Statutory health insurance

Fair competition among all health insurance schemes

Individuals with statutory health insurance should benefit in future from fair competition among health insurance schemes. The Cabinet has adopted a bill to this end. The risk structure compensation scheme in statutory health insurance is to be fine-tuned.


The German government would like to ensure fair competition among health insurance schemes. Manipulation of the risk structure compensation mechanisms is to be completely ruled out. The new bill translates into legislation the pledges laid out in the coalition agreement.

Strengthening the risk structure compensation

Health insurance schemes do not all have equivalent bodies of insured persons – some have disproportionately many healthy top-earners, while others have disproportionately many sick individuals and individuals with lower incomes. Since 1994 there has been a financial compensation mechanism among health insurance schemes, which is known as the risk structure compensation mechanism in statutory health insurance, sometimes known by its German acronym RSA.

The following measures are to put the regulations of this mechanism on a new footing:

  • All diseases are to be taken into account for disease-related supplements within the risk structure compensation mechanism, rather than the 80 which have been taken into account to date.
  • A flat-rate preventive health rate will be introduced – a strong incentive for health insurance schemes to encourage their members to make use of preventive measures.
  • To balance regional differences in costs of care, a regional component is to be included in the financial compensation mechanism.
  • The rules of conduct in competition and in particular in advertising measures will be specified with greater clarity and the opportunities for health insurance schemes to seek legal remedy against one another are to be expanded.

Structural changes in the GKV-Spitzenverband

The structures of the GKV-Spitzenverband (national association of statutory health insurance schemes) are also to be fine-tuned. There is to be a new steering and coordination committee, on which the chairs of the health insurance schemes will sit. A quota system is to ensure a proportionate number of women in the top-level bodies.