For whom the change is worthwhile

Savings with risks

Optional tariffs with health insurance companies: Who are they useful for?

Statutory health insurance companies offer attractive tariffs and repayments of several hundred euros. But is it really worth foregoing visits to the doctor? Who benefits – and where dangers lurk.

“If you have stayed healthy for twelve months, you can look forward to a repayment of a monthly contribution of up to 600 euros in our optional tariff.” A statutory health insurance company (GKV) uses this slogan to advertise its tariff with premium refunds.

In view of constantly increasing health insurance contributions, such offers sound good. But do elective tariffs actually deliver what they promise financially? And what are the health risks? Answers to the most important questions.

Since April 2007, statutory health insurance companies have been allowed to offer optional tariffs. These are voluntary additional contracts that insured people can conclude with their statutory health insurance provider. They can include additional services that go beyond the usual health insurance benefits, or premium refunds if insured persons make little or no use of medical services.

The legislator wanted to give insured people more options for choosing health insurance tariffs and create new incentives for more competition for health insurance companies. Some of the optional tariffs must be offered by all health insurance companies, others are optional, says Peter Grieble, insurance expert at the Baden-Württemberg Consumer Center.

“Here I would particularly mention the family doctor tariffs, because these are already very widespread in some federal states,” says Jan-Marc Hodek, Professor of Finance in the Health Care System at the RWU Ravensburg-Weingarten University. If insured persons take out such a tariff, they undertake to always first consult their family doctor if they have health problems, who will then refer them to a specialist if necessary.

In return for this additional expense, some health insurance companies offer policyholders additional preventive examinations, extended consultation hours in the evening or home visits. “The financial incentive has disappeared with the abolition of the practice fee,” says Sabine Baierl-Johna, health project manager at Stiftung Warentest.

Jan-Marc Hodek points out that there is good scientific research accompanying the family doctor tariffs, which shows that older patients with multiple, often chronic illnesses are better cared for through these tariffs because their treatment is better coordinated. “But you also have to say that general practitioners actively promote these tariffs because they get slightly better remuneration. That’s another reason why they are widespread.”

Sabine Baierl-Johna points out the sick pay tariff for the self-employed, which she thinks can make sense. Here, certain members, such as full-time self-employed people or temporary employees, have the opportunity to secure six weeks of continued payment of wages in the event of illness, which they might otherwise not have. Even those who already suffer from pre-existing illnesses can take out this tariff without a surcharge.