Known in German as the ‘Gesundheitsversorgungsweiterentwicklungsgesetz’, the Health Care Development Act (GVWG) would earn a lot of points in Scrabble, yet this complex word is indeed symbolic of a highly complex subject area. In practice, the GVWG, which was passed in July 2021, is one of many regulatory frameworks that apply to private compulsory health insurance. Besides acts such as the GVWG, there are two other important types of regulatory framework: regulations that come straight from the federal ministries – such as the Social Security Computation Size Regulation, which affects the pension contributions of caregivers (SoSiP) – as well as directives and interpretation and application guidance for acts and regulations. Ultimately, these regulatory frameworks largely affect the conditions of private compulsory care insurance, which are regularly revised by the Association of German Private Healthcare Insurers (PKV) and made available to the member insurance companies.
The Association of German Private Healthcare Insurers plays an important role in the operational structure of private compulsory care insurance. As all private comprehensive health insurers in the association must provide this insurance, yet each insurer’s customer structure might be completely different – from just a few policyholders in need of care to lots of cases – the association organises the necessary balance of risk between the member companies and lays down a standardised framework for benefits to be paid.
Almost every regulatory change influences the software solutions used by the insurance companies which provide products relating to long-term care insurance. However, software providers like msg nexinsure ag and msg life are not directly involved in the development of the benefit guidelines. This makes communication between software providers and insurers even more important, so that no time is wasted in starting to find a solution that has to be implemented in the standard software as well as, potentially, in customer-specific configurations.