Standard tariff

(1) Insurance undertakings with their registered office domestically that conduct substitutive health insurance must offer a standard tariff uniform across the industry, whose contractual benefits are, in kind, scope, and amount, comparable to the benefits under Chapter Three of Book Five of the Social Code to which an entitlement exists. The standard tariff must provide, in each case, a variant for 1. children and adolescents; under this variant, no ageing provisions are established until the age of 21, and 2. persons entitled to assistance benefits (Beihilfe) in the event of sickness under civil-service rules or principles, and their eligible dependants; under this variant, the contractual benefits are limited to supplementing the assistance benefits. The insured must be given the opportunity to agree deductibles of 300, 600, 900, or 1,200 euros, and to require a change in the deductible level at the end of the contractually agreed period, subject to three months' notice. The minimum contractual commitment period for contracts with a deductible under the standard tariff is three years; where the agreed deductible does not lead to an appropriate reduction in the premium, the policyholder may at any time require the insurer to convert the contract to the standard tariff without a deductible; the conversion must take place within three months. For persons entitled to assistance benefits, the possible deductibles result from applying the percentage not covered by the assistance rate to the values of 300, 600, 900, or 1,200 euros. The conclusion of supplementary medical expense insurance is permissible.
(2) The insurer is obliged to grant insurance under the standard tariff to the following persons: 1. all persons voluntarily insured under the statutory health insurance scheme, within six months of the beginning of the switching option provided for in Book Five of the Social Code, in connection with their voluntary insurance relationship, 2. all persons resident in Germany who are not subject to compulsory insurance under the statutory health insurance scheme, who do not belong to the group of persons under point 1 or section 193(3), second sentence, points 3 and 4, of the Insurance Contract Act, and who have not already concluded private medical expense insurance with an insurance undertaking authorised to conduct business in Germany that satisfies the obligation under section 193(3) of the Insurance Contract Act, 3. all persons entitled to assistance benefits or having comparable entitlements, insofar as they require supplementary insurance cover to satisfy the obligation under section 193(3), first sentence, of the Insurance Contract Act, and 4. all persons resident in Germany who have concluded private medical expense insurance with an insurance undertaking authorised to conduct business in Germany, and whose contract was concluded after 31 December 2008. Where the private medical expense insurance contract was concluded before 1 January 2009, the conclusion of a contract under the standard tariff with the same or another insurance undertaking, with portability of the ageing provisions under section 204(1) of the Insurance Contract Act, may not be required upon a switch or termination of the contract. The application under the first sentence must be accepted where, in the event of termination of a contract with another insurer, the termination under section 205(1), first sentence, of the Insurance Contract Act has not yet taken effect. The application may be refused only where the applicant was already insured with the insurer and the insurer 1. has avoided the insurance contract on grounds of duress or fraudulent misrepresentation, or 2. has withdrawn from the insurance contract on grounds of an intentional breach of the pre-contractual duty of disclosure.
(3) The premium for the standard tariff, without a deductible and at all deductible levels, may not exceed the maximum contribution under the statutory health insurance scheme. This maximum contribution results from multiplying the general contribution rate, plus the average supplementary contribution rate under section 242a(2) of Book Five of the Social Code, by the contribution assessment ceiling then applicable under the statutory health insurance scheme. For persons entitled to assistance benefits under civil-service principles, the first and second sentences apply, with the proviso that, in place of the maximum contribution under the statutory health insurance scheme, a maximum contribution applies that corresponds to the percentage share of the entitlement supplementing the assistance benefits.
(4) Where need for assistance within the meaning of Book Two or Book Twelve of the Social Code exists, or where need for assistance would arise solely from payment of the contribution under subsection (3), first or third sentence, the contribution is reduced by half for the duration of the need for assistance, or for the period during which the need for assistance would arise; the need for assistance must be examined and certified by the competent body under Book Two or Book Twelve of the Social Code, on the insured person's application.
(5) The contributions for the standard tariff, excluding the costs of the insurance operation, are determined uniformly for all participating undertakings on the basis of shared calculation bases.