Comment: The (correct) tariff change in the PKV

With every premium adjustment in private health insurance the additional benefits are calculated according to the increasing age reached, in line with the statutory calculation guidelines. This is in line with the model of private health insurers, whose premiums at an advanced age can already amount to more than EUR 1,000 per month. One comment.


Tariff change: customers only pay if successful

Some insurance brokers who advise on tariff changes have revealed that their agents or employees successfully advise an average of about four tariff changeovers per month. Permanently employed agents who have fixed customer appointments and allegedly do not acquire customers receive a fixed salary and a performance-related commission. It is not said how many unsuccessful consultations fall on a successful one – but apparently the consulting employee has to sell his performance first.
Good consultants and brokers know all the tariffs of the private health insurance, including those that are called “closed” because they are no longer sold or advertised. The customer could also change to these with the same private health insurance company.


Tariff change brokers often earn better than others

If you calculate an average of 250 euros in contribution savings, and then twelve monthly contributions (MB) as a success commission as savings and remuneration payment, you would have four cases * 12 MB * 250 euros = 12,000 euros monthly income, of which minus profit, room costs, advertising, you can certainly pay 3,000 to 4,000 euros gross monthly to the employees, including success commission, and still achieve about 2,000 euros net profit per employee. For example, with 70 employees at the aggressively advertising tariff change broker, he would then make a monthly profit of 140,000 euros. After this example, the following applies: It still pays off.
Normal insurance brokers achieve this by working up to ten times longer.


High failure rate – demanding customers

However, the consultant only gets an appointment with a “demanding” customer. The failure rate is likely to be relatively high because the customer cannot see from the advertising that and how much he has to pay. There is an increasing number of such providers who advertise aggressively, so that customers have the choice before placing an order. Ultimately, the consultant will have to make an acquisition at the appointment and often fail because the customer is then looking for an alternative, requests an offer from the insurer himself, contacts an insurance consultant or expert, especially if he wants to have the offer from the insurer checked again.


And in the end not deserving

But not only then, for example, the customer is entitled to 250 Euro * 12 premium saving months * 1.19 for VAT. = 3,570 euros too expensive. In the case of an expert or insurance consultant, he or she pays on an hourly basis, depending on the work involved, for example only 450 to 850 euros. Experience shows that tariff change optimizers have often already done the work and in the end earn nothing, because the customer rejects the tariff change – at first – only to implement it much more cheaply perhaps a year later with the help of a consultant or expert working on an hourly basis. Since tariff change optimizers usually provide for a one-year period within which they are entitled to the contingency fee for the tariff change, they do not earn anything in this case.

In addition, there is the advertised transparency offensive of the private health insurance companies as a voluntary commitment in the event of a tariff change, with which the tariff change optimizers are to be expressly curbed from 2016 at the latest.
And yet, even today, private health insurance customers have the option of requesting good advice from the private health insurance company free of charge. Because if the private health insurance is addressed to concrete problems in an appropriate manner, there is a duty to provide advice – as in any other insurance branch (since 01.01.2008, § 6 of the German Insurance Contract Act (VVG)). It makes sense not only to request information from the insurer, but also to expressly request advice in accordance with § 6 VVG on possible tariff changes. On the other hand, the insurer is not obliged to offer a tariff change on its own initiative.


Liability of the insurer for tariff change advice

If this requested advice from the insurer on the tariff change is not complete or later proves to be incorrect, the insurer is expressly liable for this in accordance with § 6 Para. 5 VVG. In one case, for example, the Mainz Regional Court denied the insurer’s liability for failure to provide advice on changing tariffs, which is why the customer switched to another insurer with initially unrecognised disadvantages, essentially only because the customer had requested the advice only shortly before Christmas and had already changed insurers before the end of the year.


by Dr. Johannes Fiala and Dipl.-Math. Peter A. Schramm

by courtesy of (published on 16.06.2015)


Link: change in the-PKV.html

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Dr. Johannes Fiala Dr. Johannes Fiala

Dr. Johannes Fiala has been working for more than 25 years as a lawyer and attorney with his own law firm in Munich. He is intensively involved in real estate, financial law, tax and insurance law. The numerous stages of his professional career enable him to provide his clients with comprehensive advice and to act as a lawyer in the event of disputes.
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