Rates and schemes of private health insurance

Private health insurance providers as well as rates differ. That applies to both countries. However, most of insurances orientate on common standards and rate schemes that partly differ clearly between Germany and the USA.

Germany

It exist private additional insurances that apply to all who are statutorily insured. The field of private health insurance in Germany deals with two different rates, base rate and plain rate.

The base rate was introduced by 1st of January 2009 over the course of the health care reform. The insurant does not have to undergo a medical check. The base rate adheres to the statutory health insurance when it comes to the scope of services and premium. That is the reason why many private insurants consider the base rate as unattractive. The premium of the base rate is more expensive than any other private health insurance rate. In return the insurant only gets the coverage of a statutory insurance.

Most private insurants choose for a plain rate. The insurant can opt for its composition when it comes to hedging demand and funding. In general, the plain rate consists of different building blocks. These obtain of different quality grades, scopes of services respectively. It exist rates for treatments in hospital as well as for outpatient treatments, for dental care, and for loss of earnings or the like. In any case the plain rate contains the contribution to the nursing care insurance and the contribution to age provision (10 percent of the private health insurance contribution).

If an insurant wants to use a plain rate he can opt for a compact rate. He saves money but has to go without different options and extras. The provider normally offers a variety of rates including daily allowances for a stay in hospital or in a cure. A relief rate is sensible: The insurant pays voluntarily more contribution to age provision in order to keep the contribution to the private health insurance in old age as low as possible.

United States

It is not that easy to determine the rate oneself in the USA. If the insurant is covered by his employer he must accept the rate that offers the employer. However, the insurant can take out an additional insurance. Professional groups that are privately insured have free choice.

It exist different rate schemes, such as Fee-For –Service, HMO, PPO, and POS. These schemes are the framework of a “Health Plan” that can be individualised in detail. In any case it is important to read properly the mostly extensive contract in order to determine what is covered and what is not covered by the private health insurance. Statutory provisions virtually do not exist.

Fee-For-Service is a business scheme within the insurance business. Each service is deducted separately. Regardless of the service: medical inspection, test, or surgery.
This scheme means that the patient can freely choose the doctor as well as the hospital. This flexibility leads to the fact that the insurant must pay a higher deductible, higher co-payment respectively.

HMO stands for Health Maintenance Organisation. This scheme obliges the insurant to choose the doctor from a network. In the case of illness the patient directs towards the general practitioner. The GP is familiar with the medical record and therefore he can arrange all necessary checkups and treatments. In the case of emergency the patient can direct towards an emergency admission but must then turn to the GP. If an insurant with a HMO-policy turns to a doctor who is not part of the network, the insurant has to bear the costs which can be excessive in the United States.

PPO stands for Preferred Provider Organisations. POS stands for Point-of-Service-Plans.
Both combine elements of the schemes Fee-for-Service and HMO. PPO and POS schemes offer many options. However, they do not offer freedom of choice as it is the case with the Fee-for-Service scheme. Here, too exists a list of cooperation partners. The list is certainly not that constrained as is the case with the HMO scheme. The PPO scheme has the advantage of not requiring referrals to a consulting physician. The insurant directly turns to a specialist. In order to see the specialist the insurant must pay for the treatment. Afterwards, he tries to get a reimbursement of costs. Mostly, the insurant must absorb some costs.