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The Federal Court of Justice (BGH) specifies the rules of the game for premium increases from private health insurers. For the adjustment to be formally correct and effective, the insurer must indicate the calculation basis, the change of which was decisive, the judges ruled.
Therefore, it must be stated whether a change in insurance benefits or the probability of death is the basis for adjusting insurance premiums. However, according to the ruling, it is not necessary to inform the insured of the amount by which the calculation basis has changed and if other factors also influence.
The Insurance Contract Law (VVG) establishes that the insured person must be informed of the “decisive reasons” for the new determination and the changes. What that exactly means has yet to be clarified.
In the two negotiated cases in Cologne and Berlin, claimants insured with Axa protested against the premium increases because the reasons did not comply with the provisions of the VVG.
The courts of first instance followed the action in one of the processes and ordered Axa to reimburse the difference for certain years of contribution. The BGH now opposed both decisions in part in favor of the insurance company.
Insurers can make up for missing information
The notification obligations served to show the insured “that neither his individual behavior nor a free decision of the insurer were the reason for the increase in the premium.” A plausibility check should not have been possible.
The judges also ruled that insurers can make up for missing information. With a new and effective premium increase, the above omissions are no longer relevant. Once the effective increase takes effect, the insured must pay. For previous increases that may not have been adequately justified, the lawsuits could be successful.
File number IV ZR 294/19 and others
