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Erscheinung:09.07.2024 | Topic Versicherungen Will premiums remain stable tomorrow and beyond?
A BaFin survey has shown that, in the long term, the private health insurance (PHI) system will be able to offer benefits comparable to those of the statutory health insurance (SHI) system at premiums not exceeding the SHI maximum contribution.
By Alexandra Fischer, Martin Künzler, Dr Arne Ogrowsky and Dr Maik Schwarz, BaFin Insurance Supervision
BaFin projected the developments of premiums in the PHI system over the next 50 years and examined various scenarios. Based on realistic assumptions, the results show that, in the long term, the PHI system will be able to offer benefits comparable to those of the SHI system at premiums not exceeding the SHI maximum contribution.
The process of accumulating ageing reserves in order to cushion sharp premium increases in old age is thus proving sustainable. BaFin therefore sees no need at the moment for changes to the statutory requirements.
The PHI standard tariff (see info box “At a glance”), which offers benefits largely comparable to those under the SHI system, was the tariff used as the basis for BaFin’s analysis. An important point to note is that BaFin used averages for its survey. This means that the results should not be understood to apply for individual cases. The premium of a privately insured person always depends on factors such as historical contract data and individual risk.
PHI premiums considerably influenced by medical inflation
BaFin’s projections also highlighted the considerable extent to which PHI premiums are influenced by the rate of medical inflation. Factors contributing to this inflation are not just rising healthcare costs due to medical advancements but also statutory changes.
The study showed that only in exceptional cases would the standard tariff no longer be sustainable, for example if annual medical inflation were to lie at five percent over the next 50 years with no correspondingly sharp increase in the SHI maximum contribution.
A detailed commentary of the BaFin study and relevant background information can be found here. (only available in German).
At a glance:The PHI standard tariff
The standard tariff is a uniform tariff offered throughout the private health insurance sector and was introduced in 1994 with the intention of fulfilling a social protection function. It is aimed primarily at older insured persons who require an affordable tariff for financial reasons. Privately insured persons may only change to the standard tariff within their own health insurance company and provided they meet the necessary preconditions. The spectrum of benefits is aligned with those set out in the SHI’s catalogue of benefits. The individual premiums depend on the age of the insured persons and on how long they have already been privately insured before entering the standard tariff (known as the Vorversicherungszeit). However, the premium is capped at the SHI maximum contribution for singles and at 150 percent of the SHI maximum contribution for married couples.
The German Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) or equivalent association for dentists can be contacted directly for information on which doctors or dentists provide outpatient medical or dental treatment under the conditions of the standard tariff. These associations are there to ensure that persons insured under the standard tariff receive medical treatment in accordance with the medical benefits offered under this tariff.
The standard tariff is only open to persons with private health insurance contracts signed before 1 January 2009 and based on tariffs with gender-dependent premium calculations (known as “Bisextarife”). Persons with private health insurance contracts signed after 1 January 2009 have the possibility to change to the basic tariff.
((Source: Federal Ministry of Health)
