Premium changes

(1) In health insurance conducted in the manner of life insurance, premium changes may be put into effect only after an independent trustee has consented to the premium change. The trustee must examine whether the calculation of the premiums is consistent with the legal provisions applicable to it. For this purpose, all technical calculation bases necessary for examining the premium changes must be submitted to the trustee, including the calculation derivations and statistical evidence needed for this. The technical calculation bases must present, in full, the principles for calculating the premiums and the ageing provision, including the actuarial bases used and the mathematical formulae. Consent must be given where the conditions of the second sentence are satisfied.
(2) The trustee's consent is required for 1. the timing and amount of the withdrawal, and the use, of funds from the provision for non-profit-related premium refunds, insofar as they are to be used under section 150(4), and 2. the use of funds from the provision for profit-related premium refunds. In the cases of the first sentence, points 1 and 2, the trustee must ensure that the conditions specified in the articles of association and the terms of insurance are satisfied, and that the interests of the insured are adequately safeguarded. In using the funds to limit premium increases, the trustee must, in particular, have regard to the appropriateness of the distribution among the insured portfolios with and without a premium loading under section 149, and give adequate consideration to the reasonableness of the percentage and absolute premium increases for older insured persons.
(3) For each tariff calculated in the manner of life insurance, the insurance undertaking must, at least annually, compare the required insurance benefits with the calculated insurance benefits. Where the comparison to be submitted to the supervisory authority and the trustee shows a deviation of more than 10 percent for a tariff, unless a lower percentage is provided for in the general terms of insurance, the undertaking must review all premiums of that tariff and, where the deviation is not to be regarded as merely temporary, adjust them with the trustee's consent. In doing so, a deductible fixed as a specific amount may also be adjusted, and an agreed premium loading changed accordingly, insofar as the contract so provides. No adjustment is made insofar as the insurance benefits were inadequately calculated at the time of the initial or a subsequent calculation, and a prudent and conscientious actuary should have recognised this, in particular on the basis of the statistical calculation bases available at that time. Where, in the trustee's view, an increase or a reduction of the premiums for a tariff is wholly or partly necessary, and no concurring assessment can be reached with the undertaking on this, the trustee must inform the supervisory authority without delay.
(4) For each tariff calculated in the manner of life insurance, the insurance undertaking must, annually, compare the required mortality probabilities with the calculated mortality probabilities by reference to present values. Where the comparison to be submitted to the supervisory authority and the trustee shows a deviation of more than 5 percent for a tariff, the undertaking must review all premiums of that tariff and adjust them with the trustee's consent. Subsection (3), third to fifth sentences, applies correspondingly.