309 regulation of the financial market authority (FMA) on the profit participation in the health insurance (health insurance profit-sharing regulation KV-GBV)
On the basis of article 102 paragraph 3 in conjunction with § 92 section 4 of the insurance supervision law 2016 - VAG 2016, Federal Law Gazette I no. 34/2015, as last amended by Federal Law Gazette I no. 112/2015, is prescribed:
Scope of application
1. (1) this Regulation applies to health insurance like life insurance from the direct business contracts which provide for a profit-sharing conditions of their insurance. These include also contracts, which provide for a premium refund dependent on the economic effect of the insurance company.
(2) the provisions of paragraphs 2 and 3 are to apply only to health insurance contracts referred to in paragraph 1, entered into on the basis after actuarial basis presented to June 30, 2007 the FMA. The provisions are not to apply if the template of the actuarial foundations only to customize the used actuarial bases on the changing costs of health care or changed probabilities of use of services before July 1, 2007.
2. (1) the expenses for the funding of the provision for performance-related premium refund (§ 146 paragraph 3 item II. 8.) VAG 2016) plus any direct credits and any other amounts which finance an extraordinary increase in the premium reserve or avoid rate increases, at least 85% of the minimum basis of assessment pursuant to article 3 must in each fiscal year amount (minimum profit participation). Also from the feeder of such amounts claims of individual policyholders that are not aging default, or shares subject.
(2) on the minimum profit participation referred to in paragraph 1 above allocations may be credited from previous financial years. The eligible amount arises from the following abbreviated excess funding: the reduction has to be 10% of the excess funding; for each fiscal year following on the excess contribution all already existing credits from previous years shall also be deducted. Excess allocations are in the chronological order, starting from the oldest to be the underlying expenses up to the amount of their eligibility.
3. (1) the minimum tax base shall be determined from the following items and at each balance sheet date to determine:
Deferred premiums (§ 146 paragraph 3 item II. 1.) VAG 2016);
Income from investments and interest income (§ 146 paragraph 5 item IV. 2.) VAG 2016);
Expenses for capital investments and interest expenses (§ 146 paragraph 5 item IV. 3.) VAG 2016);
Other technical income (§ 146 paragraph 3 item II. 3.) VAG 2016);
Expenses of insurance claims (§ 146 paragraph 3 item II. 4.) VAG 2016);
Increase in technical provisions (§ 146 paragraph 3 item II. 5.) VAG 2016);
Reduction of technical provisions (§ 146 paragraph 3 item II. 6.) VAG 2016);
Expenses for the bonus and rebates (§ 146 paragraph 3 item II. 7.) VAG 2016);
Expenditures on insurance business (§ 146 paragraph 3 item II. 9.) VAG 2016);
Other technical expenses (§ 146 paragraph 3 item II. 10.) VAG 2016);
Other non-insurance technical income (§ 146 paragraph 5 item IV. 5.) VAG 2016);
Other non-underwriting expenses (§ 146 paragraph 5 item IV. 6.) VAG 2016);
Taxes on income and income (§ 146 paragraph 5 item IV. 11.) VAG 2016);
Resolution of the risk reserve in accordance with § 143 VAG 2016 (§ 146 paragraph 5 item IV.13.a.) VAG 2016);
Allocation of the risk reserve in accordance with § 143 VAG 2016 (§ 146 paragraph 5 item IV.14.a.) VAG 2016).
(2) the amount of the minimum basis of assessment within the meaning of section 103 paragraph 2 in conjunction with § 92 section 4 VAG 2016 is the total of the items referred to in paragraph 1 Z 1 to 15.
(3) in the calculation referred to in paragraphs 1 and 2 shall be taken into account:
1. all items referred to in paragraph 1 only to the extent, as they health insurance contracts in accordance with § 1 para 2 account for; Items that are not directly related with the health insurance contracts in accordance with § 1 para 2, are possible causation be divided using the appropriate key on this.
2. the items referred to in paragraph 1 Nos. 2 and 3 in the ratio of the Middle cover requirement of the health insurance agreements in accordance with § 1 para 2 to the average total investment (article 144, paragraph 2 item b VAG 2016) and current balances with banks, cheques and cash (article 144, paragraph 2 post F.II. VAG 2016) calculated based on the fiscal year.
(4) in the calculation referred to in paragraph 1, the drawer or resolution of deferred taxes are not taken into account.
(5) the insurer is entitled to advance deduct 5% of the accrued premiums referred to in paragraph 1 in determining the basis of assessment referred to in paragraph 1 Z 1, that are attributable to the health insurance contracts in accordance with section 1, paragraph 2.
4. (1) in accordance with the profit plan, and taking into account the Z 2 VAG 2016 lay opinion of the responsible actuary in accordance with article 116, paragraph 1 the Board of directors or the Board of Directors and the managing directors in the context of the annual financial statements the amount of profit-participation firmly.
(2) the winnings are causing fair and reasonable to split considering of accounting associations on the health insurance agreements in accordance with § 1 para 1 by declaration. Objectively justified differentiation of the amount of profit-participation are permitted; such differentiations are required if the omission of a differentiation would lead to a systematic and unilateral load of stocks of part of with the risks of other part stocks. A differentiation is permissible in particular in terms of different guarantees and options.
(3) declared, but not yet allocated profits are within two years from the balance sheet date, the Declaration refers, as through cash payment or settlement with premiums or increase the individual premium reserve (aging default), to allocate.
Entry into force and transitional provisions
§ 5. This regulation comes into force on January 1, 2016 and is to apply for the first time to fiscal years beginning after December 31, 2015. On fiscal years ending prior to January 1, 2016, are the provisions of the regulation on the profit participation in health insurance GBVKVU, Federal Law Gazette II No. 120/2007 amended the Ordinance BGBl. No. 34/2015, to apply I.
Ettl Kumpf Müller