GKV – compulsory health insurance company and legal fundamental principles

Compulsory health insurance companies are those responsible for compulsory health insurances. These are public corporations. The legislative body decides within the social statute book about the purpose the compulsory health insurance has to fulfill. The members pay a fee and the amount depends on their income. The tasks on the agenda will be financed through this money. The members form a solidarity committee – everyone gets the same benefits, even though the fees paid are different. (the opposite of the insurance principle of the private health insurance!!!)

Different types of health insurances

· Compulsory medical insurance scheme (AOK): regional distribution (e.g. AOK Munich);
· Company health insurance fund (BKK): can be set up when taking certain requirements into consideration (e.g. BKK D. Oetker, Neckermann-BKK, BKK-Hoechst);
· Health insurance of guilds (IKK): can be set up through trade guilds for workshops of their members (IKK-Direkt, IKK gesundplus, IKK Bayern);
· Agricultural health insurances (LKK): can be set up through the health insurance of farmers according to the social statute book (§166 SGB V);
· Miners’ guild health insurance: insurance for employees and workers in mines;
· Sea-health insurance: for sailors, who work under the German flag;
· Private health insurance: In former times the health insurance had to draw up rules about who was able to become a member; this explains the existence of employee- as well as worker health insurances. Nowadays private health insurances are equal to other health insurances (e.g. Barmer)
· Employees’ health insurances: organised within the AEV (workers’ substitute fund) (deutsche Version private Krankenversicherung)

The subject to compulsory insurance is able to choose freely, where he wants to be insured. He/she is binded for 12 months and is then able to terminate the contract by the end of the year with a 3 month period of notice. When choosing a BKK or IKK it is important to check if it is accessible for everyone or only for members of the company or the guild.

The compulsory health insurance is therefore not only a standardized representative, but consists of 8 different health insurances, as mentioned above. They are organised as self-governing bodies with their insured party incl. employer (in case of private health insurances only insurance agents) and act as decision makers in a jointly founded administrative council regarding politics of the health insurance. Equal members of the administrative council are representatives of insured parties as well as employers. There are, however, slight differences:
· In case of private health insurances the administrative council consists exclusively of representatives of insured parties.
· As far as BKKs are concerned, the employer (or his representative) are part of the administrative council.
· Regarding the Federal minors’ guild, there is an assembly of representatives instead of the administrative council.
The tasks of the administrative council include setting up the budget, deciding on the rules (e.g. regarding membership rates) and the control as well as the election of the board. The full-time board will be elected for 6 years and is responsible for the current business of the health insurance.

Subjects to compulsory insurance and entitled subjects to insurance

We differentiate roughly between two groups of insured parties regarding the compulsory health insurance. These are subject to compulsory insurance and voluntarily insured parties. (particularly important are §§ 5 bis 10 SGB V.)

a) Subjects to compulsory insurance: Through law committed to join the solidarity community of the compulsory health insurance. The compulsory health insurance is, like already stated in the name, a compulsory insurance. Part of this group are mainly workers, employees and pensioners but there are exceptions of course. This compulsory insurance is not meant for every person. People, who are not subject to compulsory insurance are free to insure themselves either with a private health insurance or as
b) voluntarily insured parties or entitled subjects to insurance: This group of people consists of workers and employees with an income beyond the margin of compulsory insurance (or the contribution ceiling) (and who were insured with the compulsory health insurance either at least 12 months within the last 5 years or continuously 6 months right before dropping out) or minor employees (see §8 SGB V). (Zahnversicherung in Deutschland)

Under certain circumstances also spouses and children of subjects to compulsory insurances or voluntarily insured parties are….

Social security ceiling = amount of income, which requires compulsory insurance. It is 75% of the contribution ceiling in the legitimate pension scheme. But the margin of compulsory insurance of the compulsory health insurance changes regularly, as it will be renewed annually.

Contribution ceiling = upper limit of the earned income, which determines the premium of the compulsory health insurance.

Contribution ceiling and margin of compulsory insurance are identical within the compulsory health insurance.