Which health insurance actually fits

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Consider PKV unisex tariffs when choosing an insurance

Due to the rapid changes in the health insurance system over the past year, many insured people are currently wondering whether the principle is that private or statutory health insurance is more suitable for them. However, gender-specific differences will probably no longer play a role here in the future, because from December 2012 the so-called unisex tariffs will also apply to private health insurance. From then on, the previous differentiation of contributions according to men and women no longer applies.

When choosing health insurance, there are a number of important considerations that can have a significant impact on whether private health insurance (PKV) or statutory health insurance (GKV) is recommended. For example, at a young age, with good health and high incomes, the insured may pay higher premiums in the SHI and receive fewer benefits than in the PKV. Over the entire life course, however, private health insurance can quickly become a cost trap for many insured persons, since contributions tend to increase massively with age. If the insured can no longer pay their PKV contribution, the so-called basic tariff threatens, in which the coverage is usually worse than that of the GKV.

Better benefits in private health insurance
Since a return to statutory health insurance is normally impossible, insured persons should consider switching to private health insurance. The legislature has made the conditions under which insured persons can switch to private health insurance significantly easier, so that the decision is now open to far more people than a year ago. However, such a change is not always the most sensible option for the insured. Because the PKV overall is clearly ahead of the GKV in terms of its benefits, but there are massively increasing contributions in the course of life. As a general rule, those insured by law have the option of taking out additional insurance with private insurers in order to benefit from more comprehensive pension benefits as a member of the SHI. However, these supplementary insurance policies also result in corresponding costs. The private patients put their insurance package together individually, so that it can be adapted to their needs anyway. The level of performance is usually significantly higher than that of the GKV. The basic tariff, which was introduced with the compulsory insurance in 2009 under the then Minister of Health Ulla Schmidt (SPD) in order to guarantee the insurance protection of the privately insured, is the exception here. This tariff is based on the performance requirements of the GKV, but in practice it even lags behind in some places. The basic tariff was set up for all private patients who are unable to cope with the increase in contributions in the private health insurance in the long term, but who cannot return to the statutory health insurance.

Different costs and development of contributions
In terms of costs and the amount of contributions, the advantages are more with private health insurance, especially at a young age, with high income and good health. This is partly due to the fact that the contribution rate in the SHI - according to the principle of solidarity - also increases with increasing income, up to a maximum of almost 600 euros. In the PKV, however, the contributions are not based on income, but on the insurance risk, which can be derived from factors such as the age or health of the insured. The premiums are therefore particularly low in good health at a young age and the change appears accordingly attractive. But with increasing age and individual risk of illness, the premiums in private health insurance also increase. According to media reports, some private health insurance companies increased their premiums by up to 40 percent at the beginning of the year. In the course of their lives, the contributions often reach far higher rates than the GKV's maximum rate of around EUR 600. Since the private insurance companies are well aware of the problem of the massive increase in premiums in old age, some of them offer the possibility to set up retirement provisions in order to keep the contribution rates as constant as possible in old age. In any case, the contributions to the statutory health insurance usually remain relatively constant over the course of life, or in some cases even decrease due to a decline in income. Only changes to the collection of SHI contributions decided by the legislator could possibly cause a significant increase here, but a further adjustment seems out of the question at the moment. Especially since the contribution rate for employees was raised from 14.9 to 15.5 percent last year

Unisex tariffs prevent gender-specific differentiation
The gender of the insured has always been an important aspect when deriving the contribution rates in the private health insurance. However, from December 2012, this criterion will no longer have any influence on the level of private health insurance tariffs. Because of the EU equality guidelines from 2004, so-called unisex tariffs will be introduced from December 21, which no longer allow gender differentiation. The contributions for women will therefore probably decrease slightly, while men will have to pay significantly more from the end of December. This does not apply to contracts that currently already exist or that have been concluded by the key date. A switch to private health insurance could therefore be worth a little bit more for men at the moment, while women should wait until December. So far, women have had to pay higher premiums in private health insurance because they have a statistically higher life expectancy, have to carry out considerably more preventive medical examinations, consult a doctor more often than men in the event of illness and incur considerable costs in the event of pregnancy.

Consider family planning when choosing insurance
An important criterion when choosing the right health insurance is generally individual family planning. Because in the PKV each family member has to be individually insured, while in the GKV there is the possibility of family insurance. If children are also insured, statutory health insurance is usually significantly cheaper than private health insurance due to the free family insurance. Although these offer reduced tariffs for adolescents, the private sector cannot compete with the GKV offer here. Childless families and singles can safely ignore this point of view, but all insured who are planning a family should not neglect the benefits of free family insurance with the GKV.

Different billing of treatment costs
Ultimately, the method of payment also plays an important role in the choice of insurance for many insured persons. Because in private health insurance, patients first have to pay for their required services themselves or receive the invoice for this and then submit it to their health insurance company. While the treatment of the treatment costs incurred by the legally insured is taken over directly by the insurance. The legally insured do not have to make advance payments here, which can bring clear advantages in the event of personal liquidity shortages.

Easier switch to private health insurance
A switch to private health insurance has been possible since the beginning of 2012 for employees with a one-off annual income of EUR 50,850. Students, civil servants, the self-employed and freelancers are generally free to choose their health insurance. However, once you have decided to switch to private health insurance, you can usually no longer go back to statutory health insurance. The choice of insurance is sometimes a decision for life - a thorough weighing of the advantages and disadvantages is therefore imperative. (fp)

Also read:
PKV unisex tariffs hardly cheaper
Switching to the GKV is easier for privately insured people
Complaints about an increase in private health insurance contributions
Health insurance: what will change in 2012

Image: Gerd Altmann / Gerold Meiners / pixelio.de

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