Government wants to strengthen rights of people insured with private health insurance

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The rights of private insured persons are to be strengthened

As is apparent from a draft law by the Federal Ministry of Justice, the rights of private insured persons (PKV) are to be strengthened in the future. Accordingly, a right to information against the insurer is to be introduced, according to which the insurer is obliged to inform the insured whether the costs for treatment are covered or not. In addition, privately insured people should be given two months to give notice after a premium increase.

Claims for information against insurers Federal Justice Minister Sabine Leutheusser-Schnarrenberger (FDP) wants to strengthen the rights of privately insured persons with the new draft law. They should receive a right to information from their insurer regarding the payment of treatment costs. The insurer is obliged to respond within a maximum of 14 days. In urgent cases, the privately insured person must receive an answer immediately. Treatment costs of at least 3000 euros are required. The insurer's response is binding if it is given on the basis of a medical and cost plan.

When starting treatment, privately insured people often do not know whether their insurance will cover the costs. In theory, you can start therapy on your own account, but many privately insured cannot afford it. In addition, doctors and hospitals usually do not start treatment until the assumption of costs has been clarified, unless it is a matter of life-threatening situations.

Man suffered irreparable damage because insurance took too much time In the past, tragic individual fates have occurred. In one case, an insured person had even suffered irreparable damage because the man's private health insurance took too long to promise to cover the treatment costs. When the Bundestag's Committee on Petitions found out about the case, the Bundestag asked the Ministry of Justice to check whether there was any concrete need for action. The ministry then sent the new draft law to countries and associations on Tuesday and announced that the new law would "increase the transparency in the takeover and regulation of insurance claims".

Assumption of costs must be based on defined criteria. Recently, an insured had brought an action before the Palatinate Higher Regional Court (OLG) Zweibrücken (file number: 1 U 78/11) because private health insurance refused to cover the costs of artificial insemination.

The judges ruled in favor of the plaintiff, thereby stipulating that private health insurance should not be allowed to make arbitrary decisions regarding the assumption of costs. If - as in the current case - no comprehensible, unambiguous criteria for checking the assumption of costs are presented, this uncertainty is at the expense of the insurance company and it has to cover the treatment costs, the OLG Zweibrücken judged. The rights of the private insured are significantly strengthened by this verdict.

Termination possible two months after premium increase In addition to the right to information, the draft law also provides for an extension of the notice period after premium increases. So far, private insured persons had only one month after a premium increase to cancel their private health insurance, but the period has been extended by another month. Accordingly, the termination can take place up to two months after a premium increase.

If a private insurer has opted for the self-pay tariff as the basic tariff, he should be able to cancel the deductible at any time, provided that this tariff does not lead to a reduction in the premium. (ag)

Read on:
Introduction of a new discount tariff in private health insurance
Private health insurance: many don't pay
Complaints about an increase in private health insurance contributions
New PKV tariff for non-payers
Contributor: PKV increases tariffs massively

Image: Ronny Richert /

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