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After a BGH judgment, many people with private insurance expect to receive refunds. Consumer advocates warn against dubious companies and law firms “offering their help.”
By Angela Göpfert, tagesschau.de
The sometimes dramatic increases in premiums from private health insurers are a constant hassle for many policyholders. The 8.7 million clients of private health insurance (PKV) regularly face increases, which in individual cases can amount to more than 100 euros per month. Some later defend themselves legally.
On Wednesday, the Federal Court of Justice (BHG) declared the increases in Axa’s health insurance contributions partially ineffective (Ref .: IV ZR 294/19 and IV ZR 314/19). If there is insufficient justification for a premium increase, private policyholders are, in principle, entitled to reimbursements, BGH’s lawyers decided.
The Berlin plaintiff’s lawyer, Knut Pilz, talks about a fundamental trial and expects more trials soon, which will recover privately insured premiums.
Insured Association: “Zero Sum Game”
On the other hand, the Insured Association (BdV) views the ruling with much more skepticism, since the Karlsruhe lawyers would not have questioned the adjustment of the premium as such. It is true that policyholders could initially claim the increase in amounts if the reasons for the increase were not fully disclosed.
However, in return, future contributions would rise especially sharply. “For most insured people, this is a zero-sum game at best,” says Axel Kleinlein, spokesman for the BdV board, in a statement.
Greater increase in future contributions?
“It is possible that private insurers can repeat the increases in the long term,” emphasizes Michael Wortberg, an insurance expert at the Rhineland-Palatinate consumer center in Mainz. tagesschau.de.
But that “just won’t happen” with the next increase letter. Ultimately, companies would have to adhere to the legal and now judicial requirements of the premium increase.
“I would be extremely suspicious of that!”
The question of whether it is now worthwhile for private policyholders to sue previous premium increases cannot be broadly answered from an expert point of view. In any case, consumers should not rush to do anything and first try to reverse the increases out of court, Wortberg emphasizes. tagesschau.de.
The Mainz-based insurance expert also warns of so-called “helpers” that will soon appear on the internet and social media or even directly contact consumers and announce that they can get high payouts. “I would be extremely suspicious of that!”
Wortberg gives a catchy example: “Nobody buys a new TV or car just because the salesperson calls them without asking.” In the worst case, hundreds of euros or more could be thrown out the window with no equivalent.
“One-shot” premium increase
But why do private health insurance contributions often rise so dramatically? Whenever costs in the health care system increase significantly – industry experts also speak of “medical inflation” – and exceed a certain threshold value, contributions from private health insurance also increase.
The higher costs of medical advances would be billed to policyholders “retrospectively” in one go, “according to the homepage of the private health insurance association.
Insurers caught in the interest rate trap?
However, contributions to private health insurance also increase if the discount rate changes. This is a very abstract quantity, but the basic idea behind it is simple. Private health insurance companies invest a large part of the insured’s premium income in the capital market. The rate of return they generate is called the discount rate. For decades, the discount rate was 3.5 percent.
However, the current zero interest rate policy of the European Central Bank also poses challenges for private health insurers, as it means that the income from new fixed income investments is significantly lower. As a result, the discount rate at all private health insurance companies was lowered and further reductions are threatened.
The discount rate as an unknown quantity
But if the discount rate falls, contributions increase immediately. The BdV even sees changes in the actuarial interest rate as the main driver of the increase in premiums.
However, according to the BdV, private health insurers can withhold changes in the discount rate even after yesterday’s BGH ruling. This means that premium increases will remain, quite legally, a “black box” for many people with private insurance.
