Health reform & health insurance: What will change for everyone who is not compulsorily insured?

If you are not in a legal Health insurance are compulsorily insured, you have, for example as a self-employed person, previously had them ChoiceWhether you want statutory, private or no insurance at all. That changes with the health care reform, because from 2009 there is a general obligation to take out insurance.

Since 2007

It began in April 2007 for those who were formerly legally insured and those who had never been insured before Problem Here: The real problem of the previously uninsured remains unsolved: Anyone who cannot afford the minimum contribution from the health insurance funds is and remains excluded from the community of solidarity and only gets emergency care.

The (then theoretical) compulsory insurance does not help much and only leads to the development of more dept, since the contributions have to be paid retrospectively in the event of an insured event. And: The self-employed outside of special systems such as artists' social insurance must continue to pay the health insurance contribution on their own.

health insurance

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For those who have never had health insurance, 2007 has had to take out health insurance since April. On the question of whether the statutory or private funds are responsible, decides on the basis of the job: self-employed will usually need to insure privately.

Since April 2007, the minimum contribution has been reduced for full-time self-employed people who are insured with statutory health insurance. This applies to everyone who is voluntarily or legally insured there, but not to members of the KSK, who continue to make contributions according to their real Income pay. Since April 2007, a fictitious income of EUR 1837,50 per month can be used to calculate contributions instead of the previously assumed minimum income of EUR 1242,50. The minimum contribution can thus drop from around 260 euros a month to around 180 euros. For other self-employed people (e.g. unemployed self-employed) the minimum contribution is around 120 euros.

The sick pay rate

Are you self-employed and a member of a statutory health insurance? Then there is a good news for you: From the 1. January 2009, the health insurance funds must offer an optional tariff with a claim for health insurance to all those insured who are not yet entitled to it and therefore pay a reduced rate of contribution.

This includes all full-time self-employed workers. In addition, so-called “employed workers”, who are usually employed for a short period of time, sometimes with this, sometimes with that employer. The health fund requires a premium surcharge for the new optional tariff with sickness benefit entitlement.

Standard rate of private funds

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Since July 2007, anyone who is not legally compulsorily insured and wants to join a private insurance scheme has had to be admitted there. And at the standard rate and without a health check and risk surcharges. Those who have already been insured with a private health insurance company and those who have never had health insurance have the right to insure themselves at this rate. The never insured, the dem System are assigned to the statutory health insurance companies must insure themselves there. In addition to the aforementioned, the private health insurers must also provide access to the standard tariff to those already privately insured and (for a limited period of time) to those with voluntary statutory insurance.

Especially for people who are not in the after a bankruptcy Insurance returned and the chronically ill, whom the private health insurers had previously refused to insure, this is an improvement. - However, you have to be able to afford this upgrade first. And: The standard tariff that health insurance companies have to offer to over 55s enjoys such a bad reputation among doctors that they sometimes refuse to pay for the treatment. This is probably why only around 20.000 of the approximately eight million private health insurance policyholders have chosen him so far.

Basic rate of private insurance and compulsory insurance at the latest 2009

Formerly privately insured self-employed, who currently do not have health insurance, have to conclude a contract with a private fund from 2009. Until then, the insurance obligation applies only to those who have never previously been covered by health insurance. The general inclusion of self-employed persons in the system of statutory insurance is not provided for.

From January 1st, 2009, the private health insurers must offer a “basic rate” in which they can also include “worse insurance” without risk surcharges risks” have to record. The scope of services of the basic tariff should correspond to that of the statutory health insurance, the premiums must not exceed the maximum rate of the GKV of around 500 euros per month. In case of need, the basic tariff should be able to be halved. This basic tariff is today's "standard tariff", in a new guise.

To the 1. January 2009 is introduced by the private health insurance a base rate, which replaces the previous standard rate of private insurance. For this, the private funds are legally required.

to contract

The basic tariff contains a range of services that is comparable to that of statutory health insurance (GKV). The amount of the premiums for the basic tariff depends only on the age at entry and the gender of the policyholder, not on their health status. This is one of the most important changes for the insured, because in principle there is private autonomy in Germany. That is, a contractor is not required to enter into a contract with everyone. For example, a department store or an innkeeper does not have to serve everyone. However, there are exceptions prescribed by law, such as the so-called obligation to contract. This is the one required by law mandatory to accept a contract offer. For example, transport companies must in principle transport everyone according to the conditions of the public tariff. Or Deutsche Post AG must provide universal postal services for everyone. Statutory health insurance companies are also subject to the obligation to contract: they are obliged to accept all those who meet the insurance conditions, regardless of who they are Age, state of health or their financial capacity.

As of January 1, 2009, private health insurance, like statutory health insurance, is now subject to a so-called obligation to contract, ie a legal obligation for private insurance companies to accept insured persons. There are no risk exclusions or surcharges for the basic tariff. With the GKV Competition Strengthening Act (GKV-WSG), all people without insurance in the event of illness have the option of returning to the last insurance they belonged to - be it statutory or private health insurance. For this purpose, private health insurance must offer a basic tariff that corresponds to the scope of services provided by statutory health insurance with an obligation to contract at affordable premiums - without risk surcharges and without exclusions. In the future, therefore, private health insurance companies will all have to People who submit an application there for the conclusion of an insurance contract for the basic tariff.

Contributions in the basic rate

In order to ensure the affordability of the basic tariff, its contribution for individuals must not exceed the average maximum contribution in the GKV. The average maximum contribution in the GKV is currently around 500 euros. If the payment of such a contribution triggers a need for help in the sense of social assistance or basic security for job seekers, there are further regulations for surethat those affected are not financially overwhelmed.

Supply in basic tariff

The supply of insured in the basic rate (as well as for insured the industry uniform standard tariff) on the physicians 'and dentists' associations ensured. This means that these insured persons as well as those legally insured have a right to (dental) medical care. For the remuneration of the (dental) medical services, certain maximum rates of the medical fee schedule (GOÄ) and the fee schedule for dentists (GOZ) are laid down. By means of contractual agreements between the PKV Association and the health insurance associations of the Federal Republic of Germany, these requirements may be deviated in whole or in part.

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