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Techniker Krankenkasse (TK) has announced in recent days that it plans to distribute its surplus in the form of a rebate to its policyholders. This procedure is now under criticism, however, from other funds such as AOK Nordost. One of the allegations is that Techniker Krankenkasse is benefitting despite many years of systematic failure. It would also be a ‚false signal‘ in the direction of the insured, paying out a kind of reward that would be missing in the system of tomorrow.

The CEO of AOK Nordost, Frank Michalak, complains over the difference in premiums charged by sickness funds with many elderly and sick policyholders. The TK have profited since 2009 from a structural fault in the distribution mechanism of the health funds. This favours funds with predominantly healthy policyholders, whilst those funds with many old and seriously ill members were systematically provided with too few resources for the appropriate provision of care.

Michalak receives support for his claim from another local fund: the board of AOK Bayern calls for „an immediate correction of the calculation basis of the health funds„. What should be paid corresponds precisely to the unjustified payments over the last 3 years that the health fund has paid to TK, claimed AOK Bayern CEO Fritz Schösser. (Quote translated by kon.media)

The background: with the introduction of the health fund at the beginning of 2009, the Risikostrukturausgleich (RSA) has been fundamentally transformed.  Since then, this balance between the statutory health insurance funds has also been based on the medical condition of the insured – or the morbidity.  This so-called Morbi-RSA has placed the 1994 original introduced revenue sharing on a new footing.

This is where the criticism from local funds comes from. They refer to a systematic error in the financial balance between the funds, illustrated by the example of someone who is 30 years old: the fund would receive 104% of service expenditure, yet this ratio falls as age increases, meaning those funds with higher proportions of older people are penalised. For this reason, most large insurance providers have called it „increasingly difficult to finance medical expenses incurred.“ (Quote translated by kon.media)

Meanwhile, another fund has announced to pay premiums: The Hanseatische Krankenkasse (HEK) has achieved a high surplus and wants to return it to its members. All 300,000 members will receive a bonus of EUR 75. Moreover, all those policyholders reported in HEK as contributors as of May 2013 receive the bonus, because the payment will be independent of of duration of their membership. In early July, the HEK had decided to repay their insured the EUR 10 fee paid to dentist practices.

Moving forward, this will at least make health insurance policyholders consider switching, especially when you consider that TK members, if they were to join HEK by April, would experience two bonus payments…