private health insurance

People (e.g. self-employed, students or employees earning more than 3,825 euros per month) who are not obliged to be insured in the statutory health insurance scheme can take out private health insurance. This is based on contracts under private law and not on the principle of solidarity. Companies do not differentiate their premium scales according to income, but according to risk groups. As well as age and previous illnesses, these include sex. As a consequence of this gender-specific differentiation, women at present have to pay considerably higher premiums than men.

The definition of risk in private health insurance treats sex as biological and not as the socially constructed category of gender. It thus ignores the social diversity of women and men. This can be seen in the justifications given by the private insurance industry for higher rates for women:

• Greater life expectancy for women: as older people are on average more often ill than younger people, older people involve more expense for health insurance companies that younger people do. This, too, raises the question as to why the mortality tables used by the health insurance companies differentiate in terms of sex. The on-average greater life expectancy of women is not due to biological differences, but rather to specific living conditions and behaviour. Gender, however, is at best an indicator of more specific risk factors. These include profession or occupation, socio-economic situation or nutritional habits of the insured person. It would be more appropriate to the matter in hand to assess insured persons in a more differentiated way here, which would also eliminate discrimination.
  
  
• Differences in claiming benefits: According to the Association of Private Health Insurers (PKV), women cause 40 % higher costs than men. Three-quarters of this is due to greater use of screening or greater use of medications. In order to be able to compare the frequency of certain behaviours, the groups being compared must first be defined. In this case, it is explicitly a matter of social behaviour. Instead of differentiating on the basis of sex, it would be more appropriate to differentiate according to the factors which are really relevant.
  
  
• “Birth risk”: The last quarter of the higher expenditure on women as compared to men is due to medical benefits for pregnancy and maternity. No account whatsoever is taken of the fact that men, except in the few cases of artificial insemination, are just as involved as women in conception. The possible costs are not distributed across all potential parents equally, but one-sidedly across all women. Differences among women, such as the fact that not all women can or want to have children, are ignored. The part played by men is not appropriately reflected.

Private health insurance companies are only indirectly bound by the ban on discrimination. Premium scales that are not sex-related are thus demanded when benefits are removed from the range provided by the statutory health insurance scheme. If in this case private additional insurance providers were not to offer unisex premiums, genuine freedom of choice for women would no longer be guaranteed.

Changes have been undertaken in this regard in European law, however. On 13 December 2004, EU Directive 2004/113/EC implementing the principle of equal treatment between men and women in the access to and supply of goods and services entered into force. From the end of 2007, this Directive only permits premiums differentiated in terms of sex for new insurance policies in private health insurance schemes if the insurance companies can prove that differentiation by sex is relevant even if costs differences caused by pregnancy and maternity are not taken into account:

• Article 5 (2) "Notwithstanding paragraph 1, Member States may decide before 21 December 2007 to permit proportionate differences in individuals' premiums and benefits where the use of sex is a determining factor in the assessment of risk based on relevant and accurate actuarial and statistical data. (...)"
  
  
• Article 5 (3) "In any event, costs related to pregnancy and maternity shall not result in differences in individuals' premiums and benefits."

On the basis of the calculations made in a report prepared for the Federal Ministry for the Family, Senior Citizens, Women and Youth on differences in premiums for private health insurance policies on the basis of sex, it seems likely that sex as a determining factor in calculating premiums cannot be proved and that the introduction of unisex rates for private health insurance will be obligatory.

For health insurance schemes, Gender Mainstreaming means systematically taking different life situations of women and men  of different ages and backgrounds, etc. into account when calculating premiums and refraining from discrimination in designing premium scales. For the insurance supervisory authorities and the legislator, GM means basing the steering of the insurance industry on gender analyses and gender impact assessments, in order to contribute at this level to gender equality.

Zentrum für Sozialpolitik: Differenzierung privater Krankenversicherungstarife nach Geschlecht: Bestandsaufnahme, Probleme, Optionen. Gutachten für das BMFSFJ, Universität Bremen 2005.

Baer, Susanne/Wrase, Michael: Unterschiedliche Tarife für Männer und Frauen in der privaten Krankenversicherung - ein Verstoß gegen den Gleichheitssatz des Grundgesetzes? In: Neue Juristische Wochenschrift (23) 2004, S. 1623 - 1627.

Schmidt, Claudia: Die Frauenprämie in der privaten Krankenversicherung im Lichte des Gleichberechtigungsgrundsatzes, Saarbrücken 1989.

Sahmer, Sybille: Anti-Diskriminierungsrichtlinie. Gleichbehandlung von Frauen und Männern in der privaten Krankenversicherung - Position des Verbandes der privaten Krankenversicherer (PKV), in: Gesamtverband der deutschen Versicherungswirtschaft e.V. (Hg.): Bericht aus Brüssel, (42) 2003, S. 1-3.

Helmert, Uwe: Der Einfluss von Beruf und Familienstand auf die Frühsterblichkeit von männlichen Krankenversicherten, in: ebenda/Bammann, Karin/Voges, Wolfgang/ Müller, Rainer (Hg.): Müssen Arme früher sterben? Soziale Ungleichheit und Gesundheit in Deutschland, Weinheim/München 2000, S. 243-248.