Health insurance companies: staggered discounts are illegal



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Statutory health insurers (GKV) are no longer allowed to give graduated discounts.

(June 22, 2010) Graduated premiums of the statutory health insurance (GKV) are illegal, as decided today by the highest social court. GKV health insurance companies wanted to introduce tiered premiums for their insureds if they made little use of the health insurer's benefits over the course of the year. This offer should no longer take place, as the Federal Social Court (BSG) ruled today. GKV's may only grant discounts only if the insured person has not used any insurance benefits for a whole year. However, this does not include the following services: prevention and education, pregnancy support and services for underage members.

The Daimler Company Health Insurance Fund (BKK Daimler) had planned to change the articles of association and grant a premium if the insured only go to the doctor once or twice a year. This should create a tiered premium. However, the Federal Insurance Office denied the fund the right to create such a regulation. The health insurance company complained against this, but the Federal Insurance Office was granted the right today by the Federal Social Court. A "tiered premium" violates the law. The "all or nothing" principle applies. According to the Kassel judges, premiums may only be granted if the services are not used all year round. (BSG, file number B 1 A 1/09 R). (sb)

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