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Statutory Health Insurance: “Extensive service does not automatically mean higher premiums“
Sabine Baierl-Johna; © Stiftung Warentest
Many patients get the feeling that they have to keep paying more for increasingly worse service. This is why all the commotion over the additionally levied premiums by the statutory health insurance was high in the past and remains so now.
You don’t want to make a mistake when choosing an applicable insurance provider, but which health insurance company is best suited to you? MEDICA.de asked Sabine Baierl-Johna from the Stiftung Warentest (a German consumer reports agency), who collaborated on the most recent benchmark test for health insurance companies in the German magazine Finanztest (Finance Test). We spoke with her about the fact that there are no real winners, which benefits make the most sense and what you should look for when switching providers.
MEDICA.de: Mrs. Baierl-Johna, in the current test you compared 104 health insurance companies, but there was no real winner. Why is that?
Sabine Baierl-Johna: All in all we contacted 120 health insurance companies to be able to conduct a compelling comparison. In our test, we ended up including 104 health insurance companies, which serve over 95 percent of all statutory insured people. In the magazine, we presented the additional benefits, which in part differ greatly and are provided by these companies. The differences exist particularly in service offers and in additional statutory benefits, which exceed the legal requirements. You have to consider though that every insured person is interested in different offers. A family has different needs than a chronically ill person, which is why we did not weigh any of the benefits. We were also not able to assign a quality valuation in the sense of if a benefit is offered by a provider, then this would subsequently make this provider better than another.
MEDICA.de: How did you conduct this test?
Baierl-Johna: We took a look at the service offered and additional benefits of health insurance providers. Subsequently we surveyed the health insurance companies on these benefits. Accepted were only proven offers, which are regulated in the by-laws of the health insurance provider. The collective information is displayed in tabular form in the magazine Finanztest. Here, the reader can discern in what occurrences additional benefits are offered at the health insurance companies.
MEDICA.de: What do you need to look out for when choosing a health insurance company?
Baierl-Johna: Depending on the insured group, different additional benefits are important. That is why in our publication we displayed a type of checklist with references on what could be specifically important for an insured person. For a family for example, it could be interesting to know that there is a medical hotline available which answers questions around the clock. Several health insurance companies also offer additional preventive medical checkups for children. Since those checkups are only covered for a specific age group, they are not important for families with older children anymore. Then you might consider whether another provider might offer a benefit, which is more relevant to your particular life situation.
MEDICA.de: Does a lot of service automatically mean higher premiums?
Baierl-Johna: No. We examined several service criteria: for instance the number of branch offices or whether home visits by a doctor are being offered when a sick person is not able to visit a branch on their own for example. Seven of the reviewed health insurance providers for example offer this service, a medical round-the-clock hotline as well as a service for scheduling medical specialist appointments, yet only three of these providers charge additional premiums. Extensive service does not automatically mean higher premiums.
Many patients are afraid of higher insurance instalments; © SXC
MEDICA.de: Competition between health insurance companies has always been stiff. Wouldn’t it be better to just have a handful of health insurance providers?
Baierl-Johna: Despite many mergers, there are indeed still a large number of health insurance companies out there. This is also due to several company health insurance funds that only opened up to outside insured persons much later. We noticed that while large health insurance providers offer many services and have many service branches, smaller health insurance providers are often strongly represented regionally and where necessary accomplish a lot for their insured people. Competition also means that health insurance providers have to try harder to keep their insured persons, which in turn can be an advantage for the insured.
MEDICA.de: Competitive disadvantages for health insurance providers carrying many senior citizens or sick people are supposed to be settled through the German health funds (=Gesundheitsfonds). Does that pay off?
Baierl-Johna: The health funds are meant to have a counterbalancing effect. As a result, 80 diseases for which additional aid from the health funds is granted to the health insurance companies were specifically defined. These kinds of settlements are based on average expenditures. This means, that if a health insurance company carries many sick people, who are essentially sicker than average, the actual costs can be significantly higher and is not entirely settled by the allocation of health funds.
MEDICA.de: For starters, the additional premium means more money for the health insurance provider. Can patients therefore also expect more service and performance?
Baierl-Johna: Generally the health insurance provider is only allowed to charge an additional premium if expenditures are higher than earnings, i.e. the money for the current care provision is not sufficient. In this case it is actually forced to introduce an additional premium! However, the health insurance provider cannot ponder offering additional services and then specifically request an additional premium for it.
MEDICA.de: What do you need to look for when you switch health insurance providers?
Baierl-Johna: Generally we don’t recommend switching health insurance companies just because the provider charges an additional premium, since it is very likely that due to the health insurance deficit in 2010 or at the latest in 2011, more health insurance companies will follow. A switch is possible, if somebody has been insured by a health insurance company for at least 18 months or if the provider begins to charge an additional premium. In the latter case, extraordinary cancellation terms apply. Additional limitations apply in the case of completed option choices. There are options, which are subject to a triennial period of commitment, for example the option choice ”Deductible“ and the option ”Premium Refund.“ When somebody exercises these options, they cannot cancel, even if the health insurance company charges an additional premium.
This interview was conducted by Simone Ernst and translated by Elena O'Meara.