In addition to the statutory elective rates, there are a number of voluntary health insurance rates. A minimum binding period of three years applies to all tariffs which the fund can voluntarily offer. In other words, the insured persons are subject to such a tariff against their health insurance for this period.
When may you change?
The health insurance can be changed before the end of this time only in hardship cases. The premium payments to insured persons are limited in amount. In principle, they may not exceed 20 percent of the contributions contributed by the member in one year, but not more than 600 Euro. This is necessary to prevent abuse - for example, for insured who pay only small contributions.
At the same time, the limitation means that deductible tariffs and tariffs which provide for premium payments for non-use of benefits are only possible to a limited extent. The deductible must therefore be commensurate with the premium reimbursement. Overall, a cap was introduced that prevents premium payments in the accumulation from being disproportionate to the contributions paid.
You can offer the following voluntary tariffs:
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- Deductible rates: Each insured person can also settle a deductible with his / her cash register: the health insurance company grants a more favorable tariff; in return, the insured undertakes to pay a certain amount from his / her own pocket when using health services. In a comparable way, insured persons may choose special tariffs which provide for premium payments in the event of non-use of benefits. For example, you may agree that in the event of an illness, you will pay the first 100 Euro yourself and pay a lower contribution. If you do not get sick, it is cheaper. However, bear the risk yourself.
- Tariffs for non-use of benefits: The member and his family members do not take any benefits from the fund for one year. Also in these tariffs the member receives a premium. This is limited to one twelfth of his annual contribution.
- Tariffs for special therapy directions: So far, the health insurances have not or only very limited the costs for alternative therapies, for example for homeopathic remedies, taken over. Who wants to take such services in the future, can choose a special tariff, if it offers his cash. An additional premium will then be due for this extension of the entitlement to benefits.
- Reimbursement: The cost reimbursement tariff is aimed at legally insured persons who wish to benefit from benefits such as privately insured persons: When claiming, the insured person receives an invoice, which he initially pays himself. The services charged by the doctor or the hospital are - depending on the tariff - calculated at a higher rate than for the statutory health insurance; possible is an 2,3-fold higher fee rate. The insured person will be reimbursed by his health insurance. The scope of reimbursement is contractually agreed in the tariff. This premium is payable in addition to the monthly contribution rate.
Individual sick pay claim
Those with statutory health insurance who are not entitled to sick pay pay a reduced contribution rate. As of January 1, 2009, the health insurance companies must offer these insurance members an optional tariff for sickness benefit, insofar as they lose income from work due to incapacity for work, which also individually determines the beginning of the sickness benefit benefit. That means the members decide independently about their financial security in the event of illness and about the point in time when this should take effect. The self-employed, who often have no interest in sickness benefits, and short-term employees who are not entitled to the six-week continued payment of wages in the event of illness benefit particularly from this regulation.
Beware of the special tariffs
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Experts currently advise against agreeing to differentiated tariffs. The long commitment to new, untested tariffs with simultaneously expected tariff fluctuations speaks against it. These voluntary optional tariffs are particularly attractive for health insurers because they come with a three-year customer retention go hand in hand.. This three-year customer loyalty extends into the phase from which a uniform contribution rate applies nationwide. The calculus of the insurance companies: With the same contribution rates, the willingness of the insured to change could come to a standstill. The Insurance, which manages to retain policyholders in the meantime, should benefit in the long term.
The tariffs are also used primarily to Boyto keep healthy policyholders happy. Most health insurance companies only participate because they fear that they will customers otherwise migrate to a competitor who has the savings models in the program. In addition, many offers are not yet mature: With 250 checkouts and at least as many tariff options, it is almost impossible to keep track of them. Also from the registers themselves Criticism. Anyone who still decides on a special tariff should take a close look: not every tariff suits every insured person. The decision for the wrong model can be expensive. You should therefore seek comprehensive advice from your cash register in advance.
Little equality of opportunity
Another annoyance with the optional tariffs: Although the health insurance companies have to have each of their offers approved by their supervisory authority, there is little evidence of equal opportunities. For example, the general local health insurance companies (AOK) – unlike most of their competitors – are not subordinate to the Federal Insurance Office (BVA), but are supervised by the state authorities. The result: while most health insurance companies charge the Costs of a doctor's visit must be passed on to their customers one-to-one, the AOK may take a different path. With her, the patients do not pay the actual costs, but a flat rate that is below the real prices. This gives the local health insurance funds a competitive advantage over their competitors.
Criticism finally comes from the private health insurance companies: With the election tariffs, the possibility would be created to obtain a state-approved access to the market of supplementary insurance. In the Klartext: The health insurance funds could provide private services as legal entities. Understandably, private health insurance is seen as an unjustified intervention in its functioning market.
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