About 87 percent of the residents of Germany have statutory health insurance, i.e. GKV. As of May 2005, the GKV relied on 321 non-profit sickness funds to collect premiums from their members and pay health care providers according to negotiated agreements. Those who are not insured this way, mainly civil servants and the self-employed, receive health care through private for-profit insurance.
An estimate of 0,3 percent of the German population (around 250,000 people) has no health insurance at all. Some of them are so rich that they do not need it but most of them are poor and receive health care through social assistance.
Germany's statutory health insurance
There are three different categories of sickness funds: primary funds, substitute funds and “special” funds. Some workers are required to be members of the primary funds, e.g. if they earn less than the than the income ceiling (2006: EUR 3,937.50 per month / EUR 47,250.00 per year). Those earning more than that ceiling may be members on a voluntary basis, or they may have a choice of funds. Some of them automatically become members of a particular fund for example because of their occupation (company-based funds) or place of residence (local sickness funds). Some occupations have their own “special” funds, e.g. farmers or sailors.
Substitute funds are divided into two kinds: they provide health insurance to both white collar workers and blue collar workers earning more than the income ceiling. Membership is voluntary.
Both, employers and employees pay half of a member's premiums, which in 2006 averaged between 13 and 14 percent of a worker's gross earnings up to the contribution assessment ceiling (2006: EUR 3,562.50 monthly / EUR 42,750.00 p.a.). Premiums are fixed according to earnings rather than risk and are unaffected by the respective member's marital status, family size, or health. Premiums are the same for all members within a particular fund with the same earnings.
Germany's private health insurance
About eleven percent of Germany's residents pay for private health insurance provided by some 40 for-profit insurance carriers. Many of those choosing private insurance are civil servants who want to secure percentage of their medical bills not covered by the government. Some sickness-fund members buy additional private insurance to cover such extras as a private room or a choice of physicians while in a hospital. Otherwise, the medical care provided to the publicly and privately insured is identical. In both cases the same medical facilities are used. Self-employed persons earning above the income ceiling must have private insurance. Members of a sickness fund who leave it for a private insurance carrier are not allowed to return to public insurance.
As opposed to the statutory heath insurance, contributions to the private insurance depend on the member's age, gender, occupation and health status, that is, the individual risk. Although private insurance companies pay health care providers about twice the amount paid by the primary sickness funds, private insurance is often cheaper than statutory health insurance, especially for younger policyholders without dependents. As is the case for members of sickness funds, employees who have private insurance have half their premiums paid by their employers.
National Health Insurance System
For years the health care insurance company's agents were able to initiate critical day-to-day tasks only by contacting company representatives at the insurer's major office. With sales volume on a steady rise, this duplication of effort was becoming increasingly inefficient and burdensome for everyone involved.
The company's employees and agents were straining to process lots of policy documents each day. Integrating and streamlining policy application and document processes would ease administrative headaches for agents and greatly strengthen relationships with their customers.
Healthcare Management Administration
Radix offers healthcare insurance system for health care insurance services companies. We offer online health insurance policy management system for health care services management like preparing, printing, mailing, storing and retrieving policy documents. Our online health care administration management can reduce your time and cost of manual system and you can sell online health insurance policy from our online health insurance policy sales and management system.
Health Care Services Management – Web Based Insurance Solution
Consistent, integrated web based quoting engine : Web based quoting engines is a full-function browser-based transaction application that allows you to establish a unified, service-oriented process to quote and issue insurance policies. Designed to maximize flexibility and ease integration, web based quoting engine is the robust marketing tool, equipped with dynamic, easy user interface.
For each policy, the insurance details are dynamically created in to PDF documents, they automatically attach to the policy with descriptions and dates. Thus, the management, underwriting, claims, and authorized external users achieve over 75% time, effort saving. The system also replaces the old-school method of having to go to find a paper based file again. The following are some of the key features provided by the system.
>>>Web-enabled data entry
>>>Ability to view detailed breakdown of premium summary
>>>Automatic reflection of pre-defined characteristics from the Product Developer and Configuration such as coverage’s, rates, and forms etc…
>>>Ability to edit and save multiple quote iterations
>>>Easy transition from quick quote and/or full quote to issued policy
>>>Document Imaging
In-Force Automation
In-Force Automation streamlines the business processes associated with managing policies. By in-force the term applies to automation achieved by the solution. For e.g. in force automation will complete pending policy registration whose payment is complete, the human factor (h-factor) involvement is thus greatly reduced.
In-Force Automation encompasses all the business functionality associated with in force transaction processing, the following processes are completely automated by In-Force:
>>Cancellation/reinstatement
>>Policy correction
>>Endorsements
>>Renewals and non-renewals
>>Detailed policy transaction history including "point-in-time" detail
>>Diary, notes and renewal information windows.
>>Export data in CSV format
Claims Processing :
Claims processing accurately tracks and reports Losses claim by customers. Claims module was designed to handle simultaneous claims by sharing data between the policy and claims modules. When a new claim is created within the claims module, the system automatically verifies coverage, coverage limits, deductibles, and aggregates based upon the date of loss. The Claims module allows for complete tracking, review, and reporting of Reserves, Payments, Expenses, Salvage, Subrogation, Losses by Peril and Sub-Peril, Adjuster Diary notes, as well as Statutory reporting, Named Catastrophe tracking, and integrated claim letters that automatically incorporate and merge claim and policy information into the letter. >>Renewals. >>Reports.
Radix Health Care Insurance System Benefits : The following benefits were derived from the Policy Management System developed by Radixweb:
>>>>>The client handled his core business with the Radix-developed internet based Policy Management System and the robust architecture enabled the client to enhance productivity and cut costs.
>>>>>Manageability of the system was improved because Radixweb consolidated various systems into a single homogenous entity. This lowered maintenance costs and ensured lesser downtime.
>>>>>All the data residing on contrasting systems were combined and put into a single database. Access was also enhanced and all users could get complete access to any data required, any time. Consolidation of data also led to higher customer service levels and reduction in customer query response times.
>>>>>The application catered to the needs of the users all over the France, and this standardized the administration process.
>>>>>Many of the tasks that were earlier being handled manually were automated, presenting significant efficiency benefits to the client's operations.
>>>>>The automated flow of data between the databases belonging to the two separate modules was transparent and seamless, and this also contributed to lower cost.
Questions? If you want to make your Health care insurance business online than please visit our site http://rndinfo.com/health-care-insurance-system.html to get more details and also see the system that we have developed for health care insurance company in France.
Both Katrin Giese & Radix Web are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Katrin Giese has sinced written about articles on various topics from Health Insurance. Germany's health insurance information portal informs about news and changes in the german health insurance market and supplies insuran. Katrin Giese's top article generates over 590 views. to your Favourites.
Radix Web has sinced written about articles on various topics from Health Insurance. http://rndinfo.com/health-care-insurance-system.html. Radix Web's top article generates over 590 views. to your Favourites.
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