(1) In the case of health insurance where the premium is calculated in the manner of life insurance, the insurer may only demand payment of a premium calculated in accordance with the technical bases of calculation under sections 146, 149 and 150 in conjunction with section 160 of the Insurance Supervision Act. Other than with contracts in the basic tariff in accordance with section 152 of the Insurance Supervision Act, the insurer may agree an appropriate risk premium or release from obligation to effect payment, taking account of an aggravation of the risk insured. A risk assessment is only permissible in the basic tariff insofar as it is necessary for purposes of equalisation in accordance with section 154 of the Insurance Supervision Act, or for subsequent tariff changes.
(2) If, in the case of health insurance, the insurer’s statutory right of termination is ruled out by law or contract, the insurer is entitled, in the event of a not only temporary change to one of the bases of calculation necessary for calculating the premium, to also re-determine the premium in accordance with the adjusted bases of calculation for existing insurance agreements insofar as an independent trustee has reviewed the technical bases of calculation, and has agreed to the adjustment of the insurance premium. The amount of an excess may also be adjusted, and an agreed risk premium amended accordingly, insofar as this has been agreed. The relevant bases of calculation within the meaning of sentences 1 and 2 are the insurance benefits and the probabilities of death. As regards the adjustment of insurance premiums, additional premiums and excesses, as well as their review and approval by the trustee, section 155 of the Insurance Supervision Act applies in conjunction with a statutory ordinance enacted on the basis of section 160 of the Insurance Supervision Act.
(3) If, in the case of health insurance, the insurer’s statutory right of termination is ruled out by law or contract within the meaning of subsection (1) sentence 1, the insurer is entitled to adjust the general terms and conditions of insurance and the conditions of the tariff to the new conditions in the case of a non-temporary change in the conditions in the health system if the changes appear necessary to sufficiently safeguard the policyholders’ concerns, and an independent trustee has reviewed the conditions on which the change is based, and has confirmed their appropriateness.
(4) Section 164 applies if a provision in the insurer’s general terms and conditions of insurance has been declared void by a decision of one of the highest courts, or by a final administrative act.
(5) The re-assessment of the premium, and the changes in accordance with subsections (2) and (3), become effective from the start of the second month after the policyholder has been informed of the re-assessment or of the changes and of the relevant grounds.