As of: April 4, 2024, 11:04 a.m
By: Moritz Maier
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The Federal Court of Justice decides in the interests of insurance. When contributions increase, they no longer have to fully disclose their calculations.
Karlsruhe – The latest ruling by the Federal Court of Justice (BGH) represents a setback for around 8.7 million privately insured people across Germany. With the unwieldy name of the judgment on “limitation measures for premium adjustments”, it will in future be “unprovable for privately insured people whether the insurance company is increasing premiums too much.” This is what a consumer lawyer says, who strongly criticizes the decision from Karlsruhe.
Increases in health insurance contributions for privately insured people: errors can no longer be proven?
Specifically, the BGH ruling is about increasing health insurance contributions. If an insurer increases the contributions for the insured, it is legally obliged to mitigate the increase using its own funds from reserves, so-called limiting measures. If insurers make mistakes in this calculation, customers have previously been able to sue and have the increase ineffective. The BGH has now decided differently. And that in two senses. On the one hand, a premium increase does not automatically become ineffective due to the incorrect calculation; on the other hand, insured persons must themselves prove the errors without being allowed to view the insurance calculation in question.
For lawyer Jan Frederik Strasmann, managing director of the consumer law firm rightmart, the court ruling is “a catastrophe for privately insured people”. If there were reasonable doubts about a premium increase, insured people could previously sue, “and the insurance company usually had to demonstrate that the premium increase was calculated correctly,” Strasmann told
IPPEN.MEDIA
. Now the burden of proof has shifted to the insured. “The absurd thing about it: the insurance company no longer has to show its limitation concept,” criticizes the lawyer.
Increasing health insurance contributions: Even if the calculations are incorrect, there is no option for insured people
The consumer advocate notes that this insurance limitation concept involves highly complex mathematics that is difficult for outsiders to understand without insight. The BGH has now made it more difficult to understand the concept. “In doing so, the court has made it impossible for people to prove whether the insurance company is increasing premiums too much, because even large law firms can hardly understand the calculations without outside insight,” says Strasmann.
The trigger for the judgment was an insured person's lawsuit against premium increases. The man was mostly right in two instances before the BGH in Karlsruhe overruled the Berlin district court and returned the case to the district court with new guidelines. The court announced in its judgment that erroneous contribution increases can now only be made ineffective in the case of “particularly serious violations”. A detailed justification for the decision follows.
Increase in health insurance contributions: Statutory health insurance as the only alternative?
“We all ask ourselves why the court rules this way,” says consumer advocate Strasmann. “It's not about assuming that every premium increase is a false calculation, they aren't. However, there is no longer any possibility for insured persons to check the calculation at all.” For the lawyer, private insurance companies should also be obliged to be more transparent. Instead, insured people now have to rely on the word of the insurance companies “that the premium increase is correct.”
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Strasmann also considers the BGH ruling to be a political signal that some people might consider staying in statutory health insurance in the future. The contributions there are legally fixed at 14.6 percent. Around half of all privately insured people will probably have to prepare for premium increases this year. On average they should increase by seven percent. The lawyer advises those who already have private insurance to keep a close eye on their tariffs. “However, there is still the possibility of optimizing tariffs; if contributions increase, there is a special right to change.”