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BGH Declares Premium Increases Ineffective: Hope for Millions with Private Health Insurance
| Reading time: 4 minutes
Private policyholders benefit from significantly better medical services and treatment by the chief physician. But they often pay for these with horrible increases in premiums.
Quelle: Getty Images
New hope for millions of private policyholders: The Federal Court of Justice (BGH) has declared that the increases in Axa’s contributions are partially ineffective. Many insured people, including those from other health insurers, can now expect reimbursements.
meIn this otherwise gloomy Advent season, there is a glimmer of hope for those with private insurance. On Wednesday, the Federal Court of Justice (BGH) in Karlsruhe declared some of its contribution increases partially ineffective. Therefore, it is highly probable that millions of policyholders are entitled to a part of their contributions.
Specifically, it concerns an Axa client who had sued against the premium increases in the Ecora 1300 rate because the insurer had not given sufficient reasons for it.
An Axa customer of the El-Bonus rate had also filed a lawsuit. However, here too the judges made it clear that the contribution increases up to and including 2016 were not sufficiently justified.
The Karlsruhe judges declared the premium increases in 2014, 2015 and 2016 ineffective.
The sometimes dramatic increases in contributions to private health insurance are a constant thrill. Again and again there were doubts that everything was going well. More recently, some policyholders sued because the trustees reviewing these increases are not independent. Numerous regional courts agreed with them and declared the increases ineffective, but the Federal Court of Justice saw it differently and ended the dispute.
But private health insurers remain vulnerable. In fact, in previous years in particular, they didn’t bother to adequately justify their increases. They were often content with a few sentences. However, in the eyes of the Karlsruhe judges, this is not allowed and the increases are therefore ineffective. The insured recovers the money paid in excess.
“The judgments are the first Supreme Court decisions in which policyholders received reimbursement claims due to ineffective premium adjustments,” says Berlin lawyer Knut Pilz, who represents 1,500 clients suing private health insurance .
“Since Axa Krankenversicherung justified the premium adjustments by standardized accompanying letters with the same content for its policyholders, the lawsuit is of fundamental importance for all Axa policyholders.” Other insurers that have acted similarly in the past are also affected. The sentence here should be transferable to many cases. In this context, the final judgment is likely to be of fundamental importance.
However, the sentence is not a sure success. Any private insured person who wants to obtain their rights has to sue them. It is not yet clear for which years the premium increases are actually ineffective and which rates are affected. If you believe the Axa, the explanations were sometimes different in detail, at least until 2016. Basically:
The further back the premium increases, the greater the chances for consumers. Ten years ago, most providers barely justified premium increases.
The value of the claims depends largely on the individual case. And a reversal also has disadvantages: the insured has to pay back the tax advantage or possibly the employer contribution that he has received in excess, and he also loses the provisions for retirement.
And the premium goes back up immediately after the reversal, and then less cap funds can be used, so it could be much more drastic. Finally, in the Karlsruhe case, 60 percent of the court costs fell on the consumer. Therefore, legal protection insurance is almost mandatory for the plaintiff to really benefit.
In any case, it is not worth pursuing a claim against premium increases that have occurred in the last three years. Insurers have long made improvements here. Axa also says: “We see that our opinion confirmed that our notifications on premium adjustments, which we have been sending since 2017, comply with the formal requirements defined by the BGH. The BGH has also decided that these contribution adjustment letters will remedy the situation. Thanks to the reasons that we have been sending our clients since 2017, they have an effective premium adjustment ”. Axa always calculates premium adjustments carefully and correctly in accordance with clearly defined legal requirements.
Meanwhile, more than 20 expert opinions in other proceedings have confirmed the material correction of the Axa premium adjustments. “Our clients can be sure that they are paying a correctly calculated price for contractually agreed services, both in the past and in the future.”
