Before the premium increase: Phone terrorism is returning in healthcare

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At the beginning of the month, Swiss health insurance companies changed the rules of the game for insurance brokers. With the new “Industry Agreement for Intermediaries” they quickly eliminated the possibility of sanctions against insurance companies that make so-called cold calls, that is, advertising calls without indicating the interest of the called person. Or accepting contracts from outside intermediaries thanks to intrusive phone calls. The ban on ad searches still applies; but without the possibility of enforcement, the new industry agreement is unlikely to stop Black Sheep from picking up the phone.

This means: Telephone terror is unleashed again. At the same time, the associations Santésuisse and Curafutura removed the upper limit on how much an insurance intermediary could earn when taking out additional insurance. Consumer protection fears that brokers will be particularly active in this area this fall because they can make a lot of money with high commissions.

Health insurance companies are abolishing independent oversight bodies

Flashback: In January 2021, most health insurance companies joined an industry agreement in which they agreed to ban ad searches. This was the case if there had been no customer relationship with the insurance company for more than three years. This was to put an end to the annoying phone calls that had become a constant nuisance for the public.

If an intermediary violated this agreement, the insurer would risk being penalized by the independent supervisory commission Fair-mittler.ch if it accepted a contract created in this way. There was a risk of a penalty of up to 100,000 francs for basic insurance and 500,000 francs for additional insurance. Last year, the inspection commission received 109 reports and imposed penalties in eight cases. The highest amount was 20,000 francs.

This is over now. The new industry agreement has been in force since the beginning of September and has suspended the supervisory board with immediate effect. Ongoing procedures must be completed by March 2024; No new cases have been accepted since the beginning of September. It is unclear whether the supervisory board and its office will be abolished.

Instead, insurance associations want to establish their own reporting offices. It should seek to “resolve misunderstandings and mediate differences of views between insured persons and insurers.” Health insurance companies that do not comply with the rules need not fear the new reporting office: there will be no sanctions.

Abuses are not reported to authorities

This is the duty of the state, which provides sanctions in case of abuse in insurance audit law. Write to industry associations. The reason is “We want to prevent a violation from being punished by the audit commission and state authority.” It’s not clear why insurance companies suddenly find this double penalty system offensive. Formal sanctions options were already included in the law when industrial associations signed the old agreement that still allowed sanctions.

But that’s not all: The reporting office also does not pass on any information about errant brokers to the supervisory authorities. Industry associations believe this is not allowed for data protection reasons. It is unclear whether health insurers will make it transparent who will be on the control committee and whether this will be subject to the principle of publicity (i.e. anyone can request access to their activities and decisions). When asked about Curafutura and Santésuisse, he simply wrote: “We are in the process of setting up the registry office.”

A second point that may negatively affect the insured: The upper commission limit for additional insurance will be removed. According to the previous agreement, the additional insurance brokerage fee can be a maximum of twelve months’ premium. In the new contract, this limit has been deleted without change. The only requirement: compensation must be “generally economically reasonable”.

What is meant by this economic efficiency? This is unclear. Curafutura writes: “The fee must be in reasonable proportion to the products sold.” This approach is flexible. The Federal Financial Market Supervisory Authority (Finma) must check that excessive commissions are not paid. Finma says it is closely monitoring developments in the settlement of health insurance companies. “One thing is clear: short-term fiscal incentive systems can lead to problematic situations,” says Tobias Lux, Finma’s media spokesman.

Agencies earn a maximum of 70 francs by taking out basic insurance. Business with additional insurance is really lucrative: thanks to the new rules, agents can now earn significantly more when making a contract, instead of the previous 1,000 francs.

Stricter rules should apply to everyone soon

Consumer protection strongly condemns the actions of insurance companies. “It is no coincidence that industry agreement has been weakened in this rush, as major health insurance premium surcharges are expected this autumn,” said chair Nadine Masshardt. The brokerage business will be in full swing this fall. “Limiting the regulation of health insurance intermediaries to basic insurance is absurd and completely contrary to the democratic decisions of the National Council, the Council of States and the Federal Council,” says Masshardt.

The change to the industry agreement comes at a time when the Federal Council wants to set binding rules for the business of buying insurance companies: it sent the previous industry agreement for consultation this summer to declare it generally binding. This means that the previous provisions should also apply to insurance companies that have not previously participated in the agreement as of January 1, 2024.

Health insurance companies have the final say on the rules

If the industry associations Santésuisse and Curafutura manage to win over insurers for new rules that cover more than 66 percent of insured people, they can apply to the Federal Office for Public Health (BAG) for the implementation of new, less stringent rules. to everyone. The Federal Council will not hold any further consultations on this matter. The four major insurance companies CSS, Helsana, Sanitas and KPT are members of Curafutura; Santésuisse includes Assura, Groupe Mutuel, Visana and Swica.

Industry associations decided to regulate without consulting the BAG and the financial market supervisory authority. The question now arises as to whether this change would be permissible even if the consulting parties were merely commenting on the old arrangement. BAG writes that Parliament was aware that the agreement was a contract that the contracting parties could modify or terminate. In other words, the insurance companies still have the final say.

One thing is clear: By adapting the industry agreement, industry associations initially prevented the existing stricter rules from being applied to all health insurance companies in the future. Politicians are once again called upon to effectively put an end to phone terrorism.

Source :Blick