1. Higher scope of benefits
The benefits in the statutory health insurance (SHI) are regulated by law in SGB V. The benefits must be sufficient, appropriate and economical; they may not exceed what is necessary (§12, para. 1 SGB V).
Insured persons cannot claim services that are uneconomical, the service providers are not allowed to provide them and the health insurance funds are not allowed to approve them.
This is to avoid escalating costs. The efficiency principle applies to all areas of SHI-accredited medical care, including diagnostics and therapy, prescriptions for medicines, early detection measures etc.
In private health insurance, the basis for benefits is medical necessity (§1, para. 2 MB/KK). This means, that the doctor is not primarly bound to choose the cheapest treatment and, for example, that new medicines can be prescribed more quickly, doctors do not have to prescribe the most inexpensive medicine, and appointments with specialists can be made more quickly in many cases.
There is no efficiency requirement as in the public health insurance. The doctor can choose the treatment methods with the highest chances of success for you, even if these are more expensive than alternative, possibly less efficient treatment options.
2. Individual rates
In SHI, about 95% of the benefits are regulated by law. The statutory health insurance funds can offer additional benefits according to their statutes, such as subsidies for professional dental cleaning, non-medical practitioner treatments, etc..
In private health insurance, around 50 companies offer a wide variety of comprehensive plans. From low-cost entry-level rates to high-performance rates, a great variety is possible. The insurance cover can be adapted to personal needs. The price can thus also be influenced by the choice.
3. Autonomy and freedom of choice
The scope of services provided by the statutory health insurance system is restricted by law and is determined by the Joint Federal Committee. This means that not all forms of therapy, doctors and hospitals are accessible to those with public insurance.
In private health insurance, the customer determines the extent to which he or she wishes to receive medical care in the future by choosing the tariff. Depending on the tariff selection, private clinics, for example, may or may not be covered. Specialists can be consulted directly. People with private health insurance have more freedom as to which form of therapy they want to choose and they do not have to be told to go to the nearest hospital.
With private insurers, the chosen plan can be upgraded during the contract period - in some cases even, e.g. after 3 years, without a new medical assessment.
4. Contractually guaranteed benefits
In the past, statutory health insurance benefits have been changed by health reforms. Services that were paid for yesterday are no longer included in the public health insurance catalogue and must now be paid for by the patient. The legislator can change the benefits of the statutory health insurance. SHI clients have no right of intervention and must accept the changes.
In private health insurance, the chosen benefits are contractually guaranteed. The insurer cannot deteriorate the agreed benefits on its own during the term of the contract. However, improvements in benefits that do not lead to rising premiums are permissible. Many private insurers have made use of this option several times in recent years and improved the benefits in a cost-neutral way for the benefit of their customers.
5. Individual provision and independence
In the SHI system, contributions are levied on a pay-as-you-go basis. The income is supposed to cover the expenditure. Young people pay for older people, singles for families and the healthy for the sick. sick. Due to the demographic development, this system has become more and more cracks in recent years. The contributions of the insured alone are no longer sufficient to cover the expenses. The state has to contribute to the system through tax subsidies.
State subsidies have increased sharply in recent years.
In terms of calculation, private health insurance is comparable to life insurance. The premiums include provisions that pre-finance the higher costs in old age. Privately insuraned customers can already make more provisions on their own and pre-finance future premiums through premium relief component, which they can add to their plan. Private health insurance customers take their health care into their own hands and thus relieve the burden on younger generations. Therefore, switching to private health insurance is not an escape from the solidarity system or even lacking in solidarity.
The private health insurance companies do not receive any subsidies from the state. On the contrary: through the taxes paid, the PKV companies thus indirectly participate in the financing of the statutory health insurance scheme.
Don't leave your health insurance decision to chance - take the time to compare and contrast your options. By doing so, you can ensure that you're making the best choice for your needs and circumstances.