2023-08-17 10:49:56
Osteopathy for back pain
Many people want osteopathic treatment. Those with statutory health insurance may receive financial support from their insurance company.
(Foto: DEEPOL by plainpicture)
Dusseldorf, Munich This annual check should be as natural for those with statutory health insurance as a check-up at the dentist: Has my health insurance increased the contribution, has it canceled benefits or even added new ones? In June 2022, more than 73 million people in Germany were insured with one of the 96 statutory health insurance companies. What many insured persons do not know: Switching from one statutory health insurance fund to another has become even easier since 2021. Compulsorily insured persons can now switch health insurers after just twelve months instead of after 18 months as before.
There can be two main reasons for a change: the price – i.e. the contribution rate and programs of the funds that help insured persons to reduce their contribution – and additional services. Although about 96 percent of the health insurance benefits are fixed and therefore the same, the health insurance companies sometimes differ greatly when it comes to the remaining four percent. The annual check of the cash register is therefore worthwhile.
“Many insured people stay with the same fund for years, even decades,” says Sabine Wolter, consultant for health law and the health market at the consumer center in North Rhine-Westphalia. Nevertheless, she advises: “Consumers should regularly check whether their health insurance fund offers services that they consider important for themselves and then consider switching if necessary.”
Extensive wishes of the legally insured
The majority of the services provided by the statutory health insurance companies are determined by the Social Security Code. Decisions such as the end of co-payments for glasses for all insured persons (abolished in 2004) or the abolition of death benefits (abolished in 2003) are not made by the insurance companies, but by the legislature.
This is how additional services remain. The ranking of the Cologne-based data service provider DFSI determines which offers are most frequently requested by the insured. He evaluates which of the 163 possible additional services from Ayurveda to Feldenkrais to dental prophylaxis are given most frequently as an important criterion by users of the internet portal legalekrankenkassen.de. The 30 most requested additional services are taken into account in addition to the amount of the contribution rate.
According to Wolter, consumers are well advised to clearly determine their needs. For people who stand a lot during the day and love vacationing in Germany, it can make sense to get support for laser treatment or radio frequency therapy for varicose veins instead of travel vaccinations. Young people who like to travel the world are more likely to save if they choose the insurance company that covers part or all of the costs for vaccinations against rarer pathogens.
The desire to be treated by a doctor with additional osteopathic training is one of the most frequently requested additional services. Insured persons can save a lot of money here if the insurance company participates or covers the costs. Here, too, it is important to be careful. “Health insurance companies only cover the costs if a licensed doctor with additional training offers this treatment. It therefore always makes sense for the insured to check with the insurance company beforehand whether the costs will be covered, even if they do so in principle,” says Wolter.
On paper, some health insurers offer a whole range of naturopathic treatments – but within the framework of a so-called global budget or health account. This means nothing other than that a fixed budget is available for all naturopathic treatments. Insured persons can then choose from the total number of procedures, but the budget is usually so tight that it is only enough for one treatment. Insured persons, on the other hand, are left with invoices from naturopaths who offer osteopathy if they are subsequently submitted to the health insurance fund.
Limited leeway for statutory health insurance companies when it comes to subsidies
Interested parties should also note that the possible grants are usually capped. The BKK Gildemeister Seidensticker pays three times a year a subsidy of up to 40 euros each for treatment by a doctor who is affiliated with the contract between BKK and DZVhÄ through membership in the German Central Association of Homeopathic Doctors (DZVhÄ).
When it comes to additional services, the health insurance companies have limited scope, and the subsidy that is often advertised is subject to criteria that many insured persons do not meet. In the study period from June 2022 to June 2023, many people were looking for grants for visual aids. However, health insurance companies may only grant this to people who have eye values of less than minus four or more than plus six dioptres. According to the Central Association of Opticians and Optometrists, only about one million of the more than 40 million people who wear glasses in Germany are affected.
On the other hand, almost every person with statutory health insurance is entitled to co-payment or assumption of the costs for professional tooth cleaning, and most health insurance companies in Germany now subsidize this.
In this year’s evaluation, the PZR is the most frequently requested additional service by insured persons. “We can see that demand is increasing compared to the previous year,” says Thomas Lemke from DFSI. The large health insurance companies mainly rely on the co-payment model. Depending on the provider, the amount and frequency of the co-payment differ. The insured person pays the PZR himself and receives the subsidy from his fund after he has paid the bill.
“There are some insurance companies that have framework agreements with the Dent Net merger. The insured can then have the prophylaxis billed directly to certain dentists via the insurance company,” says Lemke. Other health insurers, such as the DAK, pay a fixed subsidy, but have also agreed fixed prices with a network of dentists that are not higher than the subsidy – the insured person therefore has no additional costs in the end.
Cash registers react to pressure
Even the largest GKV in terms of members, the Techniker Krankenkasse, gave in to the PZR after many years of refusal and has been paying a subsidy since October 2022. “The tills react to customer pressure,” says Lemke.
Ranking methodology
That has been investigated
This evaluation examined the extent to which a health insurance company also offers what is requested by the insured. It was not evaluated how useful these offers are from the point of view of the health insurance companies. In order to determine the demand, the detailed search of the comparison portal legalekrankenkassen.de was evaluated from July 2022 to June 2023. In the detailed search of the health insurance portal, you can search for up to 163 different services that a health insurance company can offer outside of the standard services that apply to all health insurance companies. For the test, the range of services offered by 68 public health insurance companies that entered their data in the Kassensuche GmbH database was measured.
The top 30 additional GKV services in demand were used for the selection, which were filtered out by a statistical evaluation of the detailed search queries on the comparison portal legalekrankenkassen.de. Since around 68.5% of all search queries in the portal were pure contribution rate queries, an additional contribution rate was also included, depending on the amount of the contribution value.
This is how the data was evaluated
To calculate the result, the respective service offer was given the value 1 (for an individual service whose budget cannot be restricted by other service offers) or 0.8 (if the respective service shares a common budget with other services and influence each other can) multiplied by the respective frequency of demand and summed up for the top 30 services most in demand.
sample calculation The hkk offers osteopathy with a budget of €160 just for this service. Osteopathy was also selected in 30.75% of all service searches. This gives the hkk 1*0.2748=0.2748 points for this range of services. Mobil Krankenkasse, on the other hand, offers osteopathy as part of a joint budget with other services. This means that if the person insured with Mobil Krankenkasse makes use of this service, fewer euros are left over for other services that burden the same budget. This means that Mobil Krankenkasse only gets 0.8*0.3075=0.246 points for this service.
Calculation of contribution rate The lowest nationwide individual contribution rate (0.90%) gets the best multiplier with 1, the fund with the highest contribution rate 0. Since only one contribution rate query was made in 68.45% of all queries at statutoryekrankenkassen.de, these percentage times the multiplier taken and added to the credit points. Example: TK, individual contribution rate (1.2%), (1.99%-1.2%)/1.09%=0.72, this multiplied by the query frequency of 68.45% gives a point value for TK from 0.493.
He observes that the comparatively small scope of the insurance companies is being used: “Insured persons should calculate this instead of just looking at the contribution rate.”
The highest average contribution for statutory health insurance is currently 807.98 euros. That is 16.2 percent of the so-called contribution assessment limit, which is currently 4987.50 euros. Since the employer pays half of the contribution, only 403.99 euros are deducted from the gross income each month. If you have a higher gross income, you still only pay as much as if you were earning 4987.50 euros.
The maximum savings in relation to the average contribution is 17.46 euros per month with the cheapest health insurance companies – these are currently BKK firmus and BKK Gildemeister Seidensticker. This means that the differences in contributions are often less significant in concrete numbers and could easily be exceeded by the sums that health insurance funds add, for example for health costs. Insured persons who know exactly what they need can not only do something for their health, but also save money.
More: Podcast Handelsblatt Today: Prices, benefits, bonuses: How to find the best statutory health insurance company
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