Regulation On The Procedure For The Risk Compensation In The Statutory Health Insurance

Original Language Title: Verordnung über das Verfahren zum Risikostrukturausgleich in der gesetzlichen Krankenversicherung

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Regulation on the procedure for the risk compensation in the statutory health insurance (risk structure compensation regulation – RSAV) RSAV Ausfertigung date: 03.01.1994 full quotation: "risk structure compensation regulation by January 3, 1994 (BGBl. I S. 55), by article 10 of the Act of July 17, 2015 (BGBl. I S. 1368) has been changed" stand: last amended by article 15 G v. 21.7.2014 I, 1133 Note: amended by art. 13 G v. 16.7.2015 I 1211 (No. 30) still not change taken into account by article 10 G v. 17.7.2015 I 1368 (No. 31) still learn not considered to the stand number in the menu see remarks footnote (+++ text detection from: 1.1.1994 +++) input formula on the basis of § 266 section 7 of the fifth book of social code, by article 1 No. 143 of the Act of 21 December 1992 (BGBl. I S. 2266) new is been taken directed the Federal Ministry of health: first section of common rules article 1 definitions (1) insured persons within the meaning of this regulation are all insurance and insurance-eligible members and family members.
(2) members within the meaning of this regulation are the health structure law insurance or pursuant to § 9 of the fifth book the social law voluntarily insured § 14 all according to § 5 of the fifth book of the social code, referred to in article 56 of the health reform law, and referred to in article 33.
(3) health insurance within the meaning of this regulation are the location, operation, and Guild health insurance, the Deutsche Rentenversicherung Knappschaft-railway-see as a carrier of miners health insurance, as well as the Lake health insurance and the spare funds.
(4) leading associations of sickness funds within the meaning of this regulation are the facilities referred to in article 213, paragraph 1 of the fifth book of the social code without the Federal Association of agricultural insurance in 2008 the Association of top federal of health insurance fund.
(5) carrier the statutory pension insurance within the meaning of this regulation, the regional carriers are the Deutsche Rentenversicherung, federal and the Deutsche Rentenversicherung Knappschaft-Bahn-see.

§ 2 groups of insured persons (1) is the post need of a health insurance company pursuant to section 266, para 2 of the fifth book of the social code to determine separately to groups of insured persons (§ 267 par. 2 of the fifth book of the social code). Groups of insured persons are after age separately to make gender and following additional status features: 1. insured persons who claim sick pay their remuneration or payment of an allowance which the compulsory insurance are entitled to sickness benefit, but for at least six weeks incapacity, without insured persons referred to in paragraph 4, 2. insured persons who claim sick pay their remuneration or payment of an allowance which the compulsory insurance are entitled to sickness benefit, but not for at least six weeks for incapacity for work , without the insured person referred to in paragraph 4, 3. insured persons, incapacity not entitled to sickness benefit have, without the insured person referred to in paragraph 5, 4. the insured persons referred to in paragraph 1 and 2, whose earning capacity is impaired to the articles 43 and 45 of the sixth book of the social code, 5. the insured person referred to in paragraph 3, whose earning capacity is impaired to the articles 43 and 45 of the sixth book of the social code.
For insured persons under section 28 d, paragraph 1 in a certified structured treatment program for diabetes bronchial or for chronic obstructive pulmonary disease are enrolled mellitus type 1 or type 2, for breast cancer, heart disease, for asthma according to § 137 g of the fifth book of the social code, for each of these diseases, according to the characteristics of the State formed in set of 2 separate groups of insured persons. Inscribes itself in an a pursuant to § 137 g of the fifth book of the social code certified structured treatment program of registered insured in another treatment program, the health insurance fund determined pursuant to sentence 3, the insured person which insurance group to associate is. The Association pursuant to sentence 4 by the health fund can only be effect from the beginning of the next fiscal year to be modified.
(2) voluntarily insured persons of the General contribution rate applies to section 241 of the fifth book of the social code, are to assign No. 1 or 4 groups of insured persons referred to in paragraph 1. Voluntarily insured persons, the increased contribution rate applies to section 242 of the fifth book of the social code, are to assign No. 2 or 4 groups of insured persons referred to in paragraph 1. Voluntarily insured applies a reduced contribution rate, are referred to in paragraph 1 No. 3 or 5 groups of insured persons; Contribution discounts referred to in § 53 of the fifth book of the social code shall be disregarded.
(3) pursuant to paragraph 1 sentence 2 a year amount the age. Insured persons are to assign the age calculated from the difference between collecting and year of birth. Insured with an age under one year are null, and insured persons with an age the age over 90 years 90 years to map the age. In the groups of insured persons pursuant to paragraph 1 Nos. 4 and 5 are an age under 35 years old to associate with insured persons aged 35.
(4) for the assignment of the insured the insured groups, the persistence of membership is even decisive, according to § 192 of the fifth book of the social code, if pension is granted retroactively.
(5) insured persons, their claims pursuant to § 16 para 1 No. 2 to 4 of the fifth book of the social code rest, members for their contribution assessment § 240 para 4a of the fifth book of the social code shall apply and whose nationals insured pursuant to § 10 of the fifth book of the social code, as well as members, whose claims rest, according to section 256a, paragraph 4, of the fifth book of the social code are not included in the insured group referred to in paragraph 1.

Survey of insurance periods (1) the health insurance levy section 3 every year for the calendar year (year) as well as for the first and the fifth year prior to the year under review, a survey for more previous years stipulates the sum of the periods of insurance completed by the insured persons in the groups of insured persons according to § 2, unless the agreement of leading associations of sickness funds according to § 267 par. 7 of the fifth book of the social code. The sum of the periods of insurance completed in the year pursuant to sentence 1 is to specify in the quarter financial statements and the financial statements.
(2) for the assignment of the insured persons to the groups of insured persons according to § 2, the statutory characteristics according to § 2 para 1 and age are decisive according to § 2 para 3 during the survey period. For its association with the groups of insured persons according to § 2 para 1 sentence 3, the enrollment is pursuant to section 28 d paragraph 1 in according to § 137 g of the fifth book of the social code effectively approved structured treatment program apply.
(3) an insurance period pursuant to paragraph 1 begins with the day on which the requirements for assignment to a group of insured persons are according to § 2; It ends with the tag where the conditions fall away. For an insured person pursuant to § 10 of the fifth book of the social code the insurance period begins with the day on which the family insurance starts; the point is to prove through a timely message after § 10 section 6 or section 289, sentence 2 and 3 of the fifth book of the social code. Sentence 2 shall apply without prejudice to a performance claim pursuant to section 19 para 2 of the fifth book of the social code. The family insurance ends with the Elimination of the requirements or with the departure of the Member from the membership. In the groups of insured persons according to § 2 para 1 sentence 2 No. 4 and 5 begins the period of coverage of people receiving a time pension on account of reduced earning capacity by January 1, 2001 with the first day of the sixth month prior to the start of the pension for the people receiving of a life pension for disability with the date of the commencement of the pension; the time pension begins before July 1, 2001, the insurance period begins at the earliest on January 1, 2001. Insured of the insured groups are Nos. 1 and 2, who were insured prior to the approval of the pension on account of incapacity with entitlement to sickness benefit to assign to no. 4 No. 1 of the fifth book the social law of the insured group health for this period up to the receipt of the notification according to section 201 (4) according to § 2 para 1 sentence 2 according to section 2, subsection 1, sentence 2. In the groups of insured persons according to § 2 para 1 sentence 3 the insurance period begins with the day of the registration according to section 28 d paragraph 1 sentence 1 No. 1 to 3 in a pursuant to § 137 g of the fifth book of the social code are certified structured treatment program, but not before the day on which met all in section 28 d paragraph 1 sentence 1 No. 1 to 3 conditions laid down , in the case of section 28 d paragraph 3 at the earliest with the day of the renewed membership of the insured person to the health insurance fund. You ends 1 with the date on which the approval of the programme in particular by abolishing pursuant to § 137 g, paragraph 3 of the fifth book of the social code or by waiver of the registration ends 2 with the day of withdrawal of the Declaration of consent according to Article 137f par. 3 of the fifth book the social act by the insured, or 3rd with the date of last documentation (documentation date), when the participation of the insured in the program ends after section 28 d paragraph 2 sentence 1 No. 2.
(4) the health insurance companies submit the data referred to in paragraph 1 until 16 April of the year following the year under review the bodies responsible for them according to § 79 paragraph 1 sentence 2 of the fourth book of the social code on machine usable disks. The leading associations of sickness funds no later than four weeks after the closing date referred to in sentence 1 of the Federal Insurance Office machine usable disk forward the data to check for completeness and plausibility. The leading associations of sickness funds Federal Insurance Office in writing inform the result of its examination pursuant to sentence 2. Details about the unified technical preparation of the data to determine the Federal Insurance Office. The data the Federal Insurance Office are not available by the deadline referred to in sentence 2 or the Federal Insurance Office finds significant errors, it can consider the insurance periods of the previous year, taking into account the Member turnover rate and a reasonable safety trigger after hearing of the affected top associations or health insurance; Paragraph 5 shall apply mutatis mutandis.
(5) corrections are included in the periods of insurance referred to in paragraph 1 in the annual adjustment of the compensation year when calculating the values still not determined; In addition, they are included in the calculation of the contribution requirement in the next year according to the applicable regulations. For years of compensation that are longer than five years prior to the year under review, corrections be carried pursuant to sentence 1 only in exceptional cases determined by the federal insurance administration. Health insurance where the amount of a correction was raised by extrapolation according to § 15a paragraph 3 sentence 1, can claim only corrections for the compensation year, the extrapolation was referring to, when a data message in accordance with § 15a paragraph 3 set 9 is properly corrected.
(6) for the monthly compensation according to § 17, the health insurance companies charge the insurance periods of the insured persons in the groups of insured persons according to § 2 for the periods of January 1, January 2 to March, 3 January-June and January 4 until September (periods) of the compensation year. The sum of the periods of insurance completed by the individual reporting periods after set is 1 No. 2-4 to specify in the respective quarterly invoice. The health insurance companies place the insurance times underlying multiplied with a factor of change pursuant to sentence 4. The scale factor is the ratio of the number of insured persons of the health insurance fund, which is logged for the first month in the monthly statistics, the average monthly insured number the last survey period pursuant to sentence 1. The Federal Insurance Office can determine a set of 4 different scale factor with the agreement of the Central associations of sickness funds. The estimated contribution requirements differs substantially and demonstrably 1 and 3, taking into account the most recently made known calculation factors according to § 10 ABS. 3 due to the calculation procedure to set the outcome to be expected in the year, the Federal Insurance Office on the proposal of the top Association of affected health insurance in individual cases to determine a procedure different from set 1 and 3.
(7) all mechanically produced in the framework of the implementation of the risk structure compensation data bases, as well as all documentation of any correction messages are to store nine years. The retention period begins with the calendar year following the year under review. A health insurance company is only obligated to a longer storage and is entitled, if in individual cases, the Federal Insurance Office finds that more storage to carry out corrections of the reported data is required; in this case, the data is to delete after twelve years. The identification of groups of insured persons is carried out according to § 2 para 1 sentence 3 alphanumeric encryption in the fifth spot of the mark according to § 267 par. 5 sentence 1 of the fifth book of the social code; in this respect, this indicator may be electronically stored and readable.

§ 4 Berücksichtigungsfähige power expenditure (1) in determining the standardized performance issues after the §§ 6 and 7 are into consideration particular expenses for 1 services for workplace health promotion, prevention of work-related health hazards, promoting self-help and primary prevention through immunization after the sections 20a to 20 d para 1 and 3 of the fifth book of social code, services for the prevention of dental diseases according to sections 21 and 22 of the fifth book of the social code , medical benefits and medical benefits for mothers and fathers after the sections 23 (1) and 24 of the fifth book of social code, health and children studies after the sections 25 and 26 of the fifth book of the social code and services pursuant to § 22 of the ninth book of social code, 2. treatment according to § 13 para 4 sentence 1 to 5 and paragraph 5, § 18 para 3, the §§ 27a of up 33, 37 para 1 sentence 1 to 4 and 2 set 1-3 , the articles 37a, 38 par. 1, the articles 39, 42 and 43a of the fifth book of the social code, 3. sickness benefit after the sections 44 and 45 of the fifth book the social law including the capitalised posts, 4. pregnancy and maternity benefits according to the § § 24 c 24i of the fifth book of the social code, benefits under the sections 24a and 24B of the fifth book of the social code, 5. medical rehabilitation benefits and rehabilitation for mothers and fathers to the §§ 40 and 41 of the fifth book of the social code, as well as contributions for pursuant to section 2 para 1 No. 15 letter a of the seventh book of social law in the accident insurance insured persons, 6 are travel costs according to section 60 of the fifth book of social code, ready-to-wear them by health insurance, 7 the medical service according to section 281 of the fifth book of social code, 8 specialized outpatient palliative care according to § 37 b of the fifth book of the social code and stationary or part of inpatient care in hospices to the amount of the minimum grant according to § 39 a para 1 sentence 3 of the fifth book of the social code , 9 hospital investments referred to in article 14 paragraph 2 and 3 of the law of health structure, 10 medical benefits pursuant to § 23 para 2 and 4 of the fifth book of the social code and complementary services of rehabilitation according to § 43 of the fifth book of social code, if and insofar as this in the framework of a structured treatment program for insured services according to § 2 para 1 sentence 3, 11 program costs for insurance written in structured treatment programs according to § 2 para 1 sentence 3 , as far as this third party payers in addition and directly in connection with the development, approval, implementation, and evaluation of structured treatment programs expenses; the expenses are as lump sums. The leading associations of sickness funds no. 1 and 2 of the fifth book of the social code, 12 determine the details in their agreement to § 267 par. 7 acquisition of amounts due to the exceeding of the load limit according to § 62 of the fifth book of social code, unless it pro rata on the expenses for the numbers 1 to 11 omitted, 13 treatment under § 27 paragraph 1a, sickness benefit according to § 44a of the fifth book of the social code, as well as the reimbursement of paid on remuneration according to § 3a paragraph 2 of pay sick pay law including this related posts.
The expenses for the services of the associations of doctors and dentists are calculated in the same way as for Panel doctors and dentists.
(2) the expenses for benefits referred to in paragraph 1 statutory additional services in primary prevention include not expenses for 1 through vaccinations according to § 20 d para 2 of the fifth book of the social code and out-patient benefits under § 23 para 2 sentence 2 and 3 of the fifth book the social law, for home nursing care according to § 37 para 2 sentence 4 of the fifth book of social code, for domestic help according to § 38 paragraph 2 of the fifth book of the social code , 2. benefits for treatment abroad according to § 13 para 4, sentence 6, article 18, paragraph 1 and 2 of the fifth book of social code, prevention and self-help according to § 20 of the fifth book of social code, when domestic nursing according to § 37 para 1 sentence 5 of the fifth book of the social code, as well as for outpatient benefits provided to insured persons according to § 2 para 1 sentence 3 according to § 23 paragraph 2 sentence 1 of the fifth book of the social code , inpatient benefits according to section 23 (4) of the fifth book of the social code and complementary services of rehabilitation according to § 43 of the fifth book of the social code, 3. pilot projects according to article 63, paragraph 2, and section 65 of the fifth book of social code, bonuses for health-conscious behaviour according to section 65a of the fifth book of the social code as well as premium payments and payment discounts according to § 53 of the fifth book of social code, 4 additional services according to section 2, paragraph 1, of the regulation on the further expansion of the miner insurance in the in the Federal Law Gazette Part III , Outline number 822-4, adjusted version published recently by article 22, Nr. 1 of the law of 22 December 1983 (Federal Law Gazette I p. 1532) has been amended is 5 research projects, in particular to section 287 of the fifth book of social code, 6 performance issues, which will be compensated for the risk pool (section 269 of the fifth book of the social code).
(3) refunds and revenue, in particular pursuant to § 19 of the Bundesversorgungsgesetzes, § 39, paragraph 2, and article 49, paragraph 1 No. 3 in conjunction with § 50 of the fifth book of social code, the infection Protection Act of 20 July 2000 (Federal Law Gazette I p. 1045), article 63 of the health reform law and §§ 102 and 117 of the tenth book of the social code, and payments of foreign agencies on the basis of intermediate or supranational regulations reduce the expenses referred to in paragraph 1 to be considered for services. Repayments of payments to be made to the insured on the basis of exceeding the load limit according to § 62 of the fifth book of the social code and advances of co-payments by the insured are assigned to the respective compensation year and 2004 will be considered by the reporting year flat rate. The leading associations of sickness funds determine Nos. 1 and 2 of the fifth book of social law book details about the need in consultation with the Federal Insurance Office in their agreement to § 267 par. 7. This is to ensure that performance issues incapable of considering attributable amounts does not lead to an increase of consideration capable performance issues by defining a suitable distribution key.
(4) for the conduct of risk structure compensation the performance issues are under paragraph 1 minus the amounts pursuant to paragraph 3 to allocate the compensation year, which according to § 37 of general administrative regulation on the accounting in the social security system by July 15, 1999 (BAnz. No. 145a by August 6, 1999) can be amended during the survey period, and in accordance with the provisions of the Kontenrahmens for the winners of the statutory health insurance.

§ 5 ratio values for calculating the standardized performance issues (1) the Federal Insurance Office calculated for all health insurance ratio according to § 266 (2) sentence 3 and para 5 No. 1 of the fifth book of the social code as follows: for each insured group (§ 2 para 1) according to § 267 par. 3 of the fifth book of the social code are 1 to share in any insurance group by the number of insured years of insured persons included in the sample (sample insured years) determined amounts of consideration capable performance issues (section 4).
2. the sum of the performance issues after number 1 of all groups of insured persons is also divided by the sum of the sample insurance years.
3. the results referred to in point 1 are respectively divided by the result referred to in point 2 and multiplied by 100.
The Federal Insurance Office may differ from the calculation requirements referred to in point with the agreement of the Central associations of sickness funds 1 to 3 If the ratio values be improved.
(2) the ratio values are referred to in paragraph 1 No. 3 after each sampling to determine § 267 par. 3 of the fifth book of the social code and to announce the Federal Insurance Office.
(3) in order to improve the sampling results you can according to § 267 par. 3 of the fifth book of the social code are collected amounts adjusted by the Federal Insurance Office in consultation with the Central associations of sickness funds through statistical calculation methods or supplemented by other available statistical basis, surveys or scientific analysis for single or multiple activity types or replaced.
(4) the health insurance their umbrella organisations present the Federal Insurance Office on machine usable disks the results of the data collection according to § 267 par. 3 of the fifth book of the social code until August 15, the results to the sickness benefit spending and sick pay days until May 31 of the following year. The umbrella organisations, examine the results pursuant to sentence 1 prior to transmission to the Federal Insurance Office for completeness and plausibility and inform the Federal Insurance Office in writing the result of the test. Details about the unified technical preparation of the data to determine the Federal Insurance Office; the provision replaces the agreement insofar § 267 par. 7 No. 1 of the fifth book of the social code.
(5) in order to improve the sampling results pursuant to paragraph 3, the sickness funds in consultation with activity types referred to in their organisation for in § 267 par. 3 of the fifth book of the social code and the groups of insured persons may raise supplementary data pursuant to article 2 on the basis of them present performance and the accounting documents not versichertenbezogen.
(6) for the avoidance of output offset of individual health insurance companies through the formation of groups of insured persons according to § 2 para 1 sentence 3 the leading associations of sickness funds set a suitable statistical smoothing technique Nos. 1 and 2 of the fifth book of the social code in the agreement according to § 267 par. 7.

§ 6 standardized performance issues the Federal Insurance Office provides for the previous business year (compensation) in each group of insured persons (§ 2) standardized performance spending per insured year (§ 3) for all health insurance companies like this binding set: 1. the amount of the compensation year taking into account enabled performance spending (section 4) of all health insurance companies is divided by the sum of insured years (section 3) of all groups of insured persons.
2. the result referred to in point 1 is multiplied for each insured group with the respective ratio according to § 5 para 1 No. 3 and divided by 100.
3. the results referred to in point 2 are multiplied for every insured group with the corresponding number of insured years of all health insurance companies and the sum of these results divided by the sum of all groups of insured persons insured years.
4. the result is number 1 to share (correction factor) the results referred to in point 3.
5. the results referred to in point 2 are to multiply the correction factor referred to in point 4.

§ 7 estimated standardized performance issues (1) which provides federal insurance office after consultation with the leading associations of sickness funds in advance for one calendar year provisional according to § 6 No. 1 for all health insurers binding set. It is known through December 15th for the following calendar year. The Federal Insurance Office can adjust the provisional value pursuant to sentence 1 and for a shorter period each until the 20th of the previous month to announce if you determine significantly changed assumptions since the last notice.
(2) the preliminary value referred to in paragraph 1 is with the last values observed relationship (§ 5 para 1 No. 3) to convert the insurance groups. The impact of the introduction of the risk pools are according to § 28a paragraph 5 and 6, as well as the formation of groups of insured persons according to § 267 par. 2 sentence 4 of the fifth book of the social code to consider. For the calculation and publication of the provisional performance issues of apply paragraph 6 and paragraph 1 standardized set of 2 and 3 according to. The preliminary standardized performance issues for the groups of insured persons according to § 267 par. 2 sentence 4 of the fifth book of the social code are valued by the Federal Insurance Office in consultation with the Central associations of sickness funds on the basis of available statistical bases, surveys or scientific analysis, as long as there are no results of data collection are according to § 267 par. 3 of the fifth book of the social code for these groups of insured persons, or if these results, this can be improved.

§ 8 insurance contributory income (1) for the determination of financial strength (§ 12) compute after paragraph 2 to 5 the sum of insurance revenue its members for each month of the year of the compensation.
(2) the sum of the contribution requirements set by the health insurance for the months in a year of compensation without those referred to in paragraph 4 and minus the during these months of the contribution requirements according to section 76, paragraph 2, sentence 1, Nos. 2 and 3, and sentence 3 of the fourth book of the social code set off amounts (post nominal) and less of contribution refunds according to § 231 of the fifth book of the social code, and less of the employer contribution pursuant to § 249 b of the fifth book of the social code is for the in the articles 241 to 246 of the fifth Book social security code to multiply these types of income with the number 100 referred members and which in paragraph 248 of the fifth book of the social code and to divide by the sum of the General contribution rate in the compensation year according to § 241 of the fifth book of the social code and the additional contribution rate according to § 241a of the fifth book of the social code. The sum of the contribution rates has changed during the year balance, the calculation is separated according to the periods to carry out, for that was the sum of the contribution rates. For post recalculations, the contribution rates sum applicable at the time of the target is to be based.
(3) for members whose contributory Einnahmen are not determinable pursuant to paragraph 2, which contributions are not calculated according to §§ 226 to 240 of the fifth book of the social code or which contributions raised after a contribution set by articles 241 to 246 of the fifth book a different social security code, the contributions made in the compensation year and contribution claims established at the end of the compensation are considered contributions within the meaning of paragraph 2. Insurance revenues can be pursuant to sentence 1 does not determine are for voluntary members who are full-time independently gainfully employed for the calendar day to apply the average insurance income of all members of this health insurance for the remaining members of the 30th part of the monthly contribution assessment ceiling.
(4) who are paid and reported in the post guarantees of the pension insurance funds monthly pensions must members for the compensation year according to § 5 ABS. 1 of the fifth book of the social code as basing contributory earnings.
(5) the sum of the results referred to in paragraph 2 and 3 and the insurance proceeds under paragraph 4 are to indicate separately in the respective quarter financial statements and in addition, for the period 1 January to 31 December in the financial statements.

Estimated contributory income (1) for the monthly compensation (article 17) are § 9 to use the amounts of insurance revenue, preceding the previous month of the month of compensation according to § 8 par. 2 and 3 of the month. § 8 para 4 in the respective month of compensation shall apply accordingly for the pensions. The Federal Insurance Office can determine in agreement with the Central associations of sickness funds that by way of derogation from sentence 2 reported for a different period than the month of compensation pensions underlying be.
(2) in the case of newly established health insurance for a calculation is not yet created according to § 8, the Federal Insurance Office determines the details on the calculation of the estimated monthly sums of insurance revenue.
(3) the Federal Insurance Office can determine a different paragraph 1 procedure in justified individual cases at the suggestion of the top Association of affected health insurance. The Federal Insurance Office can determine a different paragraph 1 procedure with the agreement of the Central associations of health insurance for all health insurance companies.

§ To determine 10 contribution requirement (1) which is post need of a health insurance for the compensation year as follows: Standardized performance spending per insured year (§ 6) are 1 to multiply in each insurance group (§ 2) with the number of insured years (§ 3).
2. the results referred to in point 1 are together and to the employer's contribution drawn by the health insurance fund pursuant to § 249 b of the fifth book of the social code as well as to reduce the participation of the Confederation on expenses according to § 221 of the fifth book of the social code.
(2) for the determination of the contribution requirement for the compensation according to § 19 the Federal Insurance Office sets underlying the performance issues standardized according to § 6 and the reported periods of insurance pursuant to § 3 para 4.
(3) for the determination of the provisional contribution required for the monthly compensation according to § 17, the health insurance companies put the expected standardized performance expenditure pursuant to section 7 and the insurance periods according to § 3 paragraph 6, sentence 1 to reason as follows: 1 the periods of coverage under section 3, paragraph 6, sentence 1 No. 1 for the compensation months March to may, 2. the insurance periods after section 3, paragraph 6, sentence 1 No. 2 for the compensation months June to August , 3. the periods of coverage under section 3, paragraph 6, sentence 1 No. 3 for the compensation months September to November, 4. the periods of coverage under section 3, paragraph 6, sentence 1 No. 4 for the compensation months December, as well as for the compensation months January and February of the following year.

Section 11 compensation requirements record (1) the compensation requirements set under section 266, paragraph 3, sentence 2 and 3 of the fifth book of the social code determines the Federal Insurance Office for annual compensation as a percentage of the insurance proceeds as follows: 1 that are contribution requirements (section 10) of all health insurance companies to include together (amount of contribution required), to increase the amount under section 28 h paragraph 2 sentence 2 and to reduce the amount of employer contributions according to § 249 b of the fifth book of the social code.
2. the insurance revenue (section 8) of the members of all health insurance companies are totalize (compensation payroll Basic).
3. the result is number 1 to multiply by 100 and to share (compensation requirements record) the results referred to in point 2.
(2) for the monthly compensation according to § 17 the provisional compensation needs set by the Federal Insurance Office after consultation with the leading associations of sickness funds is appreciated. The estimate is to adapt to interim changes in the amount of contributions required and the reason compensation payroll. § 3 par. 6, sections 7, 9 and 10 apply to the estimation of the forecast contribution requirement and the estimated insurance revenue of all health insurance companies.

Article 12 finances (1) the financial strength of an insurance company in the compensation year is the product of the insurance revenue of its members (article 8) and the compensation requirements record (section 11).
(2) for the monthly compensation according to § 17, the health insurance determined their financial strength on the basis of the estimated insurance revenue pursuant to § 9 and of provisional countervailing demand rate according to § 11 para. 2.

§ 13 calculation basis (1) that sets Federal Insurance Office the incumbent upon this regulation calculations 1 after the applicable provisions of drawn up and presented to the authorities according to article 79, paragraph 1 of the fourth book of the social code business and accounting results of health insurances, 2. billing according to section 227 of the sixth book the social law, 3rd which according to § 267 par. 4 of the fifth book of the social code submitted results underlying.
(2) the Federal Insurance Office may 1 in sections 5, span 6, 7 and 10 prescribed calculation steps to establish of the post requirements to simplify, 2nd for calculations and announcements instead of the insurance year to use the insurance day, deviate 3. in date referred to in the agreement with the Central associations of sickness funds in the taking into account of insurance income from pensions (§ 8 para 4) in § 267 par. 6 of the fifth book of the social code.

§ 14 settlement, payment transactions, late payment surcharges (1) which are monthly payments according to section 17, the year compensation according to § 19 and the risk pool to section 269 of the fifth book of the social code of the German pension insurance Federal settled. Details about the billing procedure determines Federal the Federal Insurance Office after consultation with the leading associations of sickness funds and the German pension insurance.
(2) the payments to them on the accounts relevant for the forwarding of the total social security contributions are unless the Deutsche Rentenversicherung otherwise Federal. There are accelerated transfer procedures to make contributions from 250,000 euros. Payment by cheque is not allowed. The payment is satisfied with the incriminating value position and execution before closing time Bank on the maturity day.
(3) for late payment of compensation, a late payment surcharge of 1 per cent of the arrears amount to the payee is payable for each month of delay. The time applies to the collection of late payment surcharges in monthly compensation according to § 17 par. 5 sentence 3; Article 17, paragraph 4, sentence 2 shall apply with the proviso that access of the setting by the Federal Insurance Office takes the place of the access of request. The maturity date is for the collection of late payment surcharges in annual compensation according to article 19, paragraph 3, sentence 2. A blameless credit delay, the German pension insurance to determine Federal in individual cases deviate from the amount pursuant to sentence 1. Be proof or fixing a monthly compensation payment set 1 through an adjustment according to § 17 par. 5 sentence 4, recalculate according to § 17 According to article 19, paragraph 2, sentence 2 repealed paragraph 3a or a notice, changed according to § 17 paragraph 6, sentence 1, paragraph 8 or corrected, the late payment surcharges forfeited until then remain unaffected; the same applies, if the decision on a recalculation para 3a repealed according to § 17 by a notice according to article 19, paragraph 2, sentence 2, changed or corrected.
(4) as far as Federal the of the German pension insurance amounts arising from late payment are not offset by surpluses in the monthly compensation or adjustments of the countervailing demand rate in the monthly balance or year compensation, late payment charges are entitled to Federal pursuant to paragraph 3 of the German pension insurance. In addition, they are entitled to health insurance and be taken into account in the next year. Details on the distribution and settlement of late payment surcharges determined Federal the Federal Insurance Office after consultation with the leading associations of sickness funds and the German pension insurance.

§ 15 notices
Notices provided for in this Regulation shall be by notice of the Federal Insurance Office of the leading associations of sickness funds and the Deutsche Rentenversicherung Federal. The umbrella organisations ensure that the health insurance companies, for which they are responsible, immediately become party of the notice. The Federal Insurance Office provides public notice in an appropriate electronic form.

section 15a of the examination (1) the bodies involved in the test according to section 274 of the fifth book of the social code have annually in the Exchange to examine the message of all periods of insurance under section 3 as well as the cases reported according to § 28 para 3 for one of the last two years of compensation at health insurance companies under its jurisdiction. In the context of review of insurance periods according to § 3 is for an insured person, the in a pursuant to § 137 g of the fifth book of the social code certified structured treatment program are enrolled, according to § 2 para 1 sentence 3 to examine the existence of the prerequisites for the affiliation of these insured persons to the groups of insured persons; the cases reported according to § 28 para 3 are in particular as regards the accuracy of the reported performance issues, to check the identity of the person and the reference year. The Federal Insurance Office can determine after consulting the bodies concerned with the test according to section 274 of the fifth book of the social code and the leading associations of sickness funds, that the health insurance companies have to provide the data to be checked electronically, and to determine more details. Examinations pursuant to sentence 1 the Federal Insurance Office after consulting the leading associations of sickness funds and with the test according to section 274 of the fifth book of the social code sets the sampling and extrapolation methodology, in particular the respective procedure for determining a reasonable sample size, concerned authorities for the respective test cycle and details on the requirements for the collection of samples, as well as on the communication of inspection results pursuant to sentence 5. Which dealt with the test according to section 274 of the fifth book of the social code points the results of the checks forthwith communicate to the Federal Insurance Office, the health and the organisation of the affected health insurance pursuant to sentence 1.
(2) the Federal Insurance Office that recalculates when assessing the insurance periods of a health insurance company (1) set 1 set ratio of incorrect or not plausible cases to the total number of insured of this insurance high. When assessing pursuant to paragraph 1 sentence 1 determines that a health insurance scheme has wrongly received reimbursement benefits from the risk pool (section 28a), the Federal Insurance Office to extrapolate the observed error rate on the totality of the insured of this insurance for which the sickness fund has asserted claims for reimbursement. The Federal Insurance Office determines the respectively applicable extrapolation procedure in consultation with the Central associations of sickness funds. Here it can also stipulate that the projection only takes place if the faulty or not plausible cases exceed a certain quota.
(3) the federal insurance office determined the amount of the correction on the basis of extrapolation pursuant to paragraph 2 sentence 1 and 2 and submits it by decision. § 14 para 3 sentence 1 and § 19 para 3 and 4 shall apply mutatis mutandis. The health insurance can correct the underlying data message in the context of a census when the obligation to pay the amount of a correction. If a census is conducted, is to inform the Federal Insurance Office of the health insurance fund within three months after receipt of the notification pursuant to sentence 1. The insurance company informs that no census will be conducted, or the time limit referred to in sentence 4 shall, without notice of the health insurance fund, the Federal Insurance Office finally sets the amount of the correction and the amount of the correction is taken into account in the next year. Otherwise is the time limit for carrying out the Census one year after receipt of the notification pursuant to sentence 1 the Federal Insurance Office determines the proper correction of the data message, the insurance company gets back the paid amount of correction. Otherwise the Federal Insurance Office finally sets the amount of the correction, and the correction is taken into account in the next year. The data message is considered to have been corrected, if the body responsible for inspecting the health insurance according to section 274 of the fifth book of the social code confirmed the Federal Insurance Office on the basis of a sample of newly drawn ten months after the Census referred to in paragraph 1. Paragraph 1 2 shall apply set 2 to 4, as well as sales. Interest and default surcharges are taken into account in the next year.
(4) in force until October 29, 2007 amended paragraphs 1 to 3 shall apply for the testing of compensation years including the compensation year 2004 as well as all these years in the year 2005 made corrections.
Second section monthly compensation section 16 rights and obligations for the calculation of the amount of the compensation claim or the compensation obligation of the health insurance fund their contribution requirements (§ 10) will be deducted from their financial strength (§ 12). The contribution requirement exceeds the financial strength, the excess amount is entitled to health insurance, whose contribution requirement exceeds their financial strength.

§ 17 monthly compensation (1) each health insurance calculated monthly the amount of their claim or their obligation in the risk compensation (article 16).
(2) is on the respective month (month of compensation) deferred estimated contribution requirements (§ 10 par. 3) higher than the expected financial strength (§ 12 para 2), so the insurance company receives the difference amount Federal of the German pension insurance.
(3) the estimated contribution requirement attributable to the particular month is lower than the expected financial strength, so the German pension insurance receives the difference amount Federal by the health insurance fund.
(3a) the Federal Insurance Office recalculated the estimated insurance revenue for all health insurance companies respectively as of 30 September for the period of the first half of the year and 31 March of the following year for the period of the entire previous year according to § 9 on the basis of the present quarterly invoices according to § 10 of general administrative regulation on the statistics in the statutory health insurance, as well as the temporary post requirements according to § 10 paragraph 3 on the basis of the most recent estimate according to § 11 para. 2. Federal shares with the balance to be paid, taking into account the payments incurred for the period the health insurers and the German pension insurance. For this purpose the Federal Insurance Office redetermines the balance requirements set pursuant to § 11 subsection 2 and the provisional value pursuant to § 7 para 1. The rules for the monthly compensation procedure shall apply mutatis mutandis. The Federal Insurance Office may in agreement with the Central associations of sickness funds and the German pension insurance by the dates referred to in sentence 1 Federal or refrain from performing the procedure pursuant to sentence 1. The leading associations of sickness funds can determine in consultation with the Federal Insurance Office in their agreement to § 267 par. 7 Nos. 1 and 2 of the fifth book of social security code details of the calculation method and the delivery of additional data by the health insurance companies.
(4) the health insurance companies charge the amount due to them referred to in paragraph 2, including contributions from pensions contributions to guiding further federal to the German pension insurance scheme in the respective month of the compensation due to them after section 255 para 3 sentence 1 of the fifth book of the social code. As far as a health insurance company may not charge the amount each month, the German pension insurance has to pay this amount to federal to request the health insurance after deducting the amounts expected to be in the relevant calendar month billing enabled until the fifth business day after receipt of the request. Early access of a request is the first working day of each month of compensation.
(5) the health insurance companies charge the pursuant to paragraph 3 of the German pension insurance of Federal amount to contributions from pensions due to them after section 255 para 3 sentence 1 of the fifth book of the social code. Contributions from pensions exceed the difference amount pursuant to paragraph 3, sentence 2 and 3 according to paragraph 4 shall apply. The health insurance company to pay the excess amount to the German pension insurance Federal up to the 15th of each month of the compensation exceeds the difference referred to in paragraph 3 which has contributions from pensions. Compensations are set 1 due to adjustments of evidence pursuant to paragraph 6 to the fifth working day after detection or access of the request to the German pension insurance federal, insofar as no other due date is determined by the federal insurance administration.
(5a) can the requirements pursuant to paragraph 4 sentence 2 and paragraph 5 sentence 2 is expected not from the German pension insurance are met Federal available liquid resources, which are set in paragraph 4 sentence 2 and paragraph 5 2 and 3 referred to amounts to avoid financial burdens of the German pension insurance to pay federal due to the different payment dates for payment-eligible health insurance and payment-required health insurance companies on the 18th of each month of compensation. The Federal Insurance Office determines after consultation with the leading associations of sickness funds in which compensation months sentence 1 applies.
(6) the health insurance companies have the German pension insurance federal to the 10th day of each month after paragraphs 2 and 3 shall be payable amounts and the calculation basis (§ 10 par. 3, article 12, para. 2) after. The evidence can the German pension insurance Federal will be sent on the provided forms by fax for the monthly compensation. The German pension insurance is has the evidence to be kept after the invoice documents applicable retention periods and to prove the charged according to paragraphs 4 and 5 and paid amounts for each insurance company separately. You send a bank statement; on this at the end of the calendar year of each health insurance company the more determined the Federal Insurance Office.
(7) health insurance are with each other has been United, the monthly payments are according to the sum of the values determined for the involved health insurers in the initial period to calculate. Accordingly, it is to proceed with the calculation of the first monthly discount.
(8) the not evidence pursuant to paragraph 6 sentence 1, these are defective or which are not provided resulting payments from it, the Federal Insurance Office for the health insurance may impose binding the amount of payment according to paragraph 2 or 3 for the month of compensation on the basis of available or estimated data. Be wholly or partially not payments pursuant to paragraph 3, section 19, paragraph 4 shall apply mutatis mutandis.
(9) the Federal Insurance Office delivered the Central associations of sickness funds data supplied by the health insurance companies for the implementation of the monthly settlement procedure as well as the data and results according to paragraphs 2, 3 and 3a for the individual sickness funds of its cash kind.
Third year compensation article 18 General (1) according to end of the calendar year are to offset the payments according to article 17, with the payments to be paid for this year through an annual adjustment.
(2) the Federal Insurance Office estimates the expected level of standardized performance spending per insured year in each group of the insured and of the compensation demand set immediately after the end of the calendar year for the annual accounts after consultation with the leading associations of sickness funds and Announces these values. The articles 6 and 11 15 shall apply paragraph 1 and §.

§ 19 annual compensation (1) the federal insurance office determined after the occurrence of the business and accounting results of all insurance participating in the monthly compensation and billing according to section 227 of the sixth book of the social code and the annual accounts of Deutsche Rentenversicherung Knappschaft-railway-see as the miners pensions insurance for the respective calendar year (compensation year): 1. for all health insurance companies: a) the standardized performance expenses per insured year in each group of insured persons according to § 6 on the basis of the ratio values according to § 5 , b) the compensatory requirements set pursuant to § 11 para 1;
2. for any health insurance and for all health insurance companies as a whole: a) the sum of the periods of insurance in each group of insured persons according to § 3, b) the amounts of consideration capable performance issues according to § 4, c) the height of post requirements according to § 10 para 1, d) the sum of insurance revenue according to § 8, e) the height of the financial strength to section 12 paragraph 1, f) by health insurers and the German pension insurance Federal pursuant to § 17 para 4 and 5 paid advance payments; According to § 17 para 4 and 5, the amounts certified by the federal insurance institution for employees according to § 17 para 6 considered payment.
(2) the Federal Insurance Office calculated the compensation or the obligation of compensation on the basis of figures obtained by him under paragraph 1 for any health insurance according to section 266 paragraph 2 sentence 1 of the fifth book of the social code. It shares the health insurers and the German pension insurance federal compensation according to § 266 paragraph 6 sentence 2 of the fifth book of the social code payments made and payments to be paid according to § 266 para 6 set 5 of the fifth book of the social code with. Article 17, paragraph 5, sentence 1 shall apply accordingly. A common calculation is to undertake for health insurance funds, which are been United together in the compensation year, pursuant to sentence 1.
(3) in the notice referred to in paragraph 2, the amounts to be paid are due. The Federal Insurance Office Federal with the sending of the notification gives up authentic the maturity date of the amounts to be paid health insurance and the German pension insurance referred to in paragraph 2.
(4) are wholly or partially not payments pursuant to paragraph 3, the Federal Insurance Office to avoid financial burdens of the German pension insurance may take into account the deficit Federal until its payment when determining the compensation demand rate for the monthly compensation (§ 11 para. 2) and the annual adjustment. Sentence 1 applies accordingly to deficits or surpluses, which remained after the end of the calendar year up to the execution of the annual adjustment in the monthly compensation.
(5) the annual adjustment is carried out until the end of the calendar year following the year of compensation.
(6) the Federal Insurance Office transmits the data and results the Central associations of sickness funds under paragraphs 1 and 2 for the individual sickness funds of its cash kind.
Fourth section transitional provisions § 20 groups of insured persons are 1994 and 1995 (1) pending the results of the data collection according to § 267 par. 2 of the fifth book of the social code and the ratio values (§ 5) on the basis of the results of the survey carried out in the years 1994 to § 267 par. 3 of the fifth book of the social code are found, is to go out in the fiscal years 1994 and 1995 for the monthly compensation according to article 17 by way of derogation from article 2 of groups of insured persons , which are separated by age, sex and following status features: 1 insured persons according to § 5 para 1 No. 1 to 10 and § 9 of the fifth book of the social code, 2. insured after § 5 para 1 No. 11 and 12, the §§ 10 and 189 para 1 of the fifth book of the social code, article 56 of the health reform law and article 33 § 14 of the health structure Act.
(2) up to the date referred to in paragraph 1, the age for the monthly compensation be five years notwithstanding § 2 para 3. Insured summarizes each in the age groups under 15 years of age and insured persons with an age over 80 years to an age group.
(3) for the year 1994 are not the in the groups of insured persons referred to in paragraph 1 according to § 5 para 1 No. 11 and 12 and article 189 para. 1 of the fifth book of the social code, article 56 of the health reform law, and article 33 § 14 of the health structure Act contain insurance obligations to retirees and family members of the insured pension claimants and their according to § 10 of the fifth book of the social code. Insured persons who receive a pension on account of reduced earning capacity and do not belong to the insured stated in sentence 1 containing in the groups of insured persons according to § 2 para 1 No. 1 to 3 are for the year 1994; Article 2, paragraph 1 does not apply as far as no. 4 to 6.

§ 21 1994-1995 (1) for the monthly compensation according to § 17 are insured number to set the number of insured persons in the groups of insured persons according to § 20 the date in the financial years 1994 and 1995 by way of derogation from the periods of insurance referred to in § 3 par. 6 1 October of the previous year. It is according to paragraphs 2 and 3 of the General administrative provision concerning statistics in the statutory health insurance from January 4, 1984 (BAnz. P. 289) in force on the date of the survey. Section 3, paragraph 6, sentence 3 shall apply accordingly.
(2) upon completion of the annual adjustment according to § 25 para 1 sentence 1 significant error detected in the reported periods of insurance (article 3), the Federal Insurance Office can consider this in determining the compensation requirements set for the monthly compensation (§ 11 par. 2). The more determined the Federal Insurance Office after consultation with the leading associations of sickness funds.

Section 22 Berücksichtigungsfähige power expenditure 1994 for the 1994 financial year is to subtract the sum of the amounts from the amount of consideration capable performance spending according to article 4, paragraph 1, and the sum of the amounts referred to in article 4, para. 3, as far as them on according to § 5 para 1 No. 11 and 12 and article 189 para. 1 of the fifth book of the social code, article 56 of the health reform law, and article 33 § 14 of the health structure Act eliminates must pensioners and family members of the insured pension claimants and their according to § 10 of the fifth book of the social code.

Article 23 relationship values in 1994 and 1995
(1) pending the results of the data collection for the first time according to § 267 par. 3 of the fifth book of the social code, has the Federal Insurance Office according to §5 for the monthly compensation (article 17) in the fiscal years 1994 and 1995 after hearing of the umbrella organisations of health insurance for all health insurance companies to estimate the ratio values and to make known. While the groups of insured persons are according to § 20 to apply. Performance issues are no. 1 of this regulation to take account for sick leave according to § 44 of the fifth book of the social code exclusively at the insurance group pursuant to section 20 para 1. Paragraphs 2 and 25 apply to the monthly compensation in the fiscal year 1996 2 set 3 (2) which is estimate referred to in paragraph 1 to change once from recyclable provisional results or partial results of the data collection, deviations are recognizable to the estimated ratio values before completing the data collection after consultation with the leading associations of sickness funds. § 7 No. 2 sentence 3 shall apply accordingly.
(3) in the 1994 fiscal year, the survey can be done according to § 267 par. 3 of the fifth book of social law book for a shorter period than the calendar year.

§ 24 contributory income 1994 (1) for the year 1994 are the amounts of pensions of the statutory pension insurance, the pension payments in insurance revenue according to §§ 8 and 9 and of labour income, which used for calculating contribution were not included for insured members, who receive a pension from the statutory pension insurance. Sentence 1 shall apply accordingly for the insurance revenue of pension claimants insured according to article 189, paragraph 1 of the fifth book of the social code.
(2) for the financial year 1994 contribution refunds are by post requirements according to section 8, paragraph 2, sentence 1 pursuant to article 231 para 2 of the fifth book of the social code to pull off.

§ 25 year offsets until 1997 (1) the annual adjustment for the year 1994 is initially on the basis of the ratio values (§ 5), which have been identified according to the results of the survey carried out in the years 1994 to § 267 par. 3 of the fifth book of the social code. On the basis of the ratio values (§ 5), which have been identified according to the results of the survey carried out in late 1995 after § 267 par. 3 of the fifth book of the social code, corrects the preliminary annual adjustment for the year 1994. With the consent of all leading associations of sickness funds according to the ratio values pursuant to sentence 2, the Federal Insurance Office can determine that a correction is not carried out pursuant to sentence 2.
(2) data collection is reached according to § 267 par. 3 of the fifth book of the social code in 1994, is the annual adjustment for the year 1994 on the basis of the ratio values (§ 5) that have been identified according to the results of the survey carried out in 1995 according to § 267 par. 3 of the fifth book of the social code. Sentence 1 shall not apply if the data collection has led to some exploitable results and with the annual adjustment referred to in paragraph 1 sentence 1 the results of the monthly compensation can be improved. To improve and supplement the sample results pursuant to sentence 2 scientific statistical evaluation of data sources and estimates may be used for the determination of the relative values.
(3) on the basis of the surveys carried out up to the year 1997 according to § 267 par. 3 of the fifth book of the social code, the Federal Insurance Office can correct the ratio values for 1994, 1995 and 1996, the annual compensation for 1997 after consultation with the leading associations of sickness funds. A single proposal of all leading associations of sickness funds is taken into account. A uniform proposal not concluded pursuant to sentence 2, the ratio values for 1995 and 1996, the annual compensation for 1997 need to be corrected.
(4) a correction is carried out pursuant to paragraph 3, can perform the Federal Insurance Office the annual adjustment for the year 1997 by way of derogation from the temporal requirement in § 19 para 5 to February 28, 1999. The Federal Insurance Office can determine the maturity of the attributable to the correction pursuant to paragraph 3 and article 3 par. 5 parts of equalization in consultation with the Central associations of sickness funds by way of derogation from article 19, para. 3.

Allocations due receivables and liabilities arising from the risk compensation are to charge a financial settlement in the sickness insurance of pensioners with at the same time due obligations and demands of section 26.
Fifth section special rules section 27 acceding territory (1) up to the expiry of section 313, para 10 letter a of the fifth book of the social code of the risk compensation for the acceding territory separately performed.
(2) health insurance, whose Zuständigkeit stretches on the acceding territory, collect the insurance periods according to § 3, taking into account enabled performance expenses pursuant to § 4 and insurance revenue according to §§ 8 and 9 in this area insured up to the date referred to in paragraph 1 separated. In 1994, § 3 para 3 sentence 2 with the proviso that the message must be made after 31 December 1992 applies for compensation.
(3) the federal insurance office determined the ratio values according to § 5, the expected standardized performance expenditure pursuant to § 7, the provisional compensation requirements set pursuant to § 11 subsection 2 and the values referred to in article 19 for the health insurance companies referred to in paragraph 2 to separate the date referred to in paragraph 1.

§ 27a financial force balance as of 1999 (1) for the purpose of establishing who is compensation claims and liabilities by January 1, 1999 by way of derogation from section 27 for all health insurance companies in the whole country a uniform compensation requirements record (section 11) on the basis of the sum of insurance revenues (§ 8), and divided into old and new countries determined contribution requirements of the health insurance companies in the entire Federal territory based to lay. The federal insurance office determined separately by 1 January 1999 at the values referred to in article 19, paragraph 1 for the health insurance companies and the insured persons in the article 1 para 1 of the Unification Treaty said area. In the notification of compensation the sum of insurance periods, the contribution requirement, the financial strength and the amount of the compensation obligation or compensation claim for health insurance companies, whose Zuständigkeit covering the territory of accession, separately.
(2) to determine the changes in the financial strength following article 313a of the fifth book of the social code 2 area theorem is a separate compensation demand on the basis of the separately calculated sums of insurance revenue and contribution requirements to calculate for that in paragraph 1. The difference between paragraph 1 and pursuant to sentence 1 for that in paragraph 1 2 area determined set of sums of financial strength shall not exceed 1999 1.2 billion deutsche mark; If this amount is exceeded, the financial strength of all health insurers in this area is to increase appropriate single factor one of this difference. The financial strength of the health insurance companies in the remaining Federal territory is to reduce a single factor corresponding to this difference.

§ 28 Berlin (1) for the insured in the State of Berlin is the risk compensation after previous authorities carry out the rules and regulations; section 27 does not apply in this respect.
(2) for fiscal year 1994 the health insurance companies determine insurance revenue according to §§ 8 and 9 for members in the part of the State of Berlin, in which the basic law was not up to the entry into force of the Union Treaty, as follows: 1 the insurance income of all members in the State of Berlin are divided by the number of all members in Berlin, Germany.
2. the insurance revenue of all members in the area referred to in sentence 1 are divided by the number of members in the area referred to in sentence 1.
3. the sum of the results according to the numbers 1 and 2 is divided by two, and multiplied with the number of members in the area referred to in sentence 1.
(3) as long and as far as health insurers, whose jurisdiction is that in paragraph 2 sentence 1 area the number of insured persons (§ 21) in the groups of insured persons (article 20), the level of consideration capable performance spending to be offset beyond stretches, (§§ 4, 22) or the amount of the insurance proceeds 1 area can not determine set pursuant to paragraph 2 for which in paragraph 2 , the data for the monthly balance in 1994 are as follows: 1. the ratio of the number of family members to the number of members of the health insurance fund in which in paragraph 2 sentence 1 said area corresponds to the ratio of the number of the family insured to the number of members of all health insurance companies of the relevant fund type in the acceding territory. Sentence 1 shall apply accordingly for the distribution of the family insured on the insurance groups.
2.
The ratio of the average taking into account enabled performance spending per insured of the health insurance fund to average taking into account enabled performance spending per insured person of the local health insurance fund where in paragraph 2 sentence 1 said area corresponds to the ratio of average taking into account enabled performance spending per insured of all health insurance companies of the relevant fund type average taking into account enabled performance spending per insured person of all place health insurance in the acceding territory.
3. the ratio of the average insurance income per Member of the health insurance fund to average insurance income per Member of the local health insurance fund where in paragraph 2 sentence 1 said area corresponds to the ratio of average insurance income per Member of all health insurance companies of the relevant type of Fund to average insurance income per Member of all local health in the acceding territory.
4. the ratio between of the average insurance revenue per Member of the health insurance fund pursuant to § 313, para. 10 letter b sentence 2 of the fifth book of social security code (arithmetic mean) to insurance revenue referred to in point 3 corresponds to the ratio of the average insurance income per Member of the General local health insurance Berlin according to § 313, para. 10 point (b) sentence 2 of the fifth book of social law book to its insurance revenue per Member in which in paragraph 2 sentence 1 said area.
The regional allocation is for workers members and their insured family members according to the place of employment and for other insured persons according to the place of residence.
(4) paragraph 3 shall apply for the balance of the year 1994 accordingly.
(5) the more than the estimate under paragraph 3 determines the Federal Insurance Office after consultation with the leading associations of sickness funds. The Federal Insurance Office can determine different estimation methods with the agreement of the Central associations of sickness funds from paragraph 3.

section 28a (dropped out) - sixth section requirements on the approval of structured treatment programs according to Article 137f par. 2 of the fifth book the social law § 28 b (dropped out) section 28 c (dropped out) section 28 d requirements of the procedure of registration of the insured in a structured treatment program pursuant to § 137 g of the fifth book, social code, including the duration of participation in (1) a structured treatment program may only be admitted to, if it is provided, that the insured 1 only on the basis of a written confirmation of a safe diagnosis by the doctor according to the guidelines of the Joint Federal Committee according to Article 137f of the fifth book of the social code and the initial documentation according to the guidelines of the German Federal Joint Committee according to Article 137f of the fifth book of the social code is enrolled, 2. after Article 137f para 3 sentence 2 of the fifth book the social law the participation survey related, processing and use of his data agrees and 3rd about the contents of the programme, in particular also about that to finding data structured treatment programme to the delivered health insurance and this data from the health insurance fund to support the care of the insured person in the framework of the structured treatment program processes and can be used, and may be that in the cases of article 28f par. 2 transmits the data to the use of pseudonyms of the insurance cover of a joint venture or by these third parties responsible, the Division of tasks between the supply levels and the supply targets, the voluntary nature of participation in the program and the possibility of withdrawal of consent, as well as his cooperation obligations listed in the program to achieve the objectives and , when a missing participation has the end of participation in the program to result, is informed and confirmed this information in writing.
(2) a structured treatment program may only be admitted to also, if it is provided that 1 the active participation of the insured person on the basis of the documentation reviewed the health insurance according to the guidelines of the German Federal Joint Committee according to Article 137f of the fifth book of the social code, 2. the participation of the insured in the programme ends, if a) he no longer meets the requirements for registration, b) he period of twelve months, two who according to the guidelines of the German Federal Joint Committee according to Article 137f of the fifth book of the social code training without plausible led Justification has not been recognised or c) two consecutive who quartalsbezogen to create documentation according to the guidelines of the German Federal Joint Committee according to Article 137f of the fifth book the social law within a period of six weeks after which in section 28f, paragraph 2, sentence 1 No. 1 letter of a period have been submitted, and 3. the health insurance the participating in the programme of beginning and end of participation in one informing insured persons in the programme.
(2a) (dropped out) (3) a structured treatment program can be admitted also, if it is provided that a disruption of the affiliation of the insured person to the health insurance fund, covering not more than six months, his participation in the program on the basis of a subsequent documentation can continue. During the interruption period paragraph 2 applies no. 2 according to.

section 28e section 28f (dropped out) requirements of the procedure of for collection and delivery of for the implementation of the programmes pursuant to § 137 g of the fifth book of the social code required personal data (1) the approval of a structured treatment program requires that to be 1 in the program at the place of service is provided electronically and be provided insurance and follow-up documentation are provided, which include only the guidelines of the German Federal Joint Committee information each listed Article 137f of the fifth book of the social code and only for the treatment , establishing quality assurance objectives and measures and implementation, verification of enrollment for section 28 d, the training of the insured persons and service providers and the evaluation each according to the guidelines of the German Federal Joint Committee according to Article 137f of the fifth book of the social code are used, and 2. the programme is intended, that access to the to the data submitted health insurance under that provision only persons who perform tasks in the context of care insured in structured treatment programs and have been trained for this particular.
(1A) (fallen off) (2) as far as the implementation of a structured treatment programme with an Association of statutory health insurance physicians agreed, can the program be allowed if 1 the treaties has been agreed, that a) which took part in the implementation of the programme contract doctors and medical facilities directed the health insurance of them according to the guidelines of the German Federal Joint Committee according to Article 137f of the fifth book the social law for gathering data and the use of pseudonyms of the insurance cover of an association according to § 219 of the fifth book the social law within ten days from the after Submit the documentation period mechanically recycled and insured - and performance heritage ring er involved, b) is taught to the insured in writing of the data referred to in a, c) the Working Group referred to in a pseudonymisiert the data you submitted on the physicians associations who are members of this working group, as well as delivered a joint organization formed by members of the Association may use this data only for the performance of their respective tasks in the framework of quality assurance and evaluation of structured treatment program , d) the use of pseudonyms of the insurance cover in one for the purposes referred to in paragraph 1 is appropriate, e) (lapsed) and 2nd in the program provided is that these agreements implementing the programme to actually be placed.
Sentence 1 applies for other contracts with service providers to carry out structured treatment programs be closed without the participation of the associations of statutory health insurance physicians.
(2a) (dropped out) (3) unless in the agreements relating to the implementation of structured treatment programmes forming an Arbeitsgemeinschaft set provided 1 No. 1 not referred to in paragraph 2, the program can only be approved, if it is provided, that in the systems according to paragraph 1, to collect data from providers and the health insurance fund mechanically recycled and are insured - and performance heritage ring er involved not later than within ten days after the expiry of the period of the documentation to submit. Paragraph 2 sentence 1, paragraph 1 (b) shall apply mutatis mutandis.
(4) the health insurance companies make sure that the performance data for the second section of the tenth chapter of the fifth book of social code, if necessary, and the data referred to in paragraph 1 to the expert responsible for carrying out the evaluation in accordance with Article 137f paragraph 4 sentence 1 of the fifth book of the social code is transmitted. Personal data must be pseudonymise prior to transmission to the experts by the health insurance companies.

section 28 g (dropped out) § 28 h calculation of costs for over-riding applications
(1) the over-riding of an application for approval of a structured treatment program includes all activities which are directly caused by the processing of the application. The personnel records of the Federal Government including the thing flat rate basis to lay are the charge. The staff cost rates are per hour. Is a submission prior to the issuance of the permit is withdrawn, the processing costs incurred until then underlying sets the fee calculation. Expenses are to be added to the fees in their actual height.
(2) the necessary costs incurred in the federal insurance administration, which are initiated by services in connection with the admission of structured treatment programs, but not directly caused by the decision granting retention costs. To the cost of holding the sum is for a year of compensation on the basis of paragraph 1 to reduce identified personnel and material costs of employees dealing with the admission of structured treatment programs to paying the fees charged for the compensation year for providing notice.
Seventh section development of risk structure compensation as of 2009 § 29 principles for the further development of the risk structure compensation by the year 2009 on are to create risk characteristics underlying the insured group demarcation by way of derogation from article 2, paragraph 1 and 2 the following: 1. is the morbidity groups of insured classification model laid down by the Federal Insurance Office on the basis of diagnostics and pharmaceuticals risk surcharges has been determined and that based on classification models, whose Einsatzfähigkeit scientifically examined in the statutory health insurance and confirmed , 2. the reduction of earning capacity according to the articles 43 and 45 of the sixth book the social law, differentiated according to age and gender, 3. age and gender groups, 4. for the calculation of standardized sick pay expenditure, with the exception of expenditure according to § 44a of the fifth book of social code, the Member groups according to § 267 (2) sentence 2 of the fifth book of social code, differentiated according to age and gender, and disability.

Section 30 collection and use of data for the development of risk structure compensation (1) for the further development and implementation of risk structure compensation according to § 268 of the fifth book of the social code raise the health insurance from the reporting year 2005 every year, in addition to following the data according to § 3 versichertenbezogen: 1 the insurance days, specifying the year of birth and gender, 2. the number of insured days with receipt of a disability pension, 3. information about the implementation of extracorporeal blood purification , 4. medicinal characteristics according to article 300 para. 3 of the fifth book the social law including the agreed special indicators as well as each the number of regulations, 5 the hospital dismissed relevant primary and secondary diagnoses according to section 301, paragraph 1, sentence 1 No. 7 in the encryption after section 301 paragraph 2 sentence 1 of the fifth book of social code, 6 the diagnoses according to § 295 paragraph 1 sentence 1 No. 2 of the fifth book of the social code as well as the information according to § 295 paragraph 1 sentence 4 of the fifth book of the social code , 7 taking into account enabled performance issues pursuant to section 4, with the exception of expenses according to § 4, paragraph 1, sentence 1 number 10 and 11, 8 the number of days of insured persons domiciled or habitually resident outside the territory of the Federal Republic of Germany, 9 the number of insured days with choice of the reimbursement of costs for the medical care, differentiated according to article 13, paragraph 2, and article 53, paragraph 4 of the fifth book of the social code , 10 diagnoses according to § 295 paragraph 1 sentence 1 No. 1 of the fifth social code book for the years 2008 and 2009, as well as the calendar days for the sickness benefit is paid according to the sections 44 and 45 of the fifth book of the social code, 11 the number of days of insurance entitled to sickness benefit after the sections 44 and 45 of the fifth book of the social code.
Temporal mapping of data pursuant to sentence 1 No. 4 is the regulation date, for the assignment of the information pursuant to sentence 1 No. 5 the day of dismissal applicable. The leading associations of sickness funds may Nos. 1 and 2 of the fifth book of the social code provide in consultation with the Federal Insurance Office in the agreement according to section 267, paragraph 7, that the collection of data pursuant to sentence 1 No. is limited 7 on a sample.
(2) the data referred to in paragraph 1 are to pseudonymise before submission pursuant to paragraph 4 of the health insurance fund. As for which in paragraph 1 sentence 1 purposes may the data be used only for others, insofar as this is necessary for the inspection according to § 42, as well as to clarify double insurance conditions under paragraph 5 or to take account of any subsequent changes of the transmitted data. The use of pseudonyms in the health insurance fund and any use pursuant to sentence 2, a transcript is to customize. Insured related merge of the data collected across multiple performance ranges across the health insurance fund is not permitted. The manufacture of the insurance cover by the health insurance companies is permitted, insofar as this is necessary for the tests according to § 42, as well as to clarify double insurance conditions according to paragraph 5. The health insurance companies are bound to machine all in the framework of the implementation of the risk structure compensation data bases, as well as all documentation produced (1) six years revision safe and verifiable to save sentence 1 number 1 to 6 and number 8, 9, and 11 in connection with paragraph 4, as well as the underlying these messages, legally stored at health insurance data or to store all correction messages for the data messages to; Section 3, paragraph 7, sentence 2 and 3 shall apply mutatis mutandis.
(3) the leading associations of sickness funds agree in consultation with the Federal Insurance Office in the agreement according to § 267 par. 7 1 and 2 of the fifth book of social law book details about the survey referred to in paragraph 1 sentence 1 and the temporal Association pursuant to paragraph 1 sentence 2, for several years concerning hospital cases also by derogation from paragraph 1 sentence 2, and also in consultation with the Federal Office for security in information technology , the process of the use of pseudonyms. A key-dependent process with annual key change is to determine, which ensures that one regardless of his Fund membership each the same pseudonym is associated with insured and the data of each insured over the reporting periods remain across linkable. Details about the unified technical preparation and the necessary amount of data may determine after consultation with the leading associations of sickness funds Federal Insurance Office.
(4) the collected pursuant to paragraph 1 and pseudonymized data shall be transmitted in accordance with § 3 section 4 the Federal Insurance Office up to August 15th of the year following the year under review after. The data messages referred to in paragraph 1 sentence 1 number 1 to 6 and 8, 9 and 11 until August 15th of the second year following the year under review, number 1, 2, 8, 9 and 11 up to 15 April of the second and third year following year by a new message corrected the data messages referred to in paragraph 1. The transmission of data for the year 2005, which may be limited Nos. 1 and 2 of the fifth book of social security code on a representative sample of the Central associations of sickness funds in consultation with the Federal Insurance Office in the agreement according to § 267 par. 7 is carried out at the latest up to August 15, 2007. Data on time delivered the Federal Insurance Office or to exhibit significant errors, the Federal Insurance Office may reject all or part the data; instead of the rejected data it can refer to data in the previous year, taking into account a reasonable safety trigger, but then the insurance development and morbidity development. The Federal Insurance Office shall inform the organisation Federal of health insurance fund type and scope of data rejected by him and instead adopted pursuant to sentence 4. The leading associations of sickness funds are entitled, the data pursuant to sentence 1 to the fulfillment of their duties under this regulation, in particular according to § 5 para 1 sentence 2 and paragraph 6 and section 31 para 4, sentence 1, save for 32 months.
(5) the organisation finds Federal of health insurance fund that has to a pseudonym of insurance at more than a health insurance scheme has reported data, in sum, more days of insurance were submitted than compensation year calendar days, or that provided different information on the year of birth and gender, it shall notify the respective insured pseudonym, the type of error as well as other affected health insurance affected health insurance , to bring a clarification of the circumstances of the insured. The organisation determines Federal of health insurance fund details about the procedure.

Article 31 selection and adaptation of the classification model
(1) the selection of the insured classification model pursuant to § 29 sentence 1 No. 1 and its adaptation to the conditions of the statutory health insurance must be done so that no incentives for medically unjustified capacity expansions and avoiding incentives for risk selection. The insured classification model adapted pursuant to sentence 1 of the statutory health insurance is to filter diseases from 50 to 80 on hand and prospectively to shape. In particular diseases with fatal course and costly chronic diseases, where average performance spending per insured exceed the average performance issues of all insured persons to at least 50 per cent, to be considered when selecting the diseases referred to in sentence 2. The disease should be closely distinguished.
(2) the Federal Ministry of Health appointed a Scientific Advisory Board to the Federal Insurance Office on the proposal of the Federal Insurance Office and after consulting the leading associations of sickness funds, has 1 to submit a proposal for the adaptation of the classification model to the statutory health insurance and to propose a procedure for its ongoing maintenance, 2 up to October 31, 2007 an opinion to reimburse, in which are selected set 2 to 4 these diseases in paragraph 1 and 3 the selection of referred to in paragraph 2 Has to check diseases on a regular basis.
In carrying out the tasks referred to in sentence 1 of the Scientific Advisory Board has in paragraph 1 set to note 1 criteria. In the opinion to set, 1 No. 2 are to specify the identifying these diseases of required ICD codes and drug agents to determine of the relevant morbidity groups of the selected classification model for all selected diseases.
(3) of the Scientific Advisory Board, persons are appointed pursuant to paragraph 2, who have a special expertise in relation to the classification of insured medical, pharmaceutical, pharmacological, clinical or statistical issues relating, as well as in the development and maintenance of insurance classification models. The Federal Insurance Office sets up a secretariat to support the work of the Scientific Advisory Board.
(4) the Federal Insurance Office sets on the basis of the recommendation referred to in paragraph 2 referred to in paragraph 1 sentence 2 to consider diseases, the morbidity group to be based on basis of these diseases, the algorithm for the mapping of the insured persons to the groups of morbidity, the regression method for determining the weighting factors and the calculation method for determining the risk premiums for the following compensation year after consultation with the leading associations of sickness funds until September 30 the Nos. 2 and 3 and announced it in an appropriate manner. For determining the risk premiums for those in section 29, sentence 1 risk characteristics referred to no. 1 morbidity groups established pursuant to sentence 1 are taken into account. Paragraph shall accordingly apply 1 sentence 1. Morbidity group for disability pensioners are made for insured persons who have received a pension on account of reduced earning capacity during most of the year preceding the year of compensation. In the formation of ages, the Federal Insurance Office in consultation with the organisation to determine age different federal of health insurance fund by section 2, paragraph 3, sentence 1. The Federal Insurance Office can adjust during the year the provisions of Federal of health insurance fund after hearing of the top Association pursuant to sentence 1, if the universal coding of diagnoses or the medicinal classification is updated. The adjustments are for set 6 in an appropriate way to announce. The data messages according to § 30 paragraph 1 for insured within the meaning of paragraph 5 set 1 retain 1 the regression technique for determining the weighting factors and the calculation method for determining the risk premiums pursuant to sentence not considered. In agreement with the organisation can Federal of health insurance fund the Federal Insurance Office distinguish the Member groups according to § 29 number 4 by way of derogation. For the calculation of allocations to cover the standardized performance issues of health insurance funds for the area of vaccinations after the regulation on the liability of the statutory health insurance for vaccinations against the new influenza A(H1N1) from 19th August 2009 (BAnz. S. 2889) is to apply article 37 paragraph 4 in accordance with.
(5) for insured persons who had their domicile or habitual residence outside the territory of the Federal Republic of Germany during most of the year preceding the year of compensation, are separate groups at risk by age and gender to form and to determine risk premiums on the basis of average risk spreads for all insured persons of the corresponding age and gender groups. Insured persons who have chosen reimbursement during most of the year preceding the year of compensation for the medical care according to article 13, paragraph 2 or article 53, paragraph 4 of the fifth book of the social code, the risk groups be replaced after § 29 number 1 through a separate risk group; the regression method for determining the weighting factors and the calculation method for determining the risk premiums are set 1 after paragraph 4 apply mutatis mutandis. In agreement with the organisation can Federal of health insurance fund the Federal Insurance Office within the risk group to be formed pursuant to sentence 2 make more differentiation. Unless insured both pursuant to sentence 1 and the risk group pursuant to sentence 2 are allocated to the Group of risk, is the risk group pursuant to sentence 1 instrumental. Performance issues for the risk groups pursuant to sentence 1 are you laid booked expenses for services rendered abroad to reason by health insurers in the financial statements; After that must be considered in accordance with the provisions of the Kontenrahmens, the areas of flat-rate or calculated according to the actual expense refunds to foreign insurers, as well as refunds to employers according to § 17 of the fifth book of the social code. The organisation can meet federal of health insurance fund any further or different provision of areas affecting expenses for services abroad, in consultation with the Federal Insurance Office.

§ 32 data messages for the monthly compensation by way of derogation from § 3 par. 6 raise the health insurance for the monthly compensation to article 39 paragraph 3 for performance issues without sickness benefit versichertenbezogen the periods of insurance completed by the insured person for the periods 1 January to June and January 2 to December (periods). The health insurance companies place the insurance periods pursuant to sentence 1 for the period pursuant to sentence 1 No. 1 August 31st of the reporting period and for the period pursuant to sentence 1 No. 2 to February 28 of the year following the year under review the Federal Insurance Office through the top Association Federal of health insurance fund machine usable before. Article 30, paragraph 4, sentence 4 shall apply mutatis mutandis.

§ 33 opinion on assignment to cover the expenses for sickness benefits and overseas insured (1) the Federal Insurance Office commissioned people or groups of people who have, with the creation of one or more scientific advice on specific expertise in relation to the insured classification according to section 31, paragraph 4 to article 269, paragraph 3 of the fifth book of the social code.
(2) the opinion should make proposals, as the allocations to cover the expenses for sickness benefit and the assignments for insured persons who had their domicile or habitual residence outside the territory of the Federal Republic of Germany during most of the year preceding the year of balance, target can be determined. The provisions of § 268 paragraph 1 sentence 1 number 2 to 4 are in the development of the models. There is also the need for a broadening of the data base to examine.
(3) in the opinion to the allocations to cover the expenses for sickness benefit will be which of the factors that influence the level of sick pay expenditure of a health insurance company, are also taken into account and which data to depict these determining factors and raise let to achieve the objective referred to in paragraph 2 sentence 1 investigated initially.
(4) the opinion about the assignments for insured persons who had their domicile or habitual residence outside the territory of the Federal Republic of Germany during most of the year preceding the year of compensation, to which the factors which influence the level of expenditure of health insurance for these groups of insured persons, are in addition to take into account and which data to depict these determining factors and raise examines first, , to achieve an improvement of the purpose referred to in paragraph 2 sentence 1. Also proposals to improve the quality, transparency and separation of the data should be submitted to it.
(5) the Federal Insurance Office has to ensure that the investigations after are complete paragraphs 3 and 4 respectively to 31 December 2015.

§ 33a to 34 (dropped out) eighth section assignments from the Health Fund (risk compensation) from 2009 section 35 applicable regulations
(1) by the year 2009 to apply for allocations from the health funds and the implementation of risk structure compensation the provisions of this section. The first are up to seventh section of this regulation continue to apply, unless the following provisions or in the fifth book of the social code otherwise determined.
(2) for tests up to compensation in 2008, section 15a in the version applicable up to 31 December 2008 shall apply. Corrections of the reporting years until 2008 and the associated data collection are no longer carried out from January 1, 2012.

Section 36 determine of the amount of the basic allowance (1) form the basis for the determination of the basic package the expected standardized performance expenditure of health insurance companies according to § 266 paragraph 2 sentence 1 of the fifth book of the social code, which provided that these assignments include an appropriate share to clean up on these percentages of allocation to § 38 attributable performance issues. The adjusted expenditure are to share the estimated sum of insured persons of all health insurance companies.
(2) the Federal Insurance Office determines the basic fee for a year of compensation on the basis of the values relevant for the determination of the average additional fee according to section 242a of the fifth book of the social code in advance.
(3) the notice of the flat rate calculated by the Federal Insurance Office the following year, as well as the values according to § 266 paragraph 5 sentence 2 of the fifth book of the social code is by November 15 of each year, the notice for 2011 is up to January 5, 2011. The health insurance companies announce their insured the flat rate determined for the coming year including their explanation every year in a suitable manner until 31 December, the announcement of the basic packages determined for the year 2011 is January 15 2011. (4) for the period from 1 August to 31 December 2009 is the flat rate as follows determined and made known in an appropriate manner : 1 the expected standardized benefits expenditure of health insurance for the insured, the number 2 or 3 of the fifth book of the social code submitted a declaration of choice according to article 44, paragraph 2, sentence 1, be divided by 5, 2. After investigating the paragraphs 1 and 2 for the year 2009 monthly flat rate is 1 to the value referred to in point increases.
The forecasts of the estimators circle are basis for the expected benefits expenditure pursuant to sentence 1 according to article 241, paragraph 1 of the fifth book social code at its last meeting before August 1, 2009. The flat rate determined pursuant to sentences 1 and 2 is taken into account for the first time in the monthly compensation pursuant to section 39 paragraph 3 to September 30, 2009.

§ 37 assignments for other expenses (1) the health insurance companies receive from the health fund allocations to cover the costs of their standardized management. The federal insurance office determined the height of these assignments for each health insurance in advance for each year of compensation on the basis of the values relevant for the determination of the average additional fee according to section 242a of the fifth book of the social code as follows: expenditures for administrative costs of health insurance are 1 comprises the expenses reimbursed by third parties for administrative costs, as well as the administrative costs relating to the shares of allocation to § 38 , unless these assignments contain appropriate proportions, remain unconsidered.
50% of the result referred to in point 1 are 2 to share the No. 1 by periods of all health insurance companies provided health insurance by the sum according to § 30 para 1 sentence 1 and with the periods of insurance completed by the health insurance fund to multiply;
50% of the result referred to in point 1 are 3 to divide by the sum of the allocations according to § 266 paragraph 2 sentence 1 of the fifth book of social law code for all health insurance companies and to multiply with the allocation to § 266 paragraph 2 sentence 1 of the fifth book the social law for the health insurance.
4. the amount of the assignment for each health insurance arises from the sum of the results determined in accordance with paragraphs 2 and 3.
In determining the assignments for the compensation years 2011 and 2012 the administrative expenditure of the year 2010 are at most to be based; This does not apply for expenses after section 291a, paragraph 7, sentence 4 and 5 of the fifth book of the social code.
(2) the percentages referred to in paragraph 1 sentence 2 No. 2 and 3 apply until December 31, 2010. Before this period expires, the Federal Ministry for health on the basis of for the year reviewed 2009 business and accounting results of the health insurance companies created the financial impact of the application of the percentages referred to in paragraph 1 sentence 2 No. 2 and 3 on the health insurance companies. Based on this review, the percentages from the are by decree with the consent of the Federal Council to set January 1, 2011. Determined until the entry into force of the Legislative Decree pursuant to sentence 3 the Federal Insurance Office the amount of monthly allocations in accordance with paragraph 1 (3) by way of derogation from paragraph 1 sentence 2 determines the Federal Insurance Office the amount of allocations for the miner health insurance in advance for each year of compensation on the basis of the values relevant for the determination of the average additional fee according to section 242a of the fifth book of the social code as follows : expenses for administrative costs of all health insurance rate no. 1 are 2 referred to in paragraph 1 by the sum according to § 30 para 1 sentence 1 No. 1 by periods of all health insurance companies provided health insurance to share and to multiply with the periods of insurance completed by the miner health insurance. The so determined height of the assignments for the miner health insurance is the expenses for administrative costs of all health insurance companies pursuant to paragraph 1 No. 1 to deduct from set 2. Paragraph 2 shall apply mutatis mutandis.
(4) the health insurance receive assignments to cover their standardized expenses from the Health Fund according to § 266, paragraph 4, sentence 1 No. 2 of the fifth book of the social code. The federal insurance office determined the height of these assignments for each health insurance in advance for each year of compensation on the basis of the values relevant for the determination of the average additional fee according to section 242a of the fifth book of the social code as follows: 1 are expenses of all health insurance statutory surplus and testing services as well as services, on which no legal entitlement, to count up, and Charter services on the basis of article 2, paragraph 1, sentence 2 and 3 of the regulation on the further expansion of miners health insurance , Stay expenses for pricing of options according to § 53 of the fifth book of the social code and the additional statutory benefits on the basis of § 11 paragraph 6 of the fifth book of social security code not taken into consideration.
2. the result referred to in point 1 is to share the No. 1 by periods of all health insurance companies provided health insurance by the sum according to § 30 para 1 sentence 1.
3. the result is referred to in point 2 to multiply with the periods of insurance completed by the health insurance fund.
(5) the notice of the amount estimated by the Federal Insurance Office of allocation to § 266 paragraph 2 sentence 1 of the fifth book the social law for health insurance companies, the estimated amount of the allocations to cover the standardised expenses for administrative costs of all health insurance companies, which tentatively identified grant allocated to cover the standardized expenses according to § 266, paragraph 4, sentence 1 No. 2 of the fifth book the social law of all health insurance companies, as well as the sum according to § 30 para 1 sentence 1 No. 1 by health insurers submitted Insurance times of all health insurance companies is done by November 15 of each year, the announcement for the year 2011 to January 5, 2011.

§ 38 allocation for structured treatment programs 2009 (1) to facilitate the implementation of structured treatment programs pursuant to § 137 g of the fifth book of the social code receive the health insurance from the health fund assignments for each to § 2 para 1 sentence 3 attributed a insured to cover the program costs for medically necessary expenses such as documentation and coordination services. The Federal Insurance Office revokes g paragraph 3 of the fifth book the social law the approval of a programme according to article 137, the assignment to repay is pursuant to sentence 1.
(2) the Association determines the amount of the assignment referred to in paragraph 1 and the details on the registration procedure for the registered insured Federal of health insurance fund. The provision pursuant to sentence 1 does not favour the Federal Insurance Office determines the amount of the assignment and the reporting process. § 30 paragraph 2 to 4 shall apply mutatis mutandis.

Article 39 implementation of payments, monthly compensation and liability for costs (1) the federal insurance office determined the amount of assignments, which according to § 266 para 1 sentence 1 of the fifth book of the social code receive the health insurance companies to cover their expenses, and leads the payment traffic through.
(2) the Federal Insurance Office the provisional amount of the allocations determined pursuant to paragraph 1 for the monthly tee-off procedure and communicated these to health insurance. The monthly assignments arise on the basis of determining pursuant to sentence 1 monthly adapted to the changes in the number of insured persons. Section 3, paragraph 6, sentence 4 and 5 shall apply mutatis mutandis. The sum of monthly allocations to all health insurance companies is equivalent to one-twelfth of the value according to § 40 paragraph 1 No. 1. For 2010, the value is number 1 in accordance with the § 40 paragraph 3 sentence 1 according to § 40 paragraph 1 to increase.
(3) the Federal Insurance Office calculated for the respective year of compensation for all health insurance providers each) up to April 15 of the year of compensation, b) until 15 October of the compensation year and c) until April 15 of the year following the year of compensation the provisional amount of the allocations pursuant to paragraph 2 new, taking into account the current notification according to § 32 and this tells the health insurance companies; in the case of letter c the Federal Insurance Office redetermines the expected data according to article 41, paragraph 1, sentence 1 and the amount expected also on the basis of the current quarterly invoices according to § 10 of the General regulations concerning statistics in the statutory health insurance pursuant to article 41, paragraph 2 provisionally. The Federal Insurance Office can determine at the request of a health insurance company in the individual case in the provisional amount of their assignments for the monthly discount procedure after consulting the top Association Federal of health insurance fund by way of derogation, if you substantially and demonstrably determined allocations referred to in paragraph 2 by the result to be expected in year compensation under section 41. When determining different pursuant to sentence 2 can orientate the Federal Insurance Office, taking into account of § 30 paragraph 4 sentence 4 of the assessments and applies a reasonable safety trigger. Section 3, paragraph 6, sentence 4 and 5 shall apply mutatis mutandis. The assignments for the compensation year set up for the recalculation pursuant to sentence 1 and 2 be calculated afresh on the basis of the findings pursuant to sentence 1 and 2. Details on the procedure under paragraphs 2 and 3 the Federal Insurance Office determines Federal of health insurance fund after hearing of the top Association.
(3a) the amount of allocation determined in accordance with paragraph 3 so far exceeds the amount of allocations laid down pursuant to paragraph 2, the health fund is the excessive amount of the insurance. The amount of the difference to the health fund is the amount of the allocations determined pursuant to paragraph 3 is less than the monthly assignments to pay. The Federal Insurance Office binding specifies the due date of the amounts to be paid by the sending of the notification. § 14 paragraph 3 and 4 shall apply mutatis mutandis with the proviso that the responsible for the payments Federal Insurance Office at the place of the German pension insurance shall Federal. A health insurance scheme pays the amount pursuant to sentence 2 within a period of 14 days after the due date fully to the health fund, the outstanding amount of the payable pursuant to paragraph 4 assignments in the amount of the claims cover, will be charged, starting with the following month of compensation. At the request of a health insurance company the Federal Insurance Office to distribute the allocation pursuant to sentence 5 on the following months of compensation, if it determines, on the basis of sufficient evidence provided by the health insurance fund, that existing health resources number 3 and 5 of the fifth book of the social code claims referred to and claims not sufficient which according to the sections 260 and 261 of the fifth book of social code, taking into account in article 155, paragraph 5, sentence 1 , to the payment in full; at the latest within six months after the due date, the payment must be fully effected pursuant to sentence 2.
(4) the Federal Insurance Office pays the assignments for the monthly procedure of tee-off in instalments, geared in particular to the monthly main maturity dates of sums for the health fund. The assignments for a month of compensation be paid in full until the 15th of the month following that month.
(5) that the Federal Insurance Office on the basis of the management of the Fund incurred expenditure including expenditure for the implementation and further development of the risk structure compensation from the revenue of the Fund according to § 271 of the fifth book of the social code carried.

Article 39a determination of the amount of the correction (1) the Federal Insurance Office checks the data messages according to § 30 paragraph 4 sentence 1 (initial report) and the data messages according to § 30 paragraph 4 sentence 2 (correction suggestion) a year, whether the requirements of section 268 paragraph 3, sentence 1, 2, and 14 of the fifth book of the social code have been met. Does not have a health insurance requirements or only partially respected, determined the Federal Insurance Office the amount of correction according to § 273 (4) sentence 2 of the fifth book of the social code in accordance with the following paragraphs separately for the first message and the correction message and sets him.
(2) the Federal Insurance Office calculates adjusted annual allocations for the compensation year following the reporting year for the affected health insurance. For the calculation are to determine of the amount of the allocations according to § 266 paragraph 2 sentence 1 of the fifth book of the social code regulations to be used with the proviso that the frequency of the risk characteristics according to § 29 number 1 for the affected health insurance pursuant to paragraphs 3 and 4 will be evaluated. In a first indication the adjusted annual assignments be pulled off letter c obtained provisional amount of assignments according to § 39, paragraph 3, sentence 1 (difference in initial meld). When a correction message, the adjusted annual allocations will be deducted from the allocation determined in accordance with section 41, paragraph 3 (difference correction message). A corrective amount is determined only with a positive difference.
(3) the Federal Insurance Office to determine which data contrary to the provisions of § 268 paragraph 3 sentence 1, 2, and 14 of the fifth book of the social code were collected, these data may be taken into account number 1 not in determining the frequency of the risk characteristics according to § 29; This does not apply to data that are included in a calculation according to § 42 paragraph 5. The Federal Insurance Office may require additional information and evidence for the determination of the concerned insurance company according to § 273 paragraph 3 sentence 3 of the fifth book of the social code. Article 30, paragraph 4, sentence 5 shall apply mutatis mutandis.
(4) the Federal Insurance Office to determine, what data contrary to the provisions of § 268 paragraph 3 sentence 1, 2, and 14 of the fifth book of the social code were raised, it determines the frequency of the risk characteristics according to § 29 number 1 on the basis of the last previous message for the Federal Insurance Office has not found that the affected health insurance the listed specifications not or only partly complied with has. The Federal Insurance Office can limit the use of the previous message to individual risk features according to § 29 number 1. The interim change in the insured structure affected health is considered an age - and gender-related adaptation of insured days per risk characteristic according to § 29 number 1. The frequency of the risk characteristics according to § 29 number 1 from the previous notification pursuant to sentence 1 for audited data indication of all health insurance companies in the average declined, the number of insured days affected health is adjusted for these risk characteristics; the adjustment can be age - and gendered.
(5) the amount of correction in a first message sentence 3 is 10 percent of the difference referred to in paragraph 2. The amount of correction with a correction message obtained by additional pursuant to paragraph 2 sentence 4 a surcharge of 25% of the difference will be added to the difference. On the collection of the surcharge can be omitted entirely or in part, if the survey were unreasonable according to the individual case. Paragraph 3a set 3 to 6 shall apply accordingly § 39. The revenue referred to in this paragraph and the interest income paid into the Health Fund and will be added to number 1 in the next annual adjustment to the value pursuant to section 41, paragraph 2.
(6) the further procedure pursuant to paragraph 4 determines Federal of health insurance fund the Federal Insurance Office in consultation with the Association.

§ 40 member related change of assignment (1) the federal insurance office determined for each health insurance company in advance for a compensation year on based on the for the determination of the average additional contribution according to section 242a of the fifth book of the social code relevant values the amount, monthly allocations for each insurance company to change the are, by it to 1 the amount of the estimated annual revenue of the Health Fund according to article 271, paragraph 1 of the fifth book of the social code to construct of the liquidity reserve according to § 271 par. 2 of the fifth Book the social law planned revenues, spending according to § 39, paragraph 5, the cost according to § 28q paragraph 1a of the fourth book the social law and the settled retention costs pursuant to § 137 g of paragraph 1 pack of 10 of the fifth book the social law for allowing structured treatment programs, 2.
the value referred to in point 1 the expenditure estimated standardized performance according to § 266 paragraph 2 sentence 1 of the fifth book of social security code plus the amount of the expected standardized other expenditure by section 270 of the fifth book the social law of all health insurance companies, adjusted for the standardized performance issues as well as administrative costs attributable share of allocation to § 38, unless these assignments contain corresponding parts, pulls, 3. the result referred to in point 2 by the estimated average number of members of all health insurance companies and the number 12 shares and multiplied for every health insurance company with the number of their members, which is signed to the first of the month in the monthly statistics of the previous month.
(2) the notice of the amounts determined by the Federal Insurance Agency for the following year is done by November 15 of each year, the announcement for the year 2011 is the amount pursuant to paragraph 1, increasing the value referred to in paragraph 1 No. 1 to the cyclical involvement of the Federal Government according to section 221a of the fifth book of social law code in force on January 1, 2010 until 5th January 2011. (3) for the year 2010 determined the Federal Insurance Office. The Federal Insurance Office discloses the amount determined in accordance with sentence 1 in the appropriate form.

Section 41 year compensation (1) the federal insurance office determined after existence of the business and accounting results of all participating in the monthly compensation health insurance companies for the respective calendar year (compensation year) 1 the age, gender and risk-adjusted to and tees, and 2. the values specified in section 37, paragraph 1, sentence 2 number 2 and 3 and paragraph 4 sentence 2 number 2 new. The sum of the risk premiums is to limit the amount of performance spending to article 31, paragraph 5, sentence 5 and 6 according to article 31, paragraph 5, sentence 1. Half of the assignments for the groups of insured persons according to § 29 is number 4 to determine for any health insurance fund on the basis of the costs of insurance for sickness benefit.
(2) the Federal Insurance Office determines the amount to the assignments for each health insurance company in the annual adjustment to change are pursuant to paragraph 3, for each health insurance company by of 1 value according to § 40 paragraph 1 number 1 the amount of standardized performance expenditure according to § 266 paragraph 2 sentence 1 of the fifth book, social code, plus the amount of standardized other expenditure by section 270 of the fifth book of social law of insurance , adjusted for the standardized performance issues as well as administrative costs attributable share of allocation to § 38, unless these assignments contain corresponding parts, pulls and 2 divides the result by number 1 by the average annual number of members of all health insurance companies and multiplied for every health insurance company with the annual average number of their members.
In the annual adjustment for the year 2011, it is important to consider paragraph 2 on 3 August 2011 in the applicable version.
(3) the Federal Insurance Office calculates the height of the assignments on the basis of the figures determined in accordance with paragraphs 1 and 2, as well as the basic packages under section 36 for each health insurance according to section 266, paragraph 2, sentence 1 and section 270 of the fifth book the social law in annual compensation. For health insurers, which are United in the compensation year in with each other, is a common calculation to make. For health insurers, which are been United together in the year following the year of compensation, the Federal Insurance Office in consultation with the Association may make a common calculation Federal of health insurance fund.
(4) the Federal Insurance Office announces the values determined in accordance with paragraphs of 1 and 2 No. 2 in an appropriate manner and shares with the amounts determined in accordance with paragraphs 2 and 3 the health insurance companies. Exceeds the amount of the allocations determined pursuant to paragraph 3 to the monthly assignments, the excess amount shall be entitled to the health insurance fund. The amount of the difference to the health fund is the amount of the allocations determined pursuant to paragraph 3 is less than the monthly assignments to pay. Paragraph 3a set 3 to 6 shall apply accordingly § 39.
(4a) (lapsed) (5) the annual adjustment is carried out until the end of the year following the year of compensation and in the next year on the basis of the notification according to § 30 paragraph 4 sentence 2 second half-sentence correct. Details on the procedure determines the Federal Insurance Office after hearing of the top Association Federal of health insurance fund.

§ 42 examination of data messages (1) who have dealing with the test according to section 274 of the fifth book of the social code at health insurance companies under its jurisdiction at least every two years following data, each related to one of the two completed most recently according to section 41 and corrected years of compensation, to check on its accuracy: 1 the information according to § 30 paragraph 1 sentence 1 Nos. 1, 2, and 11 of the notification according to § 30 paragraph 4 sentence 2 second half-sentence, and that after article 38 paragraph 2 reported Data, 2 the information according to § 30 paragraph 1 sentence 1 number 3 to 6 of the notification according to § 30 paragraph 4 sentence 2 first half-sentence and the information according to § 30 paragraph 1 sentence 1 number 2, 8 and 9 of the notification according to § 30 paragraph 4 sentence 2 second half-sentence.
Pursuant to sentence 1, the points can set in agreement with the Federal Insurance Office that they each year perform checks 1 Nos. 1 and 2 to set.
(2) for the testing referred to in paragraph 1 sentence 1 sets after hearing of the top Association pursuant to paragraph 1 sentence 1 for the respective test cycle the sampling methodology and in particular the respective procedure for determining a reasonable sample size the Federal Insurance Office Federal of health insurance fund and of the bodies and determine details on the requirements for the collection of samples. The Federal Insurance Office pulls the samples for the testing and provides 1 set the points referred to in paragraph 1 the list of collected samples in pseudonymised form. In agreement with the authorities referred to in paragraph 1 sentence 1, the Federal Insurance Office sets which the him present data according to § 30 paragraph 1 sentence 1's in addition for the sampling places after paragraph 1 sentence 1 for the respective test provides.
(3) the federal insurance office determined after consulting the top Association Federal of health insurance fund and the authorities referred to in paragraph 1 sentence 1 details to nature, scope and form of processing the data and documents that shall set 1 the bodies referred to in paragraph 1 have the health insurance companies. The bodies referred to in paragraph 1 sentence 1 share the Federal Insurance Office, the health insurance fund and the Association Federal of health insurance fund without delay with the results of their checks. The further to the communication of inspection results determines the Federal Insurance Office after consultation with the bodies referred to in paragraph 1 set 1 (4) for the accuracy which is reported data to examine pursuant to article 38, paragraph 2, whether for the taking into account of insurance periods relevant requirements of § 3 paragraph 3 sentence 7 and 8 with regard to the participation of one to article 137 g of the fifth book of the social code are certified structured treatment program. For the test, whether the conditions laid down in sentence 1 are available, are to review the reports of the respective compensation year. to take into account are the documents of the compensation year, underlying the messages of this previous and this subsequent calendar year.
(5) the Federal Insurance Office recalculates the exams at paragraph 1 sentence 1 each identified faulty or not plausible cases on the underlying the respective sample population high. The Federal Insurance Office determines the respectively applicable extrapolation procedure in consultation with the Association of top federal of health insurance fund. This it can also determine that the projection only takes place if the faulty or not plausible cases exceed a certain quota.
(6) the initial determination referred to in paragraph 2 and the first-time provision under paragraph 5 are made on the basis of the scientific opinion. The Federal Insurance Office commissioned a person or group of persons which has special expertise in statistical methods and knowledge of the insured classification according to section 31, paragraph 4. The opinion should submit in particular proposals for the sampling methodology according to paragraph 2, in order to ensure sample quality, for an extrapolation procedure according to paragraph 5, as well as for the further development of these procedures in the following test cycles. Before completion of the opinion of the organisation are Federal of health insurance fund and the authorities referred to in paragraph listen to 1 sentence 1.
(7) the federal insurance office determined the amount of the correction on the basis of the respective grossing under paragraph 5 and asserts it by decision. Paragraph 3a set 3 to 6 shall apply accordingly § 39. The revenue referred to in this paragraph and the interest income paid into the Health Fund and will be added to number 1 in the next annual adjustment to the value pursuant to section 41, paragraph 2.

§ 43 implementation of income compensation (1) the federal insurance office determined the amount of funds that received the health insurance out of the income compensation section 270 of the fifth book of the social code and leads through payments.
(2) the federal insurance office determined the preliminary funds pursuant to paragraph 1 for the monthly tee-off procedure and tells them the health insurance companies; Section 39 paragraph 2 shall apply mutatis mutandis. The monthly means for each Fund for the respective month of compensation arise, by the estimated average insurance revenue per Member of all health insurance companies with the additional contribution rate of the health insurance fund is multiplied according to article 242 paragraph 1 of the fifth book social security code and the number of their members. § 39, paragraph 4, sentence 1 shall apply accordingly. The means for a month of compensation be paid in full until the 15th of the month following the month of the first payment.
(3) the Federal Insurance Office is recalculated on the basis of the current membership of the monthly statistics created on the first of the month for the previous months of compensation on the dates referred to in article 39, paragraph 3, sentence 1 the provisional amount of funds for any health insurance. Article 39, paragraph 3, sentence 5 and paragraph 3a shall apply mutatis mutandis.
(4) the Federal Insurance Office redetermines the amount of funds for any health insurance after the business and accounting results of all participating in the monthly compensation health insurance funds for the compensation year to the date referred to in article 41, paragraph 5, sentence 1. Article 41, paragraph 4 shall apply mutatis mutandis.

Concluding formula the Federal Council has approved.

Facilities 1-12 (dropped out)

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