Substitutive health insurance

(1) Insofar as health insurance can wholly or partly replace the health or long-term care insurance cover provided under the statutory social insurance system (substitutive health insurance), it may, domestically, subject to subsection (3), be conducted only in the manner of life insurance, whereby 1. premiums must be calculated on an actuarial basis using probability tables and other relevant statistical data, in particular having regard to the relevant assumptions on the risk of disability and sickness, mortality, the age and gender dependency of the risk, and the probability of lapse, and having regard to security and other loadings and an actuarial interest rate, 2. the ageing provision must be established under section 341f of the Commercial Code, 3. the insurance contract must exclude the insurance undertaking's ordinary right of termination, in health daily allowance insurance from no later than the fourth year of insurance, and must reserve the right to increase premiums, 4. the policyholder must be granted, in the insurance contract, the right to amend the contract by switching to other tariffs with equivalent insurance cover, with the rights acquired from the term of the contract and the ageing provision being credited, 5. the insurance contract must provide for the portability of the transfer value of the part of the insurance whose benefits correspond to the standard tariff within the meaning of section 152(1), where the policyholder switches to another private health insurance undertaking; this does not apply to contracts concluded before 1 January 2009, and 6. an official information sheet issued by the Federal Institute, explaining the different principles of statutory and private health insurance, must be handed to the prospective policyholder before conclusion of the contract; receipt of the information sheet must be confirmed by the prospective policyholder.
(2) Section 138(2) applies correspondingly to substitutive health insurance. The premiums for new business may not be lower than the premiums that would result, in the existing portfolio, for insured persons of the same age, without taking their ageing provision into account. The second sentence does not apply to a premium difference resulting from the fact that the premiums for new business were calculated on a gender-neutral basis.
(3) Substitutive health insurance with fixed contract terms under section 195(2) and (3) of the Insurance Contract Act, and health daily allowance insurance after the insured person's 65th birthday under section 196 of the Insurance Contract Act, may be calculated without an ageing provision.