Reform of sickness insurance for non-payers and the uninsured

– Advantages of a private health insurance (PKV) with vital transplant –


Experts believe that hundreds of thousands of citizens still do not have health insurance. Above all, the obligation to pay contributions plus – in the GKV – up to 60% interest annually, keeps affected persons from registering with their last insurance company in order to then receive, for example, health insurance in the basic tariff. In future, the late payment surcharge in the GKV is to be only 1% p.m. if one voluntarily registers with the last insurer by the end of the year.

In addition, those who do not pay their private health insurance contributions will have to change to a new non-payment tariff – where they will receive a new insurance cover for EUR 100 per month. exactly what he would receive even if he did not pay contributions, which is essentially acute emergency benefits. For those affected, the targeted private insolvency already offers a possibility of legally freeing themselves from old burdens of the insurance system, in future within three years.


Legal trick of the non-payers in the private health insurance (PKV) ?

A popular but still largely unknown trick for non-payers in private health insurance is to attack premium adjustments as ineffective. This is sometimes reminiscent of the assertion of rent deficiencies and rent reduction in the case of rent nomads. A reminder with wrong – because because of possibly judicially ascertainable alleged ineffectiveness of the premium adjustments too high – premiums by the private health insurer is ineffective. The naming of amounts that are incorrect in terms of content does not trigger the legal consequences of a reminder, as this does not put one in default.

However, the PKV insurer will take the opposite position until a ruling is reached. However, this has the advantage that the person who has nevertheless been pushed into the non-payer tariff for the time being – if after years even one adjustment proves to be ineffective – can submit all unpaid bills and retroactively return to his old tariff. Since the insurer naturally also refrained from notifying further adjustments in the old tariff during the unjustified forced stay in the non-payer tariff, it will also not be allowed to charge these retroactively.


Action for benefits and re-billing of insurance premiums

The policyholder will then wait until the PHI insurer threatens to discontinue benefits – except for emergency benefits – and then request a determination of the
Duty to perform. The policyholder will argue that he was not in default because he had been overcharged for ineffective private health insurance premium adjustment and with a reminder that was not in accordance with the law (with too high premiums).


It is not uncommon for the insurer to then reassert the benefits and consider suing for premium payment, in which case the policyholder also disputes the premium claims on the grounds that the premium adjustments are ineffective. Occasionally, especially when all premium adjustments are contested over a period of years, some individual ones actually turn out to be ineffective, because mistakes do happen, even with insurers.


Compulsory insurance despite insolvency

By the way, you have to take out a health insurance policy even if you know that you cannot pay for it. The compulsory insurance in the statutory or private health insurance does not provide an exception for the case that one cannot afford the contributions at all. In this respect, the similarity with the rent nomad is certainly given,
who, from his point of view, also has to live somewhere, even if he cannot pay the rent, and therefore advances every reason for reduction.


Mass lawsuits against premium adjustments possible

In particular, those in need of private health insurance could increasingly defend themselves against the consequences of late premiums by filing lawsuits. This is an unpleasant thing for private health insurers, especially when citizens take out insurance without ever intending to pay anything. Even with this – and even though they only receive emergency benefits after reminders – they formally fulfil their legal insurance obligation. If you don’t pay 300 EUR, you probably won’t pay 100 EUR in the future emergency tariff – but you will only owe 100 EUR per month.


Privileges of the PKV in the supply with necessary donation organ

In the statutory health insurance (GKV) and in the Eurotransplant affiliated Europe, organ donation candidates are placed on a waiting list with a great chance of being placed on this list.
to die before then. SHI-insured patients are not entitled to transplantation in the USA or Israel, for example, just because they are in constant danger of losing their lives, like everyone else on the waiting list.
However, people with private health insurance already have such a legal entitlement – they do not have to put up with the waiting list and, if their tariff covers costs abroad, as is often the case, these costs are also reimbursed under the tariff for a specific trip abroad for treatment. PKV has real advantages here, which can be life-saving – an alleged preferential treatment of the PKV-insured on transplant waiting lists is therefore not needed at all. And even the GKV-insured has a better chance with it, because the PKV-insured frees his place on the waiting list.


Abroad, there is often no equal treatment or waiting lists, but those who can pay are treated. And there is a legal organized international trade in organs, if only because many countries are technically capable of organ removal but not transplantation. And perfectly legally, in many countries, everyone is a candidate for organ donation – without the possibility to object. In some countries, this also includes convicted criminals, who are allowed to enjoy a life of special health care until the demand-driven postponement of their execution date, as if they were a walking spare parts store on call.


Some “living will” forms contain consent to organ removal – regardless of how far the dying process has progressed or without defining the time of death. Premature organ donors are made, for example, by the general rejection of apparatus medicine, for example the order that hunger and thirst may only be satisfied in a natural way – which is supposed to be particularly torturous in its consequences. Appropriate free forms can help to shorten the remaining life time, which is usually costly for health insurance companies, but also to increase the supply of organs for everyone, according to the motto “Die faster, someone else needs your organ!”.


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


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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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