Vereinfachung des Abrechnungsverfahrens in der privaten Krankenversicherung

Für Privatpatienten soll das Abrechnungsverfahren mit ihrem Krankenversicherer vereinfacht werden; jedenfalls bei der AXA Krankenversicherung. Diese schloss sich mit dem Softwarekonzern CompuGroup Medical zusammen. Für Mitglieder der AXA M?glichkeit, bedeutet dies, dass sie über das Portal „Meine Gesundheit“ ihre Rechnungen einsehen und direkt an die Versicherung schicken können. Alles online, ganz wie es im modernen Zeitalter üblich ist. Das Einscannen der Rechnungen ist nicht notwendig. Grund ist, dass Ärzte, welche ebenfalls die Software von CompuGroup Medical (CMG) nutzen, die Rechnungen nicht mehr an die Patienten senden, sondern direkt in das Portal hochladen. Die Patienten rufen im Portal die Rechnungen ab und senden sie direkt an ihre Krankenversicherung. Derzeit wird geprüft, inwieweit Apotheken in dieses neue Verfahren einbezogen werden können.


Damit das Verfahren ins Laufen kommt, haben der Softwarekonzern CGM und die AXA das Portal „Meine Gesundheit“ ins Leben gerufen. Die Mitglieder der AXA haben den alleinigen Zugriff auf ihre Daten und entscheiden selbst, ob sie die Rechnung mit ihrem Anbieter abrechnen wollen oder diese selbst bezahlen. Ob das einzelne Mitglied das Portal nutzen will, bleibt ihm überlassen. Diejenigen, die sich für die Nutzung des Portals entscheiden, können dies kostenlos nutzen und ihrem heimischen „Papierkrieg“ ein Ende bereiten.
Die beiden Unternehmen zeigen mit der Einrichtung des Portals eine Reaktion auf die Ergebnisse der Marktforschung, die zeigten, dass privat Krankenversicherte eine Vereinfachung des Rechnungsmanagements wünschen.

Axa und CGM

Neben dieser Abrechnungs-Vereinfachung haben AXA und CGM vor, auf dem Portal weitere Services anzubieten. Vorstellbar ist für beide Unternehmen eine Arztsuche und Terminvereinbarung direkt online über das Portal.


Die Nutzerfreundlichkeit sowie die Funktionalität soll Zaproszenia in den kommenden Monaten die Testphase zeigen, an der ausgewählte Kunden und Ärzten teilnehmen. Für alle bei der AXA Krankenversicherte, die über eine Vollversicherung verfügen, steht das Portal etwa ab Mitte des Jahres zur Verfügung. Erst dann wollen AXA und CGM prüfen, ob sie weitere Leistungserbringer in das Verfahren einbinden. Weiterhin soll geprüft werden, ob sich auch andere private Krankenversicherer für das Online-Portal interessieren und sich einbringen wollen. Mitglieder der HUK Coburg und der PAX-Familienfürsorge brauchen seit Mitte 2015 Kosten für teure Medikamente nicht mehr aus der privaten Tasche auslegen. Die Versicherer haben mit dem Apotheker-Verband entsprechende Verträge abgeschlossen und rechnen direkt mit den Apotheken ab. Auch die Allianz und die Debeka haben mit dem Apotheker-Verband Verträge in ähnlicher Form abgeschlossen und entlasten so ihre Mitglieder. Eine Direktabrechnung mit bestimmten Apotheken bieten andere Krankenversicherer wie beispielsweise die Bayerische Beamtenkrankenkasse oder die Barmenia ihren Mitgliedern an.

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Die private Krankenversicherung steht für alle Menschen offen und nicht nur für diejenigen, denen der Wechsel gestattet ist

Andere Personen können über Zusatzversicherungen Mitglied einer privaten Krankenversicherung werden. Die PKV bietet Zusatzversicherungen für Zahnersatz, Krankenhaustagegeld sowie einer weitergehenden medizinischen Versorgung an.
Während die privaten Krankenversicherer bei ihren Volltarifen kaum Neukunden gewinnen cheap mlb jerseys konnten, war dies bei den Zusatzversicherungen anders. Hier legten sie mit 2,3 Prozent kräftig zu. Einige Mitglieder der privaten Krankenversicherung sind Mitglieder der gesetzlichen Krankenversicherung geworden. Nicht für alle wechselfreudigen Mitglieder ist die Tür zur gesetzlichen Krankenversicherung offen, doch die, welche wechseln konnten, nahmen den Wechsel vor. Grund waren die Beitragserhöhungen, die sich in den vergangenen Jahren kräftig summierten. Im Gegenzug blieben die Beiträge für die Zusatzversicherung nahezu unverändert; einige Versicherer konnten sogar die cheap jerseys Prämien für die Zusatzversicherungen senken.


Eine Zusatzversicherung springt dort ein, wo der Leistungskatalog der gesetzlichen Krankenversicherung oder Pflegeversicherung endet. Bei den Zusatzversicherungen ist die Zahnzusatzversicherung die meist abgeschlossene Versicherung. Grund sind die hohen Kosten, die auf den Versicherten zukommen, wenn er Zahnersatz benötigt. Die gesetzliche Krankenversicherung bezahlt in der Regel nur einen Bruchteil der Kosten. Auch wenn viele meinen, es seien 50 Prozent, muss sich der Versicherte im Versicherungsfall oft eines Besseren belehren lassen. Die 50 Prozent Zuschuss erhalten die Mitglieder der gesetzlichen Krankenversicherung, zahn?rztliche deren Einkommen im Rahmen von Hartz IV liegt und nur für den Zahnersatz, der am günstigsten ist. Wählt das Mitglied einen besseren Zahnersatz, For muss es die Mehrkosten selbst übernehmen. Hier springt die Zahnzusatzversicherung ein, die je nach Vertrag bis zu 80 Prozent der Kosten übernimmt, welche die gesetzliche Krankenversicherung nicht trägt.


Interessant ist auch die private Pflegezusatzversicherung. Jeder weiß, cheap nfl jerseys die gesetzliche Pflegeversicherung deckt nur einen geringen Teil cheap jerseys der Kosten ab, die im Pflegefall entstehen. Eine private Pflegezusatzversicherung deckt einen weiteren Teil ab oder gar den Rest, je nach Vertrag und Beitragshöhe. Je mehr декабря die Zusatzversicherung im Pflegefall leisten soll und je älter der Antragsteller ist, desto sind Kardashian: die monatlichen Prämien. Es gibt zwar die sogenannte Bahr-Pflegeversicherung, doch hier sind die Deckungssummen äußerst gering gehalten.
Über Zusatzversicherungen können gesetzliche Versicherte bei den privaten Krankenversicherern Vorteile herausholen und Let’s damit ihre medizinische Versorgung in höherem Maße absichern, der als es der Carpet Leistungskatalog der gesetzlichen Krankenversicherung vorgibt. Auch eine Zusatzversicherung über Krankenhaustagegeld lohnt sich, hauptsächlich, wenn der Versicherte freiberuflich tätig ist und durch den Krankenhausaufenthalt wholesale nfl jerseys einen erheblichen Verdienstausfall hinnehmen muss.
In der Regel sind die Zusatzversicherungen nicht teuer und lohnen sich für fast jeden gesetzlich Versicherten.

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Beitragserhöhungen der PKV entgegen wirken



In jedem Jahr erhöhen sich die Beiträge für die private Krankenkasse. Und in jedem Jahr überschreiten die Beiträge die finanziellen Möglichkeiten der Versicherten und selbst, die Skidjet die ceiling Beträge stemmen können zahlen nur ungern mehr.
In einem gewissen Rahmen muss man diese Erhöhungen nicht einfach hinnehmen und kann ihnen entgegenwirken.


Risikozuschläge einsparen

Risikozuschläge machen button, in einer PKV bis zu 20% des Beitrages aus. Diese werden erhoben, wenn man beim Wechseln Wholesale Miami Dolphins Jerseys in die PKV vorliegende Erkrankungen hatte. Sofern sich diese Beschwerden in Wohlgefallen aufgelöst haben, besteht kein Grund mehr für den Risikozuschlag. Allerdings stellt es sich oftmals als relativ schwierig dar, die Risikozuschläge streichen zu lassen. Hier wird definitiv ein ärztliches Schreiben benötigt und evtl. die Hilfe eines Versicherungsberaters um die Streichung durchzusetzen.

Tarif wechseln

Als wholesale MLB jerseys PKV-Kunde steht es einem frei in einen anderen bestehenden Tarif zu wechseln, den die Versicherungsgesellschaft anbietet. Eine Ausnahme bildet der Wechsel von einem Uni-Sex- in einen Bi-Sex-Tarif. Oftmals kann der Wechsel ohne erneute Risikoprüfung erfolgen. Es stellt sich nur MuhmadEmad oftmals zur als schwierig dar im Tarifdschungel einen günstigeren zu finden, der nahezu die gleichen Leistungen enthält.
Dennoch sollte ein Wechsel gut abgewogen werden. Schließlich können auch hier die Beiträge steigen und am Ende ist der vermeintlich günstigere Tarif ebenso teuer wie der alte und beinhaltet u.U. noch Leistungseinbußen.

Leistungen streichen

Als Alternative zum Tarifwechsel lassen sich auch einzelne Leistungen aus dem Tarif entfernen, welche nicht zwangsläufig sein müssen, wie vielleicht die Krankenhausunterbringung in einem Einzelzimmer. Diese Maßnahme sollte aber erst in Betracht gezogen werden, wenn man wirklich nicht mehr in der Lage ist seine Beiträge zu begleichen.

Auf freie Arztwahl verzichten

Der Versicherungsnehmer kann dem Primärarztprinzip zustimmen. In diesem Fall verzichtet der Versicherte auf die freie Arztwahl und muss bei jeder Erkrankung erst seinen Hausarzt aufsuchen, der ihn ggf. an einen agricultores Spezialisten überweist.
Eigenleistungen erhöhen
Eine weitere Möglichkeit den Beitrag zu senken, ist die Höhe des Selbstbehalts zu erhöhen. Hier sollte man aber auch die möglichen Risiken nicht außer Acht lassen. So können im Fall einer Erkrankung u.a. hohe cheap nba jerseys Arztrechnungen auf den Patienten zukommen.

Alternative: gesetzliche Krankenversicherung

Diese Alternative kommt nicht für jeden in Betracht. Um zurück in die GKV wechseln zu können, müssen diverse Voraussetzungen erfüllt werden.
Allerdings existieren auch in der PKV Tarife, die denen der gesetzlichen Krankenversicherung entsprechen und somit wesentlich günstiger sind.
Und im schlimmsten Fall existiert noch der Notlagentarif der PKV. Hier werden alle Versicherten mit den notwendigsten Leistungen abgesichert, die nach dem Mahnverfahren nicht in der Lage sind ihre Beiträge zu begleichen.


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JAE- bzw. Beitragsbemessungsgrenze


Die Beitragsbemessungsgrenze beschreibt die obere Grenze des Arbeitseinkommens, bis zu welchem die Beiträge für die Sozialversicherungen unterliegen. Die Beitragsbemessungsgrenze ist nicht zu verwechseln mit der Versicherungspflichtgrenze, die einen Wechsel von der gesetzlichen in die private Krankenversicherung erlaubt. Diese Grenze wird auch Jahresarbeitsentgeltgrenze oder JAEG genannt. Bei der Beitragsbemessungsgrenze geht es um die Höhe der Beiträge für die gesetzliche Kranken-, Renten- und Pflegeversicherung sowie der Arbeitslosenversicherung.
Die Beiträge für die Sozialabgaben richten sich nach dem sozialversicherungspflichtigen Bruttogehalt. Ist das Bruttogehalt höher als die Beitragsbemessungsgrenze, orientieren sich die Beiträge nur an dieser Grenze; das über der Grenze liegende Bruttogehalt hat beitragstechnisch keine Bedeutung. Jedes Jahr passt die Bundesregierung die Beitragsbemessungsgrenze neu an. Wie sie dabei vorzugehen hat, um den Betrag neu festzulegen, regelt der § 68 Abs. 2 S. 1 SGB VI. Während die Beitragsbemessungsgrenzen für die Mehrzahl der gesetzlichen Sozialversicherungen moderat angehoben wurden, erhielt die gesetzliche Rentenversicherung im Jahr 2002 eine stärkere Anhebung.

JAE 2015

Die Beitragsbemessungsgrenze liegt 2015 für die Deutsche Rentenversicherung bei 6.050 Euro im Westen und 5.200 Euro im Osten der Republik. Für die Arbeitslosenversicherung entspricht die Beitragsbemessungsgrenze derjenigen der Deutschen Rentenversicherung. Siehe hierzu § 341 Abs. 4 SGB III. Die Beitragsbemessungsgrenzen für die gesetzliche Kranken- und Pflegeversicherung regelt § 223 Abs. 3 SGB V und § 55 Abs. 2 SGB XI, während die Jahresentgeltgrenze im § 6 Abs.7 SGB V festgeschrieben ist. Die Beträge hierfür sind jährlich 49.500 Euro oder monatlich 4.125 Euro (für das Jahr 2015). Die steuerliche Vorsorgepauschale orientiert sich seit 2004 wieder an der Höhe der jeweils aktuellen Beitragsbemessungsgrenze.

Jahresentgeltgrenze / Versicherungspflichtgrenze

Die Jahresentgeltgrenze oder Versicherungspflichtgrenze bestimmt, ob der Arbeitnehmer den Wechsel von der gesetzlichen zur privaten Krankenversicherung vornehmen darf. Das Jahresentgelt beinhaltet entweder das vereinbarte Jahresbrutto-Gehalt oder zwölf mal das vereinbarte Monatsgehalt zuzüglich Weihnachts- und Urlaubsgeld sowie andere vereinbarte und ähnliche Zuschläge.


In die private Krankenversicherung wechseln dürfen Arbeitnehmer, deren Jahresentgelt 54.900 Euro (für 2015) oder monatlich 4.575 Euro übersteigt. Die Versicherungspflicht in der gesetzlichen Krankenversicherung regelt § 5 Abs. 1 Nr.1 SGB V; die Versicherungsfreiheit beinhaltet § 6 Abs. 1 Nr. 1 SGB V. Auch den Betrag der Jahresentgeltgrenze wird vom Bundesministerium für Arbeit und Soziales jährlich neu festgelegt. Dies geschieht in einer Rechtsverordnung nach § 6 Abs. 6 SGB V. Die Berechnung orientiert sich an der Lohnzuwachsrate des vergangenen Jahres. Der internationale Vergleich zeigt, dass die meisten Staaten die Versicherungspflichtgrenze nicht kennen oder nicht mehr haben; ihre Bürger sind automatisch zur Nutzung der Gesundheitseinrichtungen berechtigt.

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Gesetzliche Krankenversicherung

Die gesetzliche Krankenversicherung ist ein Bestandteil des Gesundheitssystems in Deutschland. Die Beiträge für die Krankenversicherung erhält der Arbeitnehmer nicht ausbezahlt; sie werden direkt mit den Beiträgen zur Arbeitslosen-, Renten- und Pflegeversicherung vom Arbeitgeber an die zuständige Verteilerstelle überwiesen. Seit 2009 ist dies der Gesundheitsfonds. Die Beiträge für die Krankenversicherung bezahlen Arbeitnehmer und Arbeitgeber anteilig; das gilt auch für Rentner, die ihre Rente von der Deutschen Rente beziehen.

Auch wenn der Krankenkassenbeitrag bei allen gesetzlichen Krankenversicherungen derselbe ist, gibt es doch verschiedene Arten der Krankenkassen. Diese sind

• Ersatzkassen (EK)
• Allgemeine Ortskrankenkassen (AOK)
• Betriebskrankenkassen (BKK)
• Innungskrankenkassen (IKK)
• Landwirtschaftliche Krankenkassen (LKK) und
• Knappschaft.


Bei diesen Krankenversicherungen kann sich jeder Arbeitnehmer pflichtversichern; Minijobber sind automatisch bei der Deutsche Rente Knappschaft zur See versichert.


Die gesetzlichen Krankenversicherungen sind verpflichtet, die Kosten für die medizinische Versorgung ihrer Mitglieder und deren Angehöriger zu übernehmen. Eine ausführliche Beschreibung ist im SGB V zu finden. Der Umfang der verschiedenen Leistungen bestimmen die §§ 2 Abs. 1 und 12 SGB V sowie § 92 SGB V. Der Leistungskatalog der gesetzlichen Krankenversicherungen wird kontinuierlich überarbeitet. Derzeit enthält dieser Katalog Leistungen zur Verhütung, Früherkennung und Behandlung von Krankheiten. Die einzelnen Leistungen sind auf den Websites der gesetzlichen Krankenversicherungen enthalten. Neben den gesetzlich verankerten Leistungen können Mitglieder auch Wahlleistungen buchen.

Wechsel der Krankenversicherung

Jede Person hat die freie Wahl der Krankenversicherung, in der er versichert sein will. Bei einem Wechsel der Krankenversicherungen kommt allerdings § 175 Abs. 4 SGB V zum Tragen. Dieser Paragraf besagt, dass ein Mitglied einer Krankenkasse frühestens nach einer Mitgliedschaft von 18 Monaten die Mitgliedschaft mit einer Frist von zwei Monaten kündigen kann.



Erhebt die Krankenversicherung jedoch Zusatzbeiträge oder erhöht die bisher geforderten Zusatzbeiträge, kann das Mitglied von seinem Sonderkündigungsrecht Gebrauch machen.
Die Kündigungsfrist verlängert sich, wenn das Mitglied der Krankenversicherung einen Wahltarif mit weiteren Konditionen nutzt. Die Verlängerung der Kündigungsfrist beträgt ein Jahr, maximal jedoch drei Jahre.

Arten der Mitgliedschaft

Mitglieder einer gesetzlichen Krankenversicherung sind in erster Linie die Beitragszahler. Diese sind versicherungspflichtige Arbeitnehmer und Rentner sowie freiwillig Versicherte. Ebenfalls Mitglied der GKV, jedoch kein Beitragszahler sind Angehörige von Mitgliedern, die über die kostenlose Familienversicherung versichert sind.
Wer versicherungspflichtig ist, ergibt sich aus § 5 SGB V und § 2 KVLG 1989. Dies sind in der Regel Arbeitnehmer und Rentner, deren Einkommen unterhalb der Beitragsbemessungsgrenze liegt. Seit Januar 2009 sind alle Bürger in Deutschland aufgefordert, sich bei einer Krankenversicherung ihrer Wahl anzumelden, sofern sie nicht krankenversichert sind.

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