New rules and pitfalls

PKV-insured persons, i.e. persons with private health insurance, will only know in a few years’ time through case law what the government meant with its laws on health reform, says the Association of German Insurance Brokers.
This year, professional organizations announced that the outlook for the private health insurance (PHI) industry was stable. However, experts believe that a market shakeout in the private health insurance industry is likely to be imminent. The health reform may not only make premiums considerably more expensive – it is to be feared that one or the other insurer will have to withdraw from the market. Those who would like to be included in the new basic tariff can be poached – without benefit restrictions and without risk surcharges. Who wants to change from the statutory health insurance to private health insurance, must now be able to show 3 years of income above the assessment limit. Cost trap when switching to private health insurance Only those who switch from one private comprehensive insurance to another in the first half of 2009 will have their ageing provision transferred from the old insurer. This means for policyholders who have a change recommended to them today that this (pro rata) ageing provision at the level of the basic tariff will not be included. The capital that is then missing with the new insurer has the effect of a loss – as an unnecessarily high insurance premium. Insurers and insurance brokers are often equally liable for such damages. Existence danger for private health insurers The danger for the insurers of private health insurers results from the fact that the insured ones can take their age reserves (on the level of the basic tariff) with them – here then money is to flow actually. Some private health insurers have already indicated that they will be well prepared in the first half of 2009 and want to go hunting for all healthy people. These should then be able to be insured with their ageing provision in modern tariffs – not only in the basic tariff. And in these modern tariffs, in return, there is no equalisation in the industry between the good risks that are changed and the bad risks that remain in the old tariffs. The compensation is in fact limited to the basic tariff. Those private health insurance companies that are among the real losers may subsequently raise their premiums substantially – not only because of rising average claims but also because of the decline in cancellations. He has had to accept cancellation losses, must now bear the entire overhead costs with his remaining insureds – in fact, he might as well give up and join Medicator – if no one else wants him. If rating companies (professional organisations) and insurance brokers are unable to answer the question of which companies could be affected and how, it is hardly possible to satisfy the duty of care in the case of private health insurance brokerage. Those insureds who did not save themselves in time by changing insurers might otherwise only be left with the basic tariff with maximum premium guarantee and risk equalisation in the industry. The broker’s liability should then be safe in such cases. A strategic option may be to use the small entitlement (health) or the large entitlement (health and old age) as a broker for his clients. Cancellations and premium increases foreseeable Overall, a double-digit percentage increase in private health insurance premiums is expected. The changer will be oriented towards the lower premium. Insurers cannot avoid giving ordinary notice of termination in the first 6 months of 2009 – those who wish to do so will give ordinary notice of termination in the first 6 months of 2009, with effect from the next ordinary notice of termination at least 3 months in the future, e.g. 31. 12. 2009. By law, it only depends on the fact that he gave notice before 1 July 2009, not on the date on which the notice took effect. The insurance industry will offer new modern rates to be part of the reinsurance business. Insurance broker liability due to gaps in the orientation The age reserves can also be fully credited in the event of a change of tariff with the same insurer: Here, the standard tariff can be a real alternative to the basic tariff, also because of the increasingly broader assessment basis for the statutory health insurance contributions. For the self-employed and tradesmen, there is the possibility of obtaining an attractive combination of statutory pension and statutory plant insurance via foreign countries. Those brokers who are aware of these European rules in a globalised landscape are better placed to avoid liability for advice. Insurer-. Sales and training manager liability Are these facts being deliberately hushed up by everyone today? Brokers and intermediaries would immediately lose their PKVPKV reinsurance business today – until 1. 1. 2009. Business-minded, but unfortunately only half-informed intermediaries will more or less blindly accompany a change from one private health insurer to another before 1. 1. 2009. And in the first half of 2009, when customers do cancel their policies, they also contribute to the loss because they take their ageing provision with them, so it is not available for imputed inheritance. And after 30. 6. 2009 hardly anyone from the old portfolio will change private health insurance companies, because those who wanted to do so did so in the first half of 2009 – after that the ageing provision will no longer be transferred. Only in the case of new insured persons may the age-related provisions be permanently transferred. So there is also an interest on the part of private health insurers in keeping these facts quiet for as long as possible. The customer will be the first to suffer the consequences of this in the form of unnecessarily high premiums if he switches before 1 January 2009 – and a short time later also the intermediary or broker, who will be liable on the grounds of incorrect advice.
Contact Sachverständigenbüro Peter A. Schramm 56355 Diethardt Tel.: 06772 9625 68 Internet: www.pkv-gutachter.de Law firm Dr. Johannes Fiala 80639 Munich Tel.: 089 179090-0 Internet: www.fi ala.de
(campingimpulse 2/2007, 34)
Courtesy ofwww.campingimpulse.de.

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Dr. Johannes Fiala
PhD, MBA, MM

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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