Health Insurance Profit-Sharing Regulation Kv-Gbv

Original Language Title: Krankenversicherung-Gewinnbeteiligungsverordnung – KV-GBV

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309. Ordinance of the Financial Market Supervisory Authority (FMA) on profit-sharing in health insurance (Health insurance-profit-sharing ordinance-KV-GBV)

Pursuant to Section 102 (3) in conjunction with Section 92 (4) of the Insurance Supervisory Law 2016-VAG 2016, BGBl. I n ° 34/2015, as last amended by the Federal Act BGBl. I No 112/2015, shall be arranged:


§ 1. (1) This Regulation shall apply to sickness insurance contracts in the form of life assurance from direct business which, in accordance with their insurance conditions, provide for a profit-sharing scheme. This includes contracts which provide for a premium refund dependent on the economic result of the insurance undertaking.

(2) The provisions of § § 2 and 3 shall apply only to health insurance contracts in accordance with paragraph 1, which shall be concluded on the basis of actuarial bases submitted to the FMA after 30 June 2007. The provisions shall not apply if the actuarial basis is only presented in order to take account of the actuarial basis used before 1 July 2007 in respect of the changed costs of the health care system or modified probabilities of the use of services.

Minimum profit sharing

§ 2. (1) The expenditure on the provision of the provision for the provision of compensation for the payment of premium rights (Section 146 (3) item II.8). VAG 2016) plus any direct direct credits and any other amounts which are used to finance an extraordinary increase in the cover provision or to avoid premium increases, shall have at least in each financial year. 85% of the minimum basis for the measurement according to § 3 (minimum profit sharing). Also from the supply of such amounts, the claims of individual policyholders are not to be deducted from the retirement provision or shares thereof.

(2) Overdose from previous financial years may be credited to the minimum profit share referred to in paragraph 1. The amount of the eligible amount shall be as follows: the reduction shall be 10% of the overdose for each financial year following the overdose; furthermore, all the accounts already made from previous years shall be: , Overdoses are to be calculated in the chronological order, starting from the elders, the expenses on which they are based up to the level of their eligibility.

Minimum basis of assessment

§ 3. (1) The minimum basis of assessment shall be determined from the following items and shall be determined at each balance sheet date:



Defined premiums (Section 146 (3) (II.1)). VAG 2016);



Income from investments and interest income (Section 146 (5), Item IV.2. VAG 2016);



Expenses for capital investments and interest expenses (Section 146 (5) Item IV.3. VAG 2016);



Other technical income (Section 146 (3) (II.3). VAG 2016);



Expenses for insurance cases (Section 146 (3) (II.4)). VAG 2016);



Increase in technical provisions (Section 146 (3) (II.5)). VAG 2016);



Reduction of technical provisions (Section 146 (3) (II.6)). VAG 2016);



Expenses for the independent premium refund (§ 146 para. 3 Item II.7. VAG 2016);



Expenses for the insurance business (Section 146 (3) (II.9)). VAG 2016);



Other technical expenses (Section 146 (3) (II.10)). VAG 2016);



Other non-insurance-related income (Section 146 (5), item IV.5. VAG 2016);



Other non-insurance-related expenses (§ 146 (5) Item IV.6. VAG 2016);



Taxes on income and income (Section 146 (5) (IV.11)). VAG 2016);



Termination of the risk reduction according to § 143 VAG 2016 (Section 146 (5) Item IV.13.a. VAG 2016);



Allocation to the risk reduction according to § 143 VAG 2016 (§ 146 (5) Item IV.14.a. VAG 2016).

(2) The amount of the minimum basis of assessment within the meaning of Section 103 (2) in conjunction with Section 92 (4) VAG 2016 shall be the sum of the items in accordance with paragraph 1 Z 1 to 15.

(3) In the calculation referred to in paragraphs 1 and 2, the following shall be taken into account:


all items in accordance with paragraph 1 only in so far as they do not apply to health insurance contracts pursuant to § 1 (2); items which are not directly attributable to the health insurance contracts in accordance with § 1 para. 2 are as causal as possible with the help of to split the appropriate key into it.


the items referred to in points (1) (2) and (3) in the ratio of the average cover requirement of the sickness insurance contracts in accordance with Article 1 (2) to the medium-total capital investments (Section 144 (2) (b) of the VAG 2016) and current assets held by credit institutions, Cheques and cash balances (Section 144 (2) item F.II. VAG 2016) in relation to the financial year respectively.

(4) In the calculation provided for in paragraph 1, the supply or dissolution of deferred taxes shall not be taken into account.

(5) The insurance undertaking shall be entitled to withdraw, in the determination of the basis of assessment in accordance with paragraph 1, not more than 5% of the deducted premiums referred to in paragraph 1 (1), which are to be attributed to the health insurance contracts in accordance with Article 1 (2).

Profit sharing

§ 4. (1) In accordance with the winning plan and taking into account the opinion of the responsible actuary in accordance with § 116 paragraph 1 Z 2 VAG 2016, the Executive Board or the Board of Directors and the Managing Directors, in the context of the annual financial statements, determine the level of profit-sharing.

(2) The profits are to be divided into the health insurance contracts in accordance with § 1 (1) by way of explanation, in a fair and proportionate way, taking account of accounting associations. Objectively justified differentiation of the level of profit-sharing is permissible; such differentiations are then necessary if the ominy of a differentiation to a systematic and one-sided burden on partial stocks with the Risks of other sub-stocks would result. Differentiation is permitted, in particular, with regard to different guarantees and options.

(3) Declarations, but not yet allocated, are within two years from the balance sheet date to which the declaration relates, for example by cash payment or settlement with premiums or the increase in the individual cover provision. (ageing reserve).

Entry into force and transitional provisions

§ 5. This Regulation shall enter into force 1. January 2016 in force and is to be applied for the first time to financial years beginning after 31 December 2015. On business years before the 1. January 2016 will end, are the regulations of the regulation on profit sharing in the health insurance GBVKVU, BGBl. II No 120/2007, as amended by the BGBl Regulation. I No 34/2015.

Ettl Kumpfmüller