Grace period for late returnees to private health insurance until 31.12.2013

Offer:

Since 1 January 2009, the legislator has introduced compulsory insurance for all. Those who had not taken out insurance must pay premiums in arrears. The first six months’ contributions in full, and one sixth for each monthly contribution thereafter.

This de facto economic discrimination has discouraged many of the uninsured from re-insuring “voluntarily” in accordance with the statutory obligation. In addition, the possibility of insolvency at home or abroad has rarely been used so far to free oneself from the old burdens, due to shame.

For this group of people, however, this hurdle has increased month by month. One-time and only limited until the end of 2013, they can now, according to the will of the legislator, insure themselves privately without any additional payments – and the private health insurance (PKV) must also accept them.

 

Compulsory insurance for a one-off amount of around 600 €

The PKV must also include seriously ill and elderly people at least in the basic tariff – in December 2013 this costs a maximum of €610.31. In addition, there is the contribution to the private compulsory nursing care insurance. The 600 € or more should not deter – because if you do not pay any further contribution to the health insurance after the first one, you automatically get into the emergency tariff for about 100 € per month. There, treatments for acute illnesses are paid for in any case – even without further premium payment. The legal insurance obligation for the health insurance is fulfilled nevertheless. Cancellations of private health insurance due to late payment have been prohibited by law since 2009. It is definitely better than continuing to be uninsured. No one should let the one-time amnesty for previously uninsured and late returnees and cancellation of all accrued penalties for applying before Dec. 31, 2013, pass.

Even if the need for assistance only arises as a result of the obligation to pay contributions and the person subject to compulsory insurance does not continue to pay, full benefits are paid in the event of illness. In addition, the premium in the basic tariff is then reduced to half. If there is still a need for assistance, it is halved again by the state subsidy. There is also the possibility that the whole contribution is financed by the state.

 

Long-term care insurance should be paid

But the nursing care insurance should be paid in any case, if it is not taken over by the state in the case of people in need of help, otherwise there is even the threat of a fine. If the contribution to the long-term care insurance is transferred, this must be explicitly and carefully noted in the “purpose of use” field of the transfer form in order to prevent misunderstandings and subsequent claims.

Another advantage of the emergency tariff for non-payers is that all waiting periods – for example for dental treatment, necessary psychotherapy or pregnancy – are waived, as are the deductibles. Furthermore, there are no risk surcharges and no premium reduction surcharge in old age, so that those who pay the premium of around € 100 per month will still be covered. By paying all arrears – to which monthly interest on arrears and any reminder costs are added – you are returned to the original tariff with full benefits on the first of the month after next.

The amnesty, which expires at the end of 2013, effectively offers debt relief, but this is only available if the application is submitted in good time. This, together with the possibilities offered by the emergency tariff, affects around 150,000 uninsured people and a further 150,000 or so non-payers. The legislator has opened up different options for both groups. For those already insured, the old debts are to a large extent automatically waived – the changeover to the low-cost emergency tariff also takes place retroactively from the time of suspension due to late payment.

For the uninsured, on the other hand, the full back-payment obligations back to 2009 will kick in again in 2014 if they do not take advantage of debt relief by the end of 2013.

Pursuant to Section 193 of the German Insurance Contract Act (VVG), policyholders have a right to be reminded in good time so that, as those already insured under private health insurance, they can be placed on the emergency tariff in good time. Moreover, in many cases the insurer is obliged to provide advice on its own initiative, even if an insurance broker is involved. After all, non-payment of insurance premiums signals an economic emergency and imposes a need for counseling. Whether the insurer has then advised correctly can be checked later by independent experts before compensation is claimed.

In addition to the low costs of around € 100 monthly premium, the emergency tariff of every PKV insurer eliminates risk surcharges, benefit exclusions and deductibles. (§ 12 Insurance Supervision Act (VAG)).

It pays for services for the treatment of acute illnesses and pain conditions, as well as treatment costs for pregnancy and maternity.

In the emergency tariff one can remain, freely after the slogan: “I pay my storm insurance only if a storm has been announced”, thus as long as hardly a doctor’s visit is really pending.

If the emergency tariff ends, the policyholder returns to his previous tariff, usually a comprehensive health insurance. Insurance in the emergency tariff is taken out if the policyholder’s arrears amount to more than one month’s premium. The insurer then initiates its reminder procedure and the policyholder is switched to the emergency tariff. Only when the arrears, including reminder costs and late payment surcharges, have been paid is the way open for a return to the previous PKV tariff. Meanwhile, preventive medical check-ups, things to do with living arrangements, treatments that are only desirable but not acutely necessary, and almost all dental prostheses and remedies are to be paid for by the insured.

For the purpose of optimising premiums through non-payment, every fully insured person can temporarily move to the emergency tariff.

These are legal provisions that every PKV-insured person could strategically exploit for himself completely legally. The remaining insured persons have the disadvantage, because every healthy premium optimiser in the emergency tariff is missing in the original tariff. He may return there to avail himself of expensive treatments, only to leave again after their completion by not paying the far cheaper emergency tariff.

Inevitably, all other insured persons pay this as well. It can only be hoped that such desolidarisation will be limited to those who really can no longer afford to pay their contribution, and that their numbers will not increase too much.

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

by courtesy of

http://www.neinhaus-verlag.de (Issue 50/2013)

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About the author

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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