The private health insurance (PKV) is in Germany a kind of the security against disease costs with under private law organized an insurance company. The term stands also for whole of the insurance companies, which offer such an insurance.

Conditions for permission

In the PKV cannot persons insure themselves, for liability to insure in the legal health insurance (GKV) exists (officials, independent ones and self-employed persons as well as employees, whose income lies over the liability to insure border). Since 2003 this value of the contribution assessment limit differs. Freelance active artists and journalist are however insured over the artist social insurance such as employees up to the liability to insure border in the GKV.

Contributions

The PKV raises appropriate insurance premiums, i.e. sex and age-dependent contrary to the legal health insurance the individual risk, in addition, dependent on the state of health with beginning of the insurance. If the applicant has rather easy Vorerkrankungen (e.g. predominance, increased blood pressure), then a risk addition or an achievement exclusion comes into consideration, which aims at the cost process of a group of comparisons. If the applicant has rather heavy or incalculable Vorerkrankungen (existed for no sufficient large group of comparisons), then the request for private health insurance is usually rejected. The income does not have influence on the premium.

The premium contains further contributions, which are saved by the insurer. These legally prescribed so-called aging resetting will related to cover the rising costs due to the old becoming of the insured person. The total contribution of a person is not to rise thus, because it becomes older, but only due to the medical progress and the general cost increase and the degradation of the insuring existence in the same wage group. At present aging resetting cannot become "“carried forward"” the next health insurer in Germany. Resulted from it that there is effectively no competition around inventory customers of a private health insurance, the insurer has thus a monopoly on the insurant. From the monopoly on the insurant and the competition lacking around inventory customers it follows that competition is possible at new customers around insurants only. These are also enlisted by many private health insurance enterprises in relation to the legal health insurance very favorable and in relation to other private health insurances still favorable tariffs. In principle the private insurance protection is more extensive than the achievements of the legal health insurance. The favorableness of such tariffs explains itself thereby:

1. The tariff is freshly presented "“"”, i.e. with an insuring existence of 0.
2. The tariff becomes strongly in certain target groups umworben, so that particularly healthy Versicherte constitute the insuring existence.
3. The contributions those the insured ones to carry out have are calculated after a risk equivalence, it to age, sex and state of health are paid attention.
4. Because of the low contributions resulting from it can be recruited well for the tariff.
5. After some years the costs rise, because the usually recent insuring existence becomes older. The contributions rise. The tariff becomes unattractive thereby for new acquisitions.
6. The insurance company presents another new tariff "“freshly"”. In the future after well-known sample the new tariff is applied, old to the however no more and does not receive as well as no more new acquisitions.
7. Those older and more becoming insured one remain ever more under itself.

Respectable and renowned enterprises do not proceed however in such a way. It is to be made certain thus that one selects an enterprise together with tariff, which already is for decades at the market. In each case there is a legally prescribed "“standard tariff"”, which can change itself at the achievements of the legal health insurance company oriented and into that for the Versicherte, if it is older than 55 years and is insured with a private health insurance enterprise for at least 10 years. For this reason a choice of the insurance company is already important very during filing of an application. Insurance companies of the legal form cooperative insurance company on mutuality are not less susceptibly to such a "“tariff fireworks"” than insurance companies of the legal form corporation, since first disburse their profits only to the insured ones, therefore for the enterprise an advantage from such a "“tariff fireworks"” develop. During filing of an application one should pay attention how often the insurance company presented new tariffs in the past and how many tariffs it at all in the insurance company gives.

According to the statistical principle of the individually risk-fair contribution must be insured contrary to the GKV into the PKV each family member with own contribution. There is no noncontributory family insurance. One must note that in the private health insurance one on one side does not exist alterable civil contract connection of the insurer. In the legal health insurance company against it the legislator can reduce the achievements at will. Contribution increases find then in particular by achievement exclusions (current: Eyeglasses, practice fee, exclusion of prescription-free medicines) instead of. At the same time the Versicherte of the legal health insurance company participates to technical progress (e.g. technical aids). In the PKV are frequently not taken off technical innovations by the contract (contracts partly run 40 to 50 years).

In principle the costs in the health system rise. The PKV is prepared by aging resetting, legal addition, standard tariff and freedom of contract (selection mostly healthy insuring) better in principle for the demographic change than the GKV. As long as however achievements in the smaller measure are limited than with the legal insurance, the contributions rise under the medical progress more steeply. The most important criterion with the choice of a PKV is contribution stability. Because as soon as a serious illness arises, a change is no longer favorable i.d.R., since one must probably pay by far higher costs by the new insurer.

Insurer

A private health insurance can be carried of two enterprise types as insurers:

• Corporation (AG)
• Cooperative insurance company on mutuality (VVaG)

The substantial difference between both enterprise types is that at the corporation the profits flow to the shareholders, at the cooperative insurance company on mutuality flows back the profits against it to the insured ones. Also there is a usually underdeveloped form of participation with the VVaGs over the enterprise. In the year 2003 the VVaGs in Germany had 44,68 % of all contribution revenues, but 50,77 % of all fullinsured.

A list of the most important insurers:

• Alliance AG (before times united)
• Old Oldenburger
• ARAG
• AXA
• Barmenia
• Bavarian official health insurance company
• Bavarian official insurance (BBV)
• Cent RAl
• Concordia
• Continentale
• Dbv Winterthur
• Debeka
• German ring
• DEVK
• DKV
• ENVIVAS
• Global one
• Gothaer (earlier Berlin fused with)
• RESOUNDING ASH health insurance on mutuality
• Hanse Merkur
• HUK Coburg
• Inter
• KarstadtQuelle
• National patient assistance (LKH)
• Agricultural cooperative insurance company (LVM)
• Mannheimer
• Munich association
• Pax (before times FAMILY WELFARE SERVICE)
• Provinzial
• R+V insurance
• South German one (SDK)
• SIGNAL IDUNA
• Union (UKV)
• Universa
• Victoria

Approx. 95 % of all privately insured ones have a contract with these insurers.

Account nature

Ambulatory treatment: Over medical costs after a physician attendance the Versicherte keeps a calculation direct from the treating physician or by an account enterprise assigned by the physician, which he submits and after examination refunded gets afterwards just like prescriptions for medicines when his insurance.

Stationary treatment: With hospitalizations the hospital accounts for usually the costs of the accommodation directly with the PKV, if the patient can submit an insurance card of the health insurance enterprise to the hospital, from which the insured kind of accommodation comes out. Calculations of the physicians however as with the ambulatory treatment are provided, since there is no uniform account system here, which a direct accounting would make possible.

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