance is not justifiable in the interests of those with private health insurance.”
The problem is the so-called calculation rule. Insurers are only allowed to adjust premiums if one of the triggering factors takes effect. This is understood to mean a change in mortality or – much more crucially – in insurers’ benefit expenditure. Only when these increase by five percent or ten percent can and must insurers adjust the premiums. But then you also have to take into account all other factors that have an influence on the premium amount. At the moment, this is mainly the low interest rates. Everything together can cause violent rashes.
Kleinlein and Weber are both specially trained actuaries. They know what they’re talking about. They are also concerned with the contributions for older insured persons. “We need a stable premium development, especially in old age,” says Weber. He advocates changing the so-called statutory premium surcharge in private health insurance.
At the beginning of 2000, the Green Health Minister Andrea Fischer introduced a surcharge of ten percent on the premiums calculated by the companies for fully insured persons in private health insurance in order to cushion the premium increases in old age. The insurers hated fishermen fervently – and especially their premium surcharges. But now they are very happy that the bid has been received. Otherwise the prices for older insured persons would be much higher and the political pressure correspondingly stronger.
Those insured with private health insurance must pay the surcharge from the age of 22 and up to the age of 60; from the age of 65, premium increases are compensated for. Certain parts of the investment income must also be set aside for old age.
But because interest rates have been so low for a long time, the funds generated in this way are no longer sufficient to offset the rise in healthcare prices. “That’s why we have to change the structures,” says Weber. His suggestion: “One should increase the contribution surcharge and perhaps start with the contribution relief earlier.” He thinks it makes sense to increase the surcharge from ten to 15 percent. Relief could start with the insured in their mid or late 50s instead of 65.
BdV boss Kleinlein can imagine that, but it is not enough for him. A completely different reform step is more important to him: “Medical inflation must be included in the premium calculation,” he demands. That would lead to fair prices and understandable premium increases.
The PKV should become more customer-friendly in special life situations such as parental leave
Weber also believes that better consideration of medical progress when calculating the premiums is a sensible approach. The Debeka board of directors should not only make friends with this in the industry: Implementation would lead to significantly higher entry premiums, which does not exactly make the sale of the policies easier. In the opinion of Debeka board member Weber, private health insurance must become more customer-friendly in special life situations such as parental leave. In contrast to the GKV, privately insured persons also have to pay their contributions during this period. Weber suggests that father and / or mother can reduce the contribution with the same scope of benefits.
It also renews an old demand from the industry: the legislature should significantly lower the compulsory insurance limit. This is the income from which it is possible for employees to switch from statutory health insurance to private health insurance (civil servants and the self-employed are also allowed to use private health insurance with lower incomes). The value for employees is currently 64,350 euros a year, Weber would rather see 58,000 euros.
In return, the PKV could commit itself to an opening action, as it is also for civil servants. Half a year after reaching the compulsory insurance limit, employees would then have the option of taking out private insurance regardless of their state of health. The private health insurance companies would also have to accept insured persons with previous illnesses or disabilities, but could demand risk surcharges.
“Federal Health Minister Karl Lauterbach knows that he cannot ignore ten percent of the insured if he wants to advance the health system,” says Weber. Of course Weber knows for his part that Lauterbach is an enemy of private health insurance. In Weber’s opinion, the establishment of a consumer advisory council at the private health insurance association could help. Proposals for stabilizing the industry could be discussed there: “Then politicians will find it harder to ignore that.”