What is a healthcare deductible

In the case of insurance, the deductible or excess is the amount that an insured person bears himself in the event of a claim. Deductibles can be structured in different ways, for example as a percentage of the service costs, as an absolute amount per accounting period or as a combination of these: x percent of the service expenditure up to a maximum of y euros per year. In insurance terms, deductibles are forms of risk sharing between the policyholder and the insurance company: the higher the expenditure risk borne by the insured person, the lower the insurance premium.

In addition to the financing function, an important control function is often ascribed to the deductible in health insurance, according to which insured persons with a deductible can make use of health services in a more cost-conscious manner. However, this steering effect is controversial. The majority of health expenditure is attributable to a relatively small proportion of those insured with severe and spending-intensive acute or chronic illnesses. With these insured persons, patient-side demand management makes little sense from the outset. On the other hand, there is a risk that necessary visits to the doctor will be postponed for cost reasons or will be omitted altogether and the illness that is not treated in good time for this reason will lead to high follow-up costs, for example due to hospital admissions that would not have been made with timely outpatient treatment.

Since April 2007, the health insurances have been able to offer all members a deductible tariff within the scope of the optional tariffs according to Section 53 of the Social Code Book V and pay a premium for voluntary participation in this tariff ΜΆ with a minimum commitment period of three years. As with all optional tariffs, however, proof must be provided to the supervisory authority that the tariff is self-sustaining and that there is no cross-financing by the other members of the fund. Stricter requirements have been in place for this proof since 2011.