Regulation on the procedure for risk structure compensation in statutory health insurance (Risk structure compensation regulation-RSAV)

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RSAV

Date of completion: 03.01.1994

Full quote:

" Risk structure compensation regulation of 3 January 1994 (BGBl. I p. 55), as defined by Article 10 of the Law of 17 July 2015 (BGBl. I p. 1368).

Status:	Last amended by Art. 15 G v. 21.7.2014 I 1133
Note:	Amendment by Art. 13 G v. 16.7.2015 I 1211 (No 30) not yet taken into account
	Amendment by Art. 10 G v. 17.7.2015 I 1368 (No 31) not yet taken into account

For more details, please refer to the menu under Notes

Footnote

(+ + + Text evidence from: 1.1.1994 + + +) 

  

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Input formula

On the basis of Section 266 (7) of the Fifth Book of the Social Code, which is defined by Article 1 (143) of the Law of 21 December 1992 (BGBl. 2266), the Federal Ministry of Health is responsible for the following:

First section
Common rules

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§ 1 Definitions

(1) insured persons within the meaning of this Regulation are all members and family insured persons subject to insurance and insurance. (2) Members within the meaning of this Regulation are all members of the Social Code according to § 5 of the Fifth Book of the Social Code, according to article 56 of the Health Reform Act and pursuant to Article 33 (14) of the German Health Structure Act (Health Structure Act) or voluntarily insured persons in accordance with § 9 of the Fifth Book of the Social Code. (3) Health insurance funds within the meaning of this Regulation are the Urban, operational and inpatient health insurance funds, the German Pension insurance Knappschaft-Bahn-See as the institution of the health insurance as well as the sea health insurance and the replacement funds. (4) Top associations of the health insurance companies within the meaning of this Regulation are those in § 213 para. 1 of the Fifth The Federal Association of Agricultural Health Insurance (Bundesverband der farms sickness funds), the top association of the health insurance companies from 2008. (5) The statutory pension insurance institutions within the meaning of this Regulation are the institutions of the Federal Government. Regional institutions, the German Pension Insurance Association and the German Federal Government Pension insurance Knappschaft-Bahn-See. Unofficial table of contents

§ 2 Insurance groups

(1) The contribution requirement of a health insurance company in accordance with § 266 (2) of the Fifth Book of Social Code is to be determined separately according to insurance groups (Section 267 (2) of the Fifth Book of Social Law). Insurance groups are to be separated by age, gender and other status characteristics:

1.

Insured persons entitled to sickness benefit in the event of incapacity for work, but for at least six weeks ' entitlement to payment of their pay or to payment of a social benefit based on compulsory insurance, without which the person referred to in point 4 said insured persons,

2.

Insured persons who are entitled to sickness benefit in the event of incapacity for work, but who do not have the right to payment of their pay for at least six weeks, or to payment of a social benefit based on the obligation to ininsurance, without the provision of the number in number 4 insured persons,

3.

insured persons who are not entitled to sickness benefit in the event of incapacity for work, without the insured persons referred to in point 5,

4.

the insured persons referred to in paragraphs 1 and 2, whose earning capacity is reduced in accordance with sections 43 and 45 of the Sixth Book of Social Code,

5.

the insured persons referred to in point 3 whose earning capacity is reduced in accordance with § § 43 and 45 of the Sixth Book of the Social Code.

For insured persons who, according to § 28d (1), are admitted to a structured treatment program for diabetes mellitus type 1 or type 2, approved in accordance with § 137g of the Fifth Book of Social Code, for breast cancer, for coronary heart disease, for bronchial asthma or in the case of chronic obstructive pulmonary disease, separate insurance groups shall be established for each of these diseases and according to the status characteristics in the second sentence. If an insured person registered in a structured treatment program approved in accordance with § 137g of the Fifth Book of Social Law entered into another treatment program, the health insurance company determines which insurance group to be insured in accordance with Sentence 3 of the insured person is to be assigned. The assignment according to sentence 4 can only be changed by the health insurance with effect from the beginning of the next financial year. (2) Voluntary insured person, for which the general contribution rate applies in accordance with § 241 of the Fifth Book of Social Code, are the In accordance with paragraph 1 (1) or (4). Voluntary insured persons, for which the increased contribution rate applies in accordance with § 242 of the Fifth Book of Social Code, are to be assigned to the groups of insured persons in accordance with paragraph 1 (2) or (4). Voluntary insured persons, for which a reduced contribution rate applies, are to be assigned to the groups of insured persons in accordance with paragraph 1 (3) or (5); reductions in contributions according to § 53 of the Fifth Book of Social Code shall not be taken into account. (3) The old-age intervals according to The second sentence of paragraph 1 shall be one year. In this case, insured persons are to be assigned to the completed year of life, which is calculated from the difference between the year of the survey and the year of birth. Insured persons with an age of less than one year are to be assigned to the age of zero and insured persons with an age over 90 years of age 90. In the categories of insured persons referred to in paragraph 1 (4) and (5), insured persons aged under 35 shall be assigned to the age of 35. (4) For the assignment of insured persons to the groups of insured persons, the continued existence of membership shall be in accordance with § 192 of the Fifth Framework Programme. Book Social Code also authoritative if retroactive pension is granted. (5) insured persons whose entitlement to benefits rest pursuant to § 16 (1) No. 2 to 4 of the Fifth Book of Social Code, members, for their contribution measurement § 240 (4a) of the Fifth Book of the Book of Social Law, and according to § 10 of the Fifth Book Members of the Social Code, as well as members whose benefits are laid down in accordance with Article 256a (4) of the Fifth Book of the Social Code, are not included in the categories of insured persons referred to in paragraph 1. Unofficial table of contents

§ 3 Collection of insurance periods

(1) The sickness funds shall collect annually for the calendar year (reference year) and for the first year and the fifth year preceding the year under review the sums of insurance periods of the insured persons in the insurance groups according to § 2, insofar as the total amount of insurance periods is not In accordance with § 267 (7) of the Fifth Book of the Social Code, the top associations of the health insurance companies provide for a survey for further previous years. The sum of the insurance periods of the reference year in accordance with the first sentence shall be stated in the quarterly accounts and in the annual accounts. (2) For the assignment of insured persons to the groups of insured persons in accordance with § 2, the statutsmal characteristics shall be according to § 2 para. 1 and the age in accordance with section 2 (3) of the survey period shall prevail. For the assignment to the insurance groups according to § 2 (1) sentence 3, the enrolement pursuant to § 28d paragraph 1 is applicable in a structured treatment program, which is effectively approved in accordance with § 137g of the Fifth Book of Social Code. (3) One The period of insurance referred to in paragraph 1 shall begin on the date on which the conditions for the assignment to an insurance group pursuant to § 2 are met; it shall end with the day on which the conditions are eliminated. In the case of insured persons according to § 10 of the Fifth Book of the Social Code, the period of insurance begins with the day on which the family insurance begins; the date is due to a timely notification pursuant to § 10 para. 6 or to § 289 sentence 2 and 3 of the Fifth Book Book the Book of Social Code. Sentence 2 shall apply without prejudice to the right to benefit under Article 19 (2) of the Fifth Book of the Social Code. The family insurance ends with the omission of the conditions or with the departure of the member from the membership. In the categories of insured persons in accordance with Article 2 (1), second sentence, no. 4 and 5, the period of insurance of the recipients of a period of inactivity shall commence on 1 January 2001 on the first day of the sixth month preceding the beginning of the pension, for which a person shall be entitled to a pension. Permanent pension on the basis of a reduction in employment with the date of the beginning of the pension; if the beginning of the period before 1 July 2001, the period of insurance shall start at the earliest on 1 January 2001. In this connection, insured persons of the insurance groups according to § 2 (1) sentence 2 no. 1 and 2, who were insured before the pension was granted for the reduction of the employment with entitlement to sickness benefit, are for this period up to the receipt of the notification in accordance with § 201 para. 4 No. 1 of the Fifth Book of the Social Code (Social Code) with the sickness insurance fund of the insurance group according to § 2 para. 1 sentence 2 no. 4. In the insurance groups according to § 2 (1) sentence 3, the insurance period begins at the earliest with the day of enrollation in accordance with § 28d (1) sentence 1 No. 1 to 3 in a structured structured according to § 137g of the Fifth Book of Social Code Treatment programme, but not before the day on which all the conditions set out in § 28d (1), first sentence, no. 1 to 3 are met, in the case of § 28d (3) at the earliest, with the day of remembering the insured person to the health insurance fund. It ends

1.

on the date on which the approval of the programme ends, in particular, by repealing in accordance with Article 137g (3) of the Fifth Book of the Social Code, or by waiving the authorisation,

2.

with the date of revocation of the declaration of consent pursuant to Section 137f (3) of the Fifth Book of the Social Code by the insured person or

3.

with the date of the last documentation (date of documentation), if the participation of the insured person in the programme ends in accordance with § 28d (2) sentence 1 no. 2.

(4) In accordance with paragraph 1 to 16 April of the year following the year under review, the health insurance funds shall submit the data to the authorities responsible for them in accordance with § 79 (1) sentence 2 of the Fourth Book of the Social Code. After checking for completeness and plausibility, the top associations of the health insurance companies forward the data to the Federal Insurance Office on machine-usable data carriers no later than four weeks after the deadline for submission of the data referred to in the first sentence. The result of their examination in accordance with the second sentence of sentence 2, the top associations of the health insurance companies shall inform the Federal Insurance Office in writing. The Federal Insurance Office can determine the details of the uniform technical preparation of the data. If the data are not available to the Federal Insurance Office up to the date specified in the second sentence, or if the Federal Insurance Office finds significant errors, it may, after consulting the relevant top associations or health insurance companies, have the insurance periods. (5) corrections in the periods of insurance referred to in paragraph 1 shall be made in the annual compensation of the compensatory year, the calculation of the values not yet determined; they shall be taken into account in the calculation of the contribution needs in the next annual compensation in accordance with the rules applicable to them. For compensatory years, which are longer than five years before the reference year, corrections in accordance with sentence 1 shall only be carried out in exceptional cases established by the Federal Insurance Office. Sickness funds where a correction amount has been levied in accordance with § 15a (3) sentence 1, can only make corrections for the compensatory year to which the statement of charges referred, if a data report pursuant to section 15a (3) of the German law (6) For the monthly compensation in accordance with § 17, the sickness insurance funds shall collect the insurance periods of the insured persons in the insurance groups according to § 2 for the periods of time.

1.

January,

2.

January to March,

3.

January to June and

4.

January to September

(reporting periods) of the compensatory year. The sum of the periods of insurance of each reporting period referred to in the first sentence of 1 (2) to (4) shall be given in the quarter-yearly invoice. The sickness funds are based on the insurance periods multiplied by the factor of change in accordance with sentence 4. The rate of change corresponds to the ratio of the number of insured persons in the health insurance company, which is reported in the monthly statistics for the first month of the previous month, to the average monthly number of insured persons in the last survey period as set out in the first sentence. The Federal Insurance Office may, in agreement with the top associations of the health insurance companies, determine a change factor which deviates from the sentence 4. In the light of the calculation method according to the first and third sentences of section 10 (3), the expected contribution requirement in accordance with section 10 (3) differs considerably and demonstrably on the basis of the anticipated calculation factors in the annual compensation. As a result, the Federal Insurance Office can, on a proposal from the top association of the health insurance company concerned, determine in individual cases a procedure which deviates from the first and third sentences. (7) All in the context of the implementation of the risk structure balancing machine generated data bases as well as the entire documentation of all Correction messages are to be kept for nine years. The retention period shall begin with the calendar year following the reference year. A health insurance fund is only obliged and entitled to a longer storage period if the Federal Insurance Office determines in individual cases that further retention is required for the implementation of corrections of the reported data; in this case shall be deleted after twelve years. The identification of the groups of insurers in accordance with § 2 (1) sentence 3 shall be carried out as alphanumeric encryption in the fifth place of the registration mark in accordance with § 267 (5) sentence 1 of the Fifth Book of Social Code; in this respect, this flag may only be to be electronically stored and readable. Unofficial table of contents

§ 4 Considerable performance expenditure

(1) In the determination of the standardized performance expenditure in accordance with § § 6 and 7, expenses shall in particular be taken into account for:

1.

Services for occupational health promotion, for the prevention of work-related health risks, for the promotion of self-help and for primary prevention by means of protective vaccinations in accordance with § § 20a to 20d (1) and (3) of the Fifth Book Social Code, Services for the Prevention of Dental Diseases in accordance with § § 21 and 22 of the Fifth Book of the Social Code, Medical Preventive Services and Medical Preventive Services for mothers and fathers in accordance with § § 23 (1) and (24) of the Fifth Book Social Code, Health and Child Investigations in accordance with § § 25 and 26 of the Fifth Book Social Code and Services according to § 22 of the ninth Book of the Social Code,

2.

Medical treatment pursuant to § 13 (4) sentence 1 to 5 and (5), § 18 (3), § 27a to 33, 37 (1) sentence 1 to 4 and (2) sentence 1 to 3, § § 37a, 38 (1), § § 39, 42 and 43a of the Fifth Book of the Social Code,

3.

Sickness benefit in accordance with § § 44 and 45 of the Fifth Book of the Social Code, including the contributions that have been made to it,

4.

Benefits in pregnancy and motherhood in accordance with § § 24c to 24i of the Fifth Book of Social Code, as well as benefits according to § § 24a and 24b of the Fifth Book of the Social Code,

5.

Medical rehabilitation and medical rehabilitation services for mothers and fathers in accordance with § § 40 and 41 of the Fifth Book of the Social Code and contributions to the Social Code in accordance with § 2 (1) No. 15 (a) of the Seventh Book of Social Law in the Accident insurance insured persons,

6.

Travel expenses in accordance with § 60 of the Fifth Book of the Social Code, insofar as they are to be borne by the health insurance companies,

7.

the Medical Service in accordance with § 281 of the Fifth Book of the Social Code,

8.

Specialist outpatient palliative care in accordance with § 37b of the Fifth Book of Social Code and stationary or partial inpatient care in Hospizen up to the amount of the minimum grant pursuant to § 39a (1) sentence 3 of the Fifth Book of Social Code,

9.

Hospital investments in accordance with Article 14 (2) and (3) of the Health Structure Act,

10.

medical services according to § 23 (2) and (4) of the Fifth Book of the Social Code and supplementary benefits for rehabilitation according to § 43 of the Fifth Book of Social Code, if and insofar as these benefits within the framework of a structured Treatment programme for insured persons pursuant to § 2 (1) sentence 3 are provided,

11.

Program costs for insured persons registered in structured treatment programs in accordance with § 2 (1) sentence 3, insofar as these expenses are additionally and directly related to the development, approval, implementation and evaluation of the health insurance funds of structured treatment programmes; expenditure must be taken into account as flat-rate amounts. The top associations of the health insurance companies determine the further details in their agreement according to § 267 (7) (1) and (2) of the Fifth Book of Social Code,

12.

the transfer of amounts due to the exceeding of the limit of charge in accordance with Section 62 of the Fifth Book of Social Code, in so far as it is accounted for in proportion to the expenditure referred to in points 1 to 11;

13.

Medical treatment in accordance with § 27 (1a), sickness benefit according to § 44a of the Fifth Book of Social Code and the reimbursement of the continuing pay according to § 3a (2) of the Law on the Payment of Remuneration, including the contributions that have been made to it.

The expenses for the services of the doctors and dentists are calculated in the same way as for contract doctors and dentists. (2) The expenses for the services referred to in paragraph 1 shall not, in particular, include expenses for:

1.

In accordance with § 20d (2) of the Fifth Book of the Social Code and in the case of outpatient pension services according to § 23 (2) sentence 2 and 3 of the Fifth Book of the Social Code, for domestic use, the added value of the primary prevention benefits in primary prevention is Nursing in accordance with § 37 (2) sentence 4 of the Fifth Book of the Social Code, for budgetary assistance in accordance with § 38 (2) of the Fifth Book of the Social Code,

2.

Benefits in the case of treatment abroad pursuant to § 13 (4) sentence 6, § 18 (1) and 2 of the Fifth Book of the Social Code, in the case of prevention and self-help pursuant to § 20 of the Fifth Book of the Social Code, in the case of domestic nursing pursuant to § 37 (1) sentence 5 of the German Social Code. Fifth Book of Social Code as well as for non-insured outpatient services pursuant to § 2 (1) sentence 3 of the Fifth Book of the Fifth Book of the Book of Social Code pursuant to § 23 (2) sentence 1 of the Fifth Book of the Book of Social Code Social Code and supplementary benefits for rehabilitation according to § 43 of the Fifth Book Social Code,

3.

Model projects according to § 63 (2) and § 65 of the Fifth Book of the Social Code, Bonuses for health-conscious behaviour according to § 65a of the Fifth Book of the Social Code, as well as premium payments and disbursed reductions in accordance with § 53 of the Fifth Book Social Code,

4.

Additional benefits in accordance with § 2 (1) of the Regulation on the further development of scarce insurance in the revised version published in the Bundesgesetzblatt part III, outline number 822-4, the latest by Article 22 (1) of the Act of 22 December 1983 (BGBl. I, p. 1532),

5.

research projects, in particular according to § 287 of the Fifth Book of the Social Code,

6.

Performance expenditure in the risk pool (§ 269 of the Fifth Book of the Social Code).

(3) reimbursements and revenues, in particular in accordance with § 19 of the Federal Law of Supply, § 39 para. 2 and § 49 (1) No. 3 in conjunction with § 50 of the Fifth Book of Social Code, the Infection Protection Act of 20 July 2000 (BGBl. 1045), Article 63 of the Health Reform Act and § § 102 to 117 of the Tenth Book of the Social Code, and payments of foreign bodies on the basis of between-or state-of-the-art arrangements to be taken into account in accordance with paragraph 1 Expenditure on benefits. Repayments of payments to the insured due to the overrun of the loading limit according to § 62 of the Fifth Book of the Social Code and advance payments of payments by the insured person are to be attributed to the respective compensation year and shall be taken into account in a flat-rate account from the 2004 reporting year In agreement with the Federal Insurance Office, the top associations of the health insurance companies determine in their agreement, in accordance with § 267 (7) (1) and (2) of the Fifth Book of the Social Code, the more detailed information on the flat-rate scheme. In doing so, it is necessary to ensure, by establishing a suitable allocation key, that the amounts to be paid on non-eligible expenditure shall not lead to an increase in the eligible expenditure expenditure. (4) For the The performance of the risk structure compensation shall be allocated to the expenditure referred to in paragraph 1, less the amounts referred to in paragraph 3, to the compensatory year to which it is referred in accordance with Article 37 of the General Administrative Regulation on the accounting in the Social security of 15 July 1999 (BAnz. No 145a of 6 August 1999) in the version in force during the survey period and in accordance with the provisions of the accounts framework for the institutions of statutory health insurance. Unofficial table of contents

§ 5 Ratio values for the determination of the standardized performance expenditure

(1) The Federal Insurance Office (Bundesversicherungsamt) shall determine the ratio values for all health insurance funds in accordance with § 266 (2) sentence 3 and (5) (1) of the Fifth Book of Social Code as follows:

1.

The sums of the eligible expenditure (§ 4) determined for each group of insured persons (§ 2 (1)) in accordance with Section 267 (3) of the Fifth Book of Social Code (§ 4) are in each insurance group by the number of years of insurance in the insurance group. Sample included insured persons (sample insurance years).

2.

The sum of the benefit expenditure according to point 1 of all insurance groups is also divided by the sum of the sample insurance years.

3.

The results referred to in point 1 shall be divided by the result in accordance with point 2 and multiplied by 100.

The Federal Insurance Office may, in agreement with the top associations of the health insurance companies, derogate from the calculation requirements according to paragraphs 1 to 3 if the ratio values are improved. (2) The ratio values referred to in paragraph 1 (3) shall be: (3) In order to improve the results of the sample, the results of each sample survey can be determined according to § 267 (3) of the Fifth Book of the Fifth Book of the Social Code. Amounts collected by the Federal Insurance Office in agreement with the Federal Insurance Office Top associations of the health insurance companies are adjusted or replaced by statistical calculation methods or supplemented or replaced by other available statistical bases, surveys or scientific analyses for individual or several types of performance. (4) The health insurance companies lay down the results of the data collection according to § 267 (3) of the Fifth Book of Social Code up to 15 August, the results on sickness expenditure and sick leave by 31 May of the following year via their top associations The Federal Insurance Office on machine-usable data carriers . The top associations shall examine the results after the first sentence before being sent to the Federal Insurance Office for completeness and plausibility and shall inform the Federal Insurance Office in writing of the result of this examination. The Federal Insurance Office can determine the details of the uniform technical preparation of the data; the provision replaces the agreement in this respect in accordance with Section 267 (7) (1) of the Fifth Book of Social Code. (5) To improve the The results of the sample referred to in paragraph 3 may be taken by the sickness funds after consultation with their top association for the categories of benefits referred to in Article 267 (3) of the Fifth Book of the Social Code and the categories of insurers according to § 2 on the basis of the Present performance and accounting documents non-insured supplementary data (6) In order to avoid the compensation of individual health insurance funds by the formation of the insurance groups in accordance with § 2 (1) sentence 3, the top associations of the health insurance companies set out in the agreement according to § 267 (7) (1) and (2) of the Fifth Book Social code, a suitable statistical smoothing process. Unofficial table of contents

§ 6 Standardized Performance Expenditure

For the previous financial year (compensatory year) in each insurance group (§ 2), the Federal Insurance Office shall establish the standardised performance expenditure per insured year (§ 3) for all health insurance funds as follows:

1.

The sum of the benefit expenditure (§ 4) of all health insurance companies which can be taken into account in the compensatory year is divided by the sum of the insurance years (§ 3) of all insurance groups.

2.

The result referred to in point 1 shall be multiplied and divided by 100 for each group of insured persons with the respective ratio value in accordance with Article 5 (1) (3).

3.

The results referred to in point 2 shall be multiplied for each group of insured persons with the corresponding number of insurance years of all health insurance funds and the sum of these results shall be divided by the sum of the insurance years of all the insurance groups.

4.

The result referred to in point 1 shall be divided by the result set out in point 3 (correction factor).

5.

The results referred to in point 2 shall be multiplied by the correction factor referred to in point 4.

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Section 7 Estimated standardised performance expenditure

(1) The Federal Insurance Office shall, after consultation with the top associations of the health insurance funds, establish in advance for a calendar year the provisional value as defined in § 6 No. 1 for all health insurance funds. It shall be notified by 15 December for the following calendar year. The Federal Insurance Office can adjust the provisional value according to the first sentence and for a shorter period of time up to the 20. of the preceding month, if the assumptions underlying the determination have changed significantly since the last notice. (2) The provisional value referred to in paragraph 1 shall be based on the most recently established ratios (§ 5). (1) (3) to be converted to the groups of insured persons. The effects of the introduction of the risk pool according to § 28a (5) and (6) as well as the formation of the insurance groups according to § 267 (2) sentence 4 of the Fifth Book of Social Code are to be taken into consideration. For the purposes of the calculation and publication of the provisional standardised expenditure, Articles 6 and 1 (2) and (3) shall apply mutatily. The provisional standardised performance expenditure for the insurance groups according to § 267 (2) sentence 4 of the Fifth Book of the Social Code are provided by the Federal Insurance Office in agreement with the top associations of the health insurance companies on the basis of available statistical bases, surveys or scientific analyses, as long as no results of a data collection pursuant to Section 267 (3) of the Fifth Book of the Social Code are available for these groups of insured persons or if the data collection is available Results can be improved. Unofficial table of contents

Section 8 Revenue by contributions

(1) For the purpose of determining the financial strength (§ 12), the health insurance funds referred to in paragraphs 2 to 5 shall calculate the amounts of the contributor income of their members for each month of the compensatory year. (2) The sum of the income from the health insurance funds for the months in a compensatory year, without the claims referred to in paragraph 4 and minus the contributions receivted in these months from the contribution claims pursuant to § 76 (2) sentence 1 no. 2 and 3 and sentence 3 of the Fourth Book of the Social Code Amounts (contribution) and minus the contribution refunds pursuant to § 231 of the Fifth Book Social Code and minus the employer's contribution according to § 249b of the Fifth Book of the Social Code is for the members mentioned in § § 241 to 246 of the Fifth Book of Social Code and the in § 248 of the Fifth Book of the Social Code shall be multiplied by 100 and by the sum of the general contribution rate applicable in the compensatory year in accordance with Section 241 of the Fifth Book of the Social Code and the additional contribution rate in accordance with Section 241a of the Fifth Book of the Fifth Book of the Fifth Book of the Fifth Book of the Fifth Book of the Fifth Book of the Book the Book of Social Code. If the sum of the contribution rates has changed during the compensatory year, the calculation shall be carried out separately after the periods for which the respective sum of the contribution rates was applied. The sum of the contribution rates in force at the time of the nominal position shall be based on the sum of the contribution rates. (3) For members whose contributions to the contributor are not determined in accordance with paragraph 2, whose contributions are not in accordance with § § 226 to 240 of the Fifth Book of the Social Code, or the contributions of which have been levied in accordance with a contribution rate deviating from § § 241 to 246 of the Fifth Book of Social Code, shall be considered to be contributions within the meaning of paragraph 2, which shall be the same in the relevant compensatory year the contributions received and those recorded at the end of the compensation year Contribution claims. If the contributor to the income in accordance with the first sentence cannot be determined, the calendar day of the 30-year period shall be the case for voluntary members who are employed as self-employed persons in their own right. Part of the monthly contribution margin for the remaining members to base the average contributory income of all members of this health insurance fund. (4) The amount of contributions for the equalisation year according to § 5 (1) of the Fifth Book The sum of the results referred to in paragraphs 2 and 2 of the Social Code of the members of the Social Code shall be based on the contributions paid to the pension insurance institutions on a monthly basis. (5) and 3 and the contributor to the revenue referred to in paragraph 4 shall be separated in the and in addition, for the reporting period 1 January to 31 December, in the annual accounts. Unofficial table of contents

Section 9 Advance payment of revenue

(1) For the monthly compensation (§ 17), the sum of the contributions to be paid shall be based on the previous month of the compensatory month, in accordance with Section 8 (2) and (3) of the Month. In the case of pensions in the relevant compensatory month, Section 8 (4) applies accordingly. The Federal Insurance Office may, in agreement with the top associations of the health insurance companies, determine that, by way of derogation from the second sentence, the pensions notified for a reference period other than the compensatory month are to be used. (2) Health insurance funds, for which a calculation according to § 8 is not yet prepared, the Federal Insurance Office shall determine the further information on the calculation of the estimated monthly sums of the contributor-liable receipts. (3) The Federal Insurance Office may in Individual cases on a proposal by the leading association of the health insurance concerned shall determine a procedure which is different from paragraph 1. The Federal Insurance Office may, in agreement with the top associations of the health insurance companies, determine a procedure which deviates from paragraph 1 for all health insurance funds. Unofficial table of contents

§ 10 Contribution requirement

(1) The contribution requirement of a health insurance fund shall be determined for the compensation year as follows:

1.

The standardised performance expenditure per year of insurance (§ 6) is to be multiplied in each group of insured persons (§ 2) with the number of years of insurance (§ 3).

2.

The results referred to in point 1 are to be counted together and the employer contribution drawn up by the sickness insurance fund in accordance with section 249b of the Fifth Book of the Social Code and the participation of the Federal Government in expenses according to § 221 of the Fifth Book Social Code.

(2) For the determination of the contribution requirement for the compensation in accordance with § 19, the Federal Insurance Office shall apply the performance expenditure according to § 6 and the insurance periods reported in accordance with § 3 (4). (3) For the determination of the provisional Contribution requirements for the monthly compensation in accordance with § 17, the health insurance funds shall lay down the prospective standardised performance expenditure in accordance with § 7 and the insurance periods pursuant to § 3 (6) sentence 1 as follows:

1.

the periods of insurance pursuant to § 3 (6) sentence 1 (1) for the compensatory months of March to May;

2.

the periods of insurance pursuant to § 3 (6) sentence 1 (2) for the compensatory months of June to August;

3.

the periods of insurance pursuant to § 3 (6) sentence 1 (3) for the compensatory months of September to November,

4.

the periods of insurance in accordance with § 3 (6) sentence 1 (4) for the compensatory months of December and for the compensatory months of January and February of the following year.

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§ 11 Compensation requirement

(1) The compensation requirement in accordance with § 266 (3) sentences 2 and 3 of the Fifth Book of the Social Code shall be determined by the Federal Insurance Office for each compensatory year as a percentage of the contributor to the contributor income as follows:

1.

The contribution requirements (§ 10) of all health insurance funds are to be counted together (contribution requirement sum) in order to increase the amount according to § 28h (2) sentence 2 and to reduce the sum of the employers ' contributions according to § 249b of the Fifth Book of the Social Code.

2.

The contributor income (§ 8) of the members of all health insurance companies is to be counted together (compensation basic salary).

3.

The result referred to in point 1 shall be multiplied by 100 and shall be divided by the result set out in point 2 (compensation requirement).

(2) For the monthly compensation in accordance with § 17, the provisional compensation requirement is to be estimated by the Federal Insurance Office after hearing the top associations of the health insurance companies. The estimate should be adjusted to changes in the amount of contribution needs and the compensation base amount. § 3 (6), § § 7, 9 and 10 shall apply for the estimation of the expected contribution requirements and the expected contribution income of all health insurance funds. Unofficial table of contents

§ 12 Financial power

(1) The financial strength of a health insurance fund in the equalisation year is the product of the contributor income of its members (§ 8) and the compensation requirement rate (§ 11). (2) For the monthly compensation according to § 17, the health insurance company shall determine its Financial strength on the basis of the expected contributor revenue in accordance with § 9 and the interim compensation requirement in accordance with § 11 para. 2. Unofficial table of contents

§ 13 Calculation bases

(1) The Federal Insurance Office shall submit the calculations made to it pursuant to this Regulation

1.

the business and accounting results of the health insurance funds presented in accordance with the provisions in force and submitted in accordance with Section 79 (1) of the Fourth Book of the Social Code of the Book of Social Security,

2.

the settlement according to § 227 of the Sixth Book of the Social Code,

3.

the results submitted pursuant to Section 267 (4) of the Fifth Book of Social Law

(2) The Federal Insurance Office may

1.

summarize the required calculation steps for the purpose of determining the contribution requirement for simplification in § § 5, 6, 7 and 10,

2.

for calculations and notices instead of the insurance year, to be based on the day of insurance,

3.

in agreement with the top associations of the health insurance companies, in taking into account the contributor income from pensions (Section 8 (4)), deviating from the reference date mentioned in § 267 (6) of the Fifth Book of Social Code.

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§ 14 Accounting procedure, payment transactions, sowing surcharges

(1) The monthly disbursements according to § 17, the annual compensation according to § 19, and the risk pool according to § 269 of the Fifth Book of the Social Code are settled via the German Pension Insurance Association. The Federal Insurance Office (Bundesversicherungsamt) is responsible for the settlement procedure after hearing the top associations of the health insurance companies and the German Pension Insurance Association. (2) Unless the German Pension Fund (Deutsche Rentenversicherung Bund) determines otherwise, the following are: to make payments to the accounts which are relevant for the transfer of the total social insurance contributions. In the case of contributions of EUR 250,000, accelerated transfer procedures shall be carried out. Payment by cheque is not permitted. The payment shall be deemed to have been fulfilled with the incriminating value and execution before the payment of a bank decision on the respective due date. (3) For delayed compensation payments, an increase in the amount of 1 of the sum of 1 from the date of the month of the event shall be deemed to be the same for each month of the month of the event. A hundred of the backward amount to be paid to the payee. For the collection of the sowing surcharges in the monthly compensation, the point in time is applicable in accordance with § 17 (5) sentence 3; § 17 (4) sentence 2 shall apply with the proviso that the access of the request to the establishment by the Federal Insurance Office shall be replaced by the requirement for access to the occurs. For the collection of the sowing surcharges in the annual compensation, the due date applies in accordance with § 19 (3) sentence 2. In case of an undue credit delay, the German Pension Insurance Association can determine on a case-by-case basis that from the amount according to sentence 1 is being wiretapped. If the proof or the fixing of a monthly compensation payment pursuant to § 17 (6) sentence 1, subsection (8) sentence 1 by a correction pursuant to § 17 (5) sentence 4, a recalculation in accordance with § 17 (3a) or a notice pursuant to § 19 (2) sentence 2 The following shall remain unaffected; the same shall apply if the communication of a recalculation pursuant to Article 17 (3a) by a notice pursuant to section 19 (2) sentence 2 is repealed, amended or (4) Insofar as the amounts of the Deutsche Rentenversicherung (German Pension Insurance) arising from sowing The Federal Government is not compensated by surpluses in the monthly compensation or adjustment of the compensation requirement in the monthly compensation or balance of the year. The supplementary allowance is due under paragraph 3 of the German Pension Insurance. In addition, they are available to the health insurance companies and will be taken into account in the next year's compensation. The Federal Insurance Office (Bundesversicherungsamt), after hearing the top associations of the health insurance companies and the German Pension Insurance Association, will determine the details of the allocation and settlement of the sowing surcharges. Unofficial table of contents

Section 15 Notices

The notices provided for in this Regulation are made by the Federal Insurance Office (Bundesversicherungsamt) to the top associations of health insurance companies and the German Pension Insurance Association (Deutsche Rentenversicherung Bund). The centres of excellence shall ensure that the sickness funds for which they are competent are immediately informed of the contract notice. The Federal Insurance Office shall make the notice available to the public in an appropriate electronic form. Unofficial table of contents

§ 15a Examination

(1) The authorities responsible for the examination in accordance with § 274 of the Fifth Book of the Social Code shall, on a yearly basis, have the notification of all periods of insurance pursuant to § 3 as well as the cases reported pursuant to section 28a (3) for one of the last two compensatory years. in the case of health insurance funds in their area of responsibility. In the context of the examination of the insurance periods in accordance with § 3, insured persons who are enrolled in a structured treatment program approved in accordance with § 137g of the Fifth Book of Social Code shall also be subject to the conditions for the insurance periods for the insurance companies. To examine the affiliation of these insured persons to the groups of insured persons in accordance with Section 2 (1) sentence 3; the cases reported in accordance with Section 28a (3) are in particular in relation to the accuracy of the reported performance expenditure, the identity of persons and the reference year shall be examined. The Federal Insurance Office may, after hearing the authorities responsible for the examination in accordance with Article 274 of the Fifth Book of the Social Code, and the top associations of the health insurance companies, determine that the health insurance companies electronically provide the data to be checked. Have to be made available, and determine the approximate. For the tests referred to in the first sentence, the Federal Insurance Office shall, after consulting the top associations of the health insurance funds and the bodies responsible for the examination in accordance with Article 274 of the Fifth Book of the Social Code, lay down the samples for each test cycle, and High-accounting methodology, in particular the respective procedure for determining a reasonable sample size, and shall determine the details of the requirements for the collection of samples and the communication of the test results in accordance with the fifth sentence. The authorities responsible for the examination in accordance with Article 274 of the Fifth Book of the Social Code shall immediately inform the Federal Insurance Office, the sickness fund and the leading association of the health insurance concerned of the result of the tests in accordance with the first sentence. (2) The Federal Insurance Office (Bundesversicherungsamt) shall calculate the percentage of defective or non-plausible cases found in the examination of the insurance periods of a sickness insurance fund referred to in the first sentence of paragraph 1 to the totality of the insured persons of this health insurance fund. If, in the examination referred to in the first sentence of paragraph 1, a sickness fund has been found to have wrongly received reimbursement benefits from the risk pool (§ 28a), the Federal Insurance Office shall calculate the error rate determined on the totality of the insured persons. this health insurance fund, for which the sickness insurance fund has claimed reimbursement claims. The Federal Insurance Office determines the respective high-accounting procedures to be applied in consultation with the top associations of the health insurance companies. In this connection, it may also be provided that the extrapolation takes place only if the erroneous or non-plausible cases exceed a certain quota. (3) The Federal Insurance Office shall determine, on the basis of the extrapolation referred to in the first and second sentences of paragraph 2, the first and second sentence. Correction amount and asserts it by communication. Section 14 (3), first sentence, and § 19 (3) and (4) shall apply accordingly. In the case of a correction amount, the sickness insurance fund may correct the underlying data message in the context of a full survey. The Federal Insurance Office must be informed of whether a full survey is carried out by the health insurance office within three months of the date of receipt of the certificate after the sentence 1. If the sickness fund informs that no full collection is to be carried out, or if the period referred to in sentence 4 passes without notice from the sickness insurance fund, the Federal Insurance Office shall fix the correction amount definitively and the amount of correction shall be in the next year of compensation. Otherwise, the time limit for the execution of the full survey shall be one year after the date of receipt of the decision after the first sentence. If the Federal Insurance Office determines the correct correction of the data report, the sickness fund shall return the amount of the correction made. Otherwise, the Federal Insurance Office shall fix the correction amount definitively and the correction amount shall be taken into account in the next annual compensation. The data message shall be deemed to have been properly corrected if the competent authority responsible for the examination of the health insurance in accordance with § 274 of the Fifth Book of Social Code shall be notified to the Federal Insurance Office on the basis of a date within ten months of the date of the Full survey of newly drawn sample referred to in paragraph 1. The provisions of the second sentence of paragraph 1 to 4 and paragraph 2 shall apply accordingly. Interest receivable and sowing surcharges shall be taken into account in the next annual balance. (4) For the examination of the compensatory years up to and including the compensation year 2004 as well as all corrections made for those years in the 2005 annual compensation, the following shall apply: Paragraphs 1 to 3 in the up to 29. 1 October 2007.

Second section
Monthly compensation

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Section 16 Claims and obligations

For the calculation of the amount of the compensation claim or the compensation obligation of the health insurance company, its financial strength (§ 12) deduces its contribution requirement (§ 10). If the financial strength exceeds the contribution requirement, the excess amount shall be allocated to the health insurance funds, whose contribution requirements exceed their financial strength. Unofficial table of contents

§ 17 Monthly compensation

(1) Each insurance company shall calculate monthly the amount of its claim or its obligation in the risk-structure compensation (§ 16). (2) If the estimated contribution required for the respective month (compensatory month) is higher than the expected amount of contributions (§ 10 para. 3) (§ 12 para. 2), the health insurance fund receives the difference from the German Pension Insurance Association. (3) If the expected contribution to the respective month is lower than the expected amount of the estimated financial strength, the amount of the pension is less than the estimated amount of the German pension insurance. The German Pension Fund receives the financial strength of the German Pension Fund. (3a) The Federal Insurance Office (Bundesversicherungsamt) shall calculate for the period of the first half-year and 31 March of the following year for the period of the previous year for each of the health insurance funds the amount of the total amount of the total amount of the total amount of the total amount of the total amount of the total amount of the total amount of Estimated contributor income according to § 9 on the basis of these quarterly accounts according to § 10 of the General Administrative Regulation on the statistics in the statutory health insurance as well as the provisional Contribution requirement in accordance with § 10 paragraph 3 on the basis of the latest estimate in accordance with § 11 paragraph 2 new. It shall inform the health insurance funds and the German Pension Fund (Deutsche Rentenversicherung Bund) of the balance to be paid in the light of the payments made for the period referred to above. For this purpose, the Federal Insurance Office shall also determine the compensation requirement in accordance with section 11 (2) and the provisional value according to § 7 (1) new. The rules applicable to the monthly compensation procedure shall apply accordingly. The Federal Insurance Office may, in agreement with the top associations of the health insurance companies and the German Pension Insurance Association, derogate from the dates specified in the first sentence or from the implementation of the procedure according to sentence 1. In agreement with the Federal Insurance Office, the top associations of the health insurance companies may, in their agreement pursuant to § 267 (7) (1) and (2) of the Fifth Book of the Social Code, the further information on the calculation procedure and the transmission of additional information. (4) The sickness funds charge the amount due to them in accordance with paragraph 2, including the contributions from pensions awarded to them pursuant to Article 255 (3) sentence 1 of the Fifth Book of the Social Code. Deutsche Rentenversicherung Bund in the respective compensation month to be forwarded Contributions. In so far as a health insurance company cannot charge the amount in the respective month, the German Pension Insurance Association has, at the request of the health insurance fund, the amount due after deduction of the amount likely to be paid in the respective month shall be paid up to the fifth working day after receipt of the request. The earliest access of a requirement is the first working day of the respective compensatory month. (5) The sickness funds charge the amount due under paragraph 3 of the German Pension Insurance (Deutsche Rentenversicherung Bund) with the amount allocated to them in accordance with Section 255 (3) sentence 1 of the Fifth Book Social Code on contributions from pensions. If the contributions from pensions exceed the difference referred to in paragraph 3, the second sentence of paragraph 4 shall apply accordingly. If the amount of the difference referred to in paragraph 3 exceeds the contributions from pensions, the sickness insurance fund has the surpassing amount to the German Pension Insurance Association up to the age of 15. of the respective compensatory month. Compensatory amounts due to corrections to the proof referred to in the first sentence of paragraph 6 shall be paid by the German Pension Insurance Association until the fifth working day after the date of the determination or receipt of the requirement, unless the due date is otherwise due to (5a) If the requirements laid down in the second sentence of paragraph 4 and the second sentence of paragraph 5 are not likely to be met from the liquid funds available to the German Pension Insurance Association, the provisions of paragraph 4 shall apply. The amounts referred to in the second and third sentences of the second and third sentence of paragraph 5 to avoid financial burdens Deutsche Rentenversicherung Bund on the basis of the different payment dates for payment-entitled health insurance funds and for payment-obligated health insurance companies on the 18th. of the respective compensatory month. The Federal Insurance Office (Bundesversicherungsamt), after hearing the top associations of the health insurance companies, determines in which compensatory month sentence 1 applies. (6) The health insurance companies have the Deutsche Rentenversicherung Bund bis zum 10. the amounts to be paid in accordance with paragraphs 2 and 3 and their calculation basis (Section 10 (3), section 12 (2)) of the respective month. The certificates can be sent to the German Pension Insurance Association (Bund) on the form provided for monthly compensation by fax. The Deutsche Rentenversicherung Bund shall keep the evidence in accordance with the retention periods applicable to invoice documents and shall demonstrate separately the amounts invoiced and paid pursuant to paragraphs 4 and 5 for each sickness insurance fund. After the end of the calendar year of each health insurance company, it sends a statement of account. The Federal Insurance Office (Bundesversicherungsamt) is responsible for further details. (7) If health insurance funds have been combined with each other, the monthly instalments are calculated on the basis of the sum of the total number of the health insurance funds. values recorded for the participating sickness funds in the initial period. Accordingly, the calculation of the first monthly discount shall be carried out. (8) The evidence referred to in the first sentence of paragraph 6 shall not be submitted within the prescribed period, if the evidence is defective or if the resulting payments are not made, the The Federal Insurance Office for the sickness insurance fund shall fix the amount of the payment referred to in paragraph 2 or 3 for the compensatory month on the basis of available or estimated data. If payments under paragraph 3 are not made in whole or in part, § 19 (4) shall apply mutagenic. (9) The Federal Insurance Office shall transmit to the top associations of the health insurance funds the data transmitted by the health insurance funds for the implementation of the the monthly countervailing procedure and the data and results referred to in paragraphs 2, 3 and 3a for the individual health insurance funds of their cash registers.

Third Section
Annual compensation

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§ 18 General

(1) After the end of the calendar year, the disbursements according to § 17 shall be compensated with the final payment to be made for this year by means of an annual compensation. (2) The Federal Insurance Office shall immediately estimate after the end of the calendar year the payments shall be made. Calendar year for the annual accounts, after consultation of the top associations of the sickness funds, the estimated level of the standardised performance expenditure per year of insurance in each group of insured persons and of the compensation requirement and shall give these values known. § § 6 and 11 (1) and § 15 apply accordingly. Unofficial table of contents

§ 19 Annual compensation

(1) The Federal Insurance Office shall determine after the existence of the business and invoice results of all health insurance funds participating in the monthly compensation as well as the settlement in accordance with § 227 of the Sixth Book of the Social Code and the annual accounts of the Deutsche Rentenversicherung Knappschaft-Bahn-See as institution of the pension insurance for the respective past calendar year (compensatory year):

1.

for all health insurance funds:

a)

the level of the standardised performance expenditure per year of insurance in each group of insurance companies in accordance with § 6 on the basis of the ratio values in accordance with § 5,

b)

the compensation requirement in accordance with Article 11 (1);

2.

for each health insurance fund and for all health insurance funds as a whole:

a)

the sums of insurance periods in each insurance group according to § 3,

b)

the sums of expenditure eligible for consideration in accordance with § 4,

c)

the amount of the contribution requirement in accordance with § 10 (1),

d)

the amounts of the contributor revenue in accordance with § 8,

e)

the amount of the financial power in accordance with section 12 (1),

f)

the payments made by the sickness funds and the Deutsche Rentenversicherung Bund pursuant to Article 17 (4) and (5); as a surcharge in accordance with § 17 (4) and (5), the Federal Insurance Office for employees shall apply the conditions laid down in Article 17 (6) of the German Social Insurance Fund (Bundesversicherungsanstalt für Anemployee) amounts shown.

(2) The Federal Insurance Office shall calculate, on the basis of the figures determined by it in accordance with paragraph 1, the compensation claim or the compensation obligation pursuant to section 266 (2) sentence 1 of the Fifth Book of Social Code for each health insurance. It shall inform the health insurance funds and the German Pension Insurance Association of the payments made as compensation pursuant to section 266 (6) sentence 2 of the Fifth Book of Social Code and which, according to § 266 (6) sentence 5 of the Fifth Book of the Social Code, are still to be paid. Payments shall be made available. Section 17 (5), first sentence, shall apply accordingly. A common calculation shall be made in accordance with the first sentence for sickness funds which have been combined with each other during the compensatory year. (3) The notice referred to in paragraph 2 shall be due to the amounts to be paid thereafter. The Federal Insurance Office shall make the due date of the amounts to be paid to the health insurance funds and the German Pension Insurance Association (Deutsche Rentenversicherung Bund) with the sending of the date of payment in accordance with paragraph 2. (4) Payments referred to in paragraph 3 shall be made in whole or in part , the Federal Insurance Office may, in order to avoid financial charges against the German Pension Insurance Association, be able to pay the shortfall until its payment is made in the determination of the compensation requirement for the monthly compensation (§ 11 (2) and take account of annual compensation. The first sentence shall apply in respect of any shortfalls or surpluses which have remained in the monthly compensation after the end of a calendar year until the annual compensation has been implemented. (5) The annual compensation shall be until the end of the compensatory year. the following calendar year. (6) The Federal Insurance Office shall transmit the data and results referred to in paragraphs 1 and 2 for the individual health insurance funds of their cash registers to the top associations of the health insurance funds.

Fourth Section
Transitional provisions

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§ 20 Insurance Groups 1994 and 1995

(1) Until the results of the data collection are available in accordance with Section 267 (2) of the Fifth Book of the Social Code and the ratio values (§ 5) based on the results of the survey carried out in 1994 according to § 267 (3) of the Fifth Book In the financial years 1994 and 1995, the monthly compensation according to § 17 of the Social Code is to be assumed by way of derogation from § 2 of the insurance groups, which are separated by age, gender and the following status characteristics:

1.

Insured persons in accordance with § 5 (1) Nos. 1 to 10 and § 9 of the Fifth Book of Social Code,

2.

Insured persons according to § 5 (1) Nos. 11 and 12, § § 10 and 189 (1) of the Fifth Book of the Social Code, Article 56 of the Health Reform Act and Article 33 (14) of the Health Structure Act.

(2) Up to the date referred to in paragraph 1, the age-limits for the monthly compensation shall be five years, by way of derogation from § 2 (3). Insured persons in the age groups up to 15 years and insured persons aged 80 and over are each combined to form one age group. (3) For the 1994 financial year, the insurance groups referred to in paragraph 1 are not the persons referred to in § 5 (1) no. 11 and 12, and § 189 (1) of the Fifth Book of the Social Code, Article 56 of the Health Reform Act and Article 33 (14) of the Health Structure Act, pensioners and pension claimants, and their persons under § 10 of the Fifth Book of the Book of Health Insurance. Social code of insured members of the family. For the 1994 financial year, insured persons who receive a pension for reduced earning capacity and are not included in the insured persons referred to in the first sentence are included in the groups of insured persons in accordance with Article 2 (1) (1) to (3); § 2 (1) (4) to (6) does not apply to this. Unofficial table of contents

§ 21 Insurance number 1994 and 1995

(1) For the monthly compensation in accordance with § 17, in the financial years 1994 and 1995, the number of insured persons in the insurance groups according to § 20 of the date of reference 1 shall be different from the insurance periods referred to in § 3 (6). It should be based on the date of October last year. It is published in accordance with § § 2 and 3 of the General Administrative Regulation on Statistics in the statutory health insurance of 4 January 1984 (BAnz. 289) in the version in force at the survey date. § 3 (6) sentence 3 shall apply accordingly. (2) If, after the end of the annual compensation pursuant to section 25 (1) sentence 1, significant errors in the reported insurance periods (§ 3) are established, the Federal Insurance Office may apply the same in the case of the fixing of the Take into account the compensation requirement for the monthly compensation (§ 11 para. 2). The Bundesversicherungsamt (Federal Insurance Office), after hearing the top associations of the health insurance companies, is responsible for this. Unofficial table of contents

Section 22 Eligible Expenditure 1994

For the financial year 1994, the sum of the expenditure pursuant to section 4 (1) and the sum of the amounts pursuant to § 4 (3) shall be deducted from the sum of the expenditure eligible for consideration in accordance with Section 4 (3), insofar as it is based on the provisions of § 5 (1) No. 11 and (12) and § 189 (1) of the Fifth Book of the Social Code, Article 56 of the Health Reform Act and Article 33 (14) of the Health Structure Act, pensioners and pension claimants liable to insurance and their insured persons in accordance with § 10 of the Fifth Book of Social Insurance Code Members of the family. Unofficial table of contents

§ 23 ratios of 1994 and 1995

(1) Until the results of the data collection pursuant to Section 267 (3) of the Fifth Book of the Social Code are available for the first time, the Federal Insurance Office has the ratio values in accordance with § 5 for monthly compensation (§ 17) in the financial years 1994 and 1995 after Consultation of the top health insurance associations for all health insurance companies to make a binding estimate and to make known. In doing so, the groups of insurers shall be based in accordance with § 20. Expenditure on sickness benefit expenses in accordance with § 44 of the Fifth Book of Social Code shall be taken into account exclusively with the group of insured persons in accordance with Article 20 (1) (1) of this Regulation. § § 2 and 25 (2) sentence 3 apply for the monthly compensation in the financial year 1996. (2) The estimate referred to in paragraph 1 shall be changed before the end of the data collection after consultation of the top associations of the health insurance funds, as soon as the data are to be evaluated. preliminary results or partial results of the data collection deviations from the estimated ratios. (3) In the 1994 financial year, the survey pursuant to Section 267 (3) of the Fifth Book of the Social Code may be carried out for a shorter period than the calendar year. Unofficial table of contents

Section 24 Revenue in 1994

(1) For the financial year 1994, the amounts of pensions of the statutory pension insurance, the pensions and the work income, which are subject to the contributions of the members who are subject to insurance, shall be subject to the contributions to be paid in accordance with § § 8 and 9. a pension from the statutory pension insurance scheme, which was used for the assessment of contributions, not included. Sentence 1 shall apply in accordance with the contributions to the contributions to the pension claimants insured pursuant to section 189 (1) of the Fifth Book of Social Code. (2) For the financial year 1994, the amounts receivedreceivedpursuant to § 8 (2) sentence 1 not to withdraw contributions in accordance with § 231 (2) of the Fifth Book of the Social Code. Unofficial table of contents

§ 25 Annual comparisons up to 1997

(1) The annual balance for the 1994 financial year is initially based on the ratio values (§ 5), which were determined according to the results of the survey carried out in 1994 in accordance with Section 267 (3) of the Fifth Book of the Social Code. . On the basis of the ratios (§ 5), which have been determined according to the results of the survey carried out in 1995 in accordance with Section 267 (3) of the Fifth Book of the Social Code, the provisional annual compensation for the financial year 1994 corrected. With the agreement of all top associations of the health insurance funds after the determination of the ratio values in accordance with the second sentence, the Federal Insurance Office can determine that a correction according to sentence 2 does not take place. (2) Comes the data collection in accordance with § 267 (3) of the Fifth Book of the Social Code in 1994 not materialized, the annual compensation for the year 1994 follows on the basis of the ratio values (§ 5), which according to the results of the survey carried out in 1995 according to § 267 (3) of the fifth book The Social Code has been established. The first sentence shall not apply if the data collection has resulted in partially usable results and the annual compensation referred to in the first sentence of paragraph 1 can be used to improve the results of the monthly compensation. In order to improve and supplement the results of the sampling referred to in the second sentence, it is possible to use the scientific-statistical analyses of other data sources and estimations for the determination of the ratios. (3) Based on the According to Article 267 (3) of the Fifth Book of the Social Code, the Federal Insurance Office may, after hearing the top associations of sickness funds, carry out the ratio values for 1994, 1995 and 1996 in the annual compensation for 1997. correct. A uniform proposal from all the top health insurance associations should be taken into account. If a single proposal does not materialize in accordance with the second sentence, the ratio values for 1995 and 1996 shall be corrected in the annual compensation for 1997. (4) If a correction is carried out in accordance with paragraph 3, the Federal Insurance Office may compensate for the annual compensation for the year. By way of derogation from the time limit in § 19 (5) to the 28th February 1999. The Federal Insurance Office may, by way of derogation from § 19 (3), determine the maturity of the parts of the compensation payments which are due to the correction referred to in paragraph 3 and in accordance with Section 3 (5) in consultation with the top associations of the health insurance companies. Unofficial table of contents

Section 26 Invoices

Due claims and obligations arising from the risk structure compensation are to be offset with simultaneously due obligations and claims arising from the financial compensation in the health insurance of the pensioners.

Fifth Section
Special arrangements

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Section 27 Accession area

(1) Until the expiry of Section 313 (10) (a) of the Fifth Book of the Social Code, the risk structure compensation for the accession area shall be carried out separately. (2) Health insurers whose competence extends to the accession area; The periods of insurance pursuant to § 3, the eligible expenditure incurred in accordance with § 4 and the contributory revenue in accordance with § § 8 and 9 of the insured persons in this territory shall be separated up to the date referred to in paragraph 1. § 3 (3) sentence 2 applies to the compensation in 1994 with the proviso that the notification must be made after 31 December 1992. (3) The Federal Insurance Office shall determine the ratios according to § 5, the prospective standardized Performance expenditure in accordance with § 7, the provisional compensation requirement in accordance with § 11 para. 2 and the values referred to in § 19 for the health insurance funds referred to in paragraph 2 are separated up to the date referred to in paragraph 1. Unofficial table of contents

Section 27a Financial Regulation of the same period as from 1999

(1) For the determination of the compensation claims and obligations of 1 January 1999, a uniform compensatory demand rate (§ 11) on the basis of the sum of the total number of sickness insurance funds in the entire Federal territory shall be determined by way of derogation from § 27. (§ 8) and separately according to old and new countries, the contribution needs of the health insurance funds in the entire Federal territory to be based. The Federal Insurance Office shall, on 1 January 1999, determine the values referred to in Article 19 (1) for the sickness funds and insured persons in the area referred to in Article 1 (1) of the 'Einigungscontracges'. In the compensatory amounts, the sums of insurance periods, the contribution requirement, the financial strength and the amount of the compensation obligation or the compensation for sickness funds whose responsibility is applicable to the accession area shall be: (2) In order to determine the changes in the financial power referred to in Article 313a of the Fifth Book of the Social Code, a separate compensation requirement on the basis of the separate provisions for the territory referred to in the second sentence of paragraph 1 shall be: , to calculate the sums of contributions and the contribution requirements determined. The difference between the sums of the financial strength determined in accordance with paragraph 1 and in the first sentence of the second sentence for the territory referred to in the second sentence of paragraph 1 may not exceed 1.2 billion Deutsche Mark in 1999; if that amount is exceeded, the financial strength shall be: of all health insurance funds in this area by a uniform factor corresponding to this difference. The financial strength of the health insurance funds in the rest of the Federal Republic is to be reduced by a uniform factor corresponding to this difference. Unofficial table of contents

§ 28 Berlin

(1) For insured persons in the Land of Berlin, the risk structure compensation shall be carried out in accordance with the regulations in force for the former federal territory; § 27 shall not apply to this extent. (2) For the financial year 1994, the health insurance funds shall determine the contributor to the contributions Revenue according to § § 8 and 9 for members in the part of the Land Berlin, in which the Basic Law was not applicable until the entry into force of the agreement of the agreement, as follows:

1.

The contributions of all members in the Land of Berlin will be divided by the number of all members in the Land of Berlin.

2.

The contributory revenue of all the members in the territory referred to in the first sentence shall be divided by the number of members in the territory referred to in the first sentence.

3.

The sum of the results referred to in points 1 and 2 shall be divided by two and multiplied by the number of members in the territory referred to in the first sentence.

(3) As long as and as far as sickness funds, the responsibility of which extends beyond the territory referred to in the first sentence of paragraph 2, the number of insured persons on the basis of the compensation (§ 21) in the groups of insured persons (§ 20), the amount of the insured persons (§ 20). for the expenditure referred to in paragraph 2 for the territory referred to in the first sentence of paragraph 2, the data for the monthly compensation in 1994 shall not be determined as follows: to estimate:

1.

The ratio of the number of family insured persons to the number of members of the sickness insurance fund in the area referred to in the first sentence of paragraph 2 shall be equal to the ratio of the number of family insured persons to the number of members of all health insurance funds of the relevant health insurance funds. Cash point in the accession area. The provisions of the first sentence shall apply to the distribution of family insured persons to the groups of insured persons.

2.

The ratio of the average expenditure eligible expenditure per insured person of the sickness fund to the average eligible expenditure per insured person in the local sickness fund in the case referred to in the first sentence of paragraph 2 Area is equal to the ratio of the average eligible expenditure per insured of all health insurance funds of the corresponding cash point to the average eligible expenditure per insured of all insured persons Local sickness funds in the accession area.

3.

The ratio of the average contributory income per member of the sickness insurance fund to the average contributory income per member of the local sickness fund in the area referred to in the first sentence of paragraph 2 is equal to the ratio of the average contributor income per member of each sickness fund of the corresponding cash register to the average contributor income per member of all the local sickness funds in the accession area.

4.

The ratio of the average contributor income per member of the sickness fund according to § 313 (10) (b), second sentence, of the Fifth Book of the Social Code (arithmetic average) to the contributor income as specified in point 3. Corresponds to the ratio of the average contributor income per member of the Allgemeine Ortskrankenkasse Berlin according to § 313 (10) (b), second sentence, of the Fifth Book of the Social Code, to its contributor revenue per member in the territory referred to in the first sentence of paragraph 2.

The regional allocation shall be made for employed members and their insured members of the family after the place of employment and for the other insured persons after the place of residence. (4) Paragraph 3 shall apply to the annual equalisation in 1994. (5) the Federal Insurance Office shall determine the estimate referred to in paragraph 3 after consultation of the top associations of the health insurance funds. The Federal Insurance Office may, in agreement with the top associations of the health insurance funds of paragraph 3, determine different estimation procedures. Unofficial table of contents

Section 28a (omitted)

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Sixth Section
Requirements for the approval of structured treatment programs according to § 137f (2) of the Fifth Book of Social Code

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§ 28b (omitted)

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§ 28c (omitted)

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§ 28d Requirements for the procedure for the enrollation of the insured in a structured treatment programme according to § 137g of the Fifth Book of Social Code including the duration of the participation

(1) A structured treatment programme may only be approved if it provides for the insured person to be

1.

only on the basis of a written confirmation of a confirmed diagnosis by the treating physician in accordance with the guidelines of the Joint Federal Committee according to § 137f of the Fifth Book of the Social Code and the initial documentation according to the Guidelines of the Joint Federal Committee according to § 137f of the Fifth Book of the Social Code are inscribed,

2.

In accordance with Section 137f (3) sentence 2 of the Fifth Book of the Social Code, consents to participation and the associated collection, processing and use of its data, and

3.

on the contents of the programme, and in particular on the fact that, in order to carry out the structured treatment programme, findings data are transmitted to the health insurance fund and these data are provided by the health insurance fund in order to support the care of the insured person in the Framework of the structured treatment program can be processed and used, and in the cases of § 28f (2), the data for the pseudonymisation of the insurance cover of a working group or of third parties commissioned by the working group , the division of tasks between the levels of supply and supply objectives, voluntary participation in the programme and the possibility of revocation of consent, as well as of the cooperation obligations set out in the programme in order to achieve the objectives and, when a lack of participation is At the end of the participation in the programme, the information will be informed and this information will be confirmed in writing.

(2) A structured treatment programme may also be authorised only if it provides that:

1.

the health insurance company reviews the active participation of the insured person in accordance with the guidelines of the Joint Federal Committee in accordance with § 137f of the Fifth Book of the Social Code,

2.

the participation of the insured person shall end in the programme if:

a)

it no longer meets the requirements for enrollment,

b)

within a period of 12 months, it has not exercised two of the training courses which have been initiated under the guidelines of the Joint Federal Committee in accordance with Article 137f of the Fifth Book of Social Code, without a plausible justification, or

c)

Two consecutive quarterly documents to be compiled in accordance with the guidelines of the Joint Federal Committee according to § 137f of the Fifth Book of the Social Code do not within six weeks after the expiry of the documents referred to in § 28f (2) sentence 1 no. 1 (a) has been submitted,

and

3.

the sickness fund informs the participants of the programme about the beginning and the end of the participation of a insured person in the programme.

(2a) (omitted) (3) A structured treatment programme may also be authorised where it provides that, in the event of an interruption of the insured person's membership of the health insurance scheme, which shall not exceed six months, its Participation in the program can be continued on the basis of a follow-up documentation. During the period of interruption, paragraph 2 (2) shall apply accordingly. Unofficial table of contents

§ 28e (omitted)

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§ 28f Requirements for the procedure for the collection and transmission of the personal data required for the implementation of the programmes pursuant to § 137g of the Fifth Book of Social Law

(1) The prerequisite for the authorisation of a structured treatment programme is that:

1.

in the programme at the place where the service is to be provided by electronic means, it is intended to cover only the first and subsequent documentation to be collected and submitted electronically, which only those documents contained in the guidelines of the Joint Federal Committee pursuant to § 137f of the Fifth Book The Social Code shall include the information listed in each case and only for the treatment, the definition of the quality objectives and measures and their implementation, the review of the enrollment in accordance with § 28d, the training of the insured persons and the Service providers and evaluation in accordance with the guidelines of the Joint Federal Committee according to § 137f of the Fifth Book of the Social Code, and

2.

in the programme, access to the data transmitted to sickness funds under this provision is intended only for persons carrying out tasks under the supervision of insurers in structured treatment programmes and, in particular, for the purpose of: have been trained.

(1a) (omitted) (2) As far as the implementation of a structured treatment programme is agreed with a cash medical association, the programme may be approved if:

1.

it has been agreed in the Treaties that:

a)

the contract doctors and medical institutions involved in the implementation of the programme, the data to be collected by them in accordance with the guidelines of the Joint Federal Committee pursuant to Section 137f of the Fifth Book of the Social Code, the Sickness funds and the pseudonymisation of the insurance cover of a working group according to § 219 of the Fifth Book of the Social Code within ten days after the end of the documentation period, machinable and insured-and submitting a service provider,

b)

the insured person is informed in writing of the data referred to in point (a);

c)

the working community referred to in point (a) shall be pseudonymised on the data transmitted to it by the associations of cashers who are members of that consortium and to a common group of members of the working community. institution which may use these data only for the performance of their respective tasks in the context of quality assurance and the evaluation of the structured treatment programme,

d)

the pseudonymisation of the insurance cover is carried out in a form suitable for the purposes referred to in paragraph 1;

e)

(dropped)

and

2.

in the programme, the implementation of the programme shall be based on the implementation of the programme.

The first sentence shall apply to other contracts concluded with service providers for the implementation of structured treatment programmes which are concluded without the participation of the associations of health insurance associations. (2a) (omitted) (3) Insofar as the Treaties provide for: Where structured treatment programmes are not provided for in the formation of a working group referred to in the first sentence of paragraph 2, the programme may be authorised only if it provides that the products listed in the annexes referred to in paragraph 1 shall be: Collect data from the service providers and machine the health insurance shall be made available at the latest within ten days of the end of the documentation period, as well as insured persons and persons responsible for the performance of the services. Paragraph 2, first sentence, point 1 (b) shall apply. (4) The sickness funds shall ensure that the performance data referred to in the second section of the Tenth Chapter of the Fifth Book of the Book of Social Code shall, where necessary, and the data referred to in paragraph 1, be applied to: the experts commissioned with the evaluation are transmitted according to § 137f (4) sentence 1 of the Fifth Book of the Social Code. Personal data are to be pseudonymized prior to transmission to the experts by the health insurance companies. Unofficial table of contents

§ 28g (omitted)

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§ 28h Calculation of costs incurred in connection with the application of applications for authorisation

(1) The application of an application for the authorisation of a structured treatment programme shall include all activities which are directly initiated by the processing of the application. The calculation of fees shall be based on the Federal Government's personnel costs, including the flat-rate flat rate. The staff rates are to be used per hour of work. If an application for authorisation is withdrawn prior to the issuing of the certificate, the calculation of the fees shall be based on the expenditure incurred up to that date. Expenses are to be added to the fees in their actual amount. (2) Pre-holding costs are the necessary costs incurred by the Federal Insurance Office, which are due to benefits in connection with the approval of structured treatment programs. but which are not directly caused by the division of the fodder. For the purpose of determining the holding costs, the sum of the personnel and material costs determined for a compensation year on the basis of paragraph 1 of the staff involved in the authorisation of structured treatment programmes shall be the amount of the staff responsible for the The compensatory year for the allocation of the fees shall be reduced.

Seventh Section
Further development of risk structure compensation from 2009

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§ 29 Principles for the further development of risk structure balancing

From the reporting year 2009, the insurance group demarcation shall be based on the following risk characteristics, by way of derogation from Article 2 (1) and (2):

1.

the morbidity groups of an insurance classification model established by the Federal Insurance Office, which determines risk surcharges on the basis of diagnoses and drug-related active substances and which is based on classification models, the the ability to work in statutory health insurance has been scientifically investigated and confirmed,

2.

the reduction of the earning capacity in accordance with § § 43 and 45 of the Sixth Book of the Social Code, differentiated by age and sex,

3.

age and sex groups,

4.

for the determination of the standardized sickness expenditure, with the exception of the expenditure according to § 44a of the Fifth Book of the Social Code, the membership groups according to § 267, paragraph 2, sentence 2 of the Fifth Book of Social Code, differentiated by age and Gender as well as the reduction of earning capacity.

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§ 30 Collection and use of data for the further development of risk structure balancing

(1) For the further development and implementation of the risk structure compensation in accordance with § 268 of the Fifth Book of the Social Code, the health insurance funds shall, as from the reference year 2005, collect each year, in addition to the data in accordance with § 3, the following information in the following insurance:

1.

the days of insurance, indicating the year of birth and sex,

2.

the number of days of insurance with respect to a disability pension,

3.

an indication of the carrying out of extracorporeal blood purification procedures,

4.

the pharmacopoeias in accordance with Article 300 (3) of the Fifth Book of the Social Code, including the agreed special identifiers, and the number of Regulations,

5.

the main and secondary diagnoses in the case of hospital dismissal in accordance with § 301 (1) sentence 1 no. 7 in the encryption in accordance with § 301 (2) sentence 1 of the Fifth Book of Social Code,

6.

the diagnoses according to § 295 (1) sentence 1 no. 2 of the Fifth Book of Social Code as well as the information according to § 295 (1) sentence 4 of the Fifth Book of the Social Code,

7.

the eligible expenditure incurred in accordance with Article 4, with the exception of the expenses in accordance with Article 4 (1), first sentence, points 10 and 11,

8.

the number of days of insurance with residence or habitual residence outside the territory of the Federal Republic of Germany,

9.

The number of days of insurance with a choice of reimbursement for medical care, differentiated according to § 13 (2) and 53 (4) of the Fifth Book of Social Code,

10.

the diagnoses according to § 295 (1), first sentence, point 1 of the Fifth Book of the Social Code for the reporting years 2008 and 2009, and the calendar days for which sickness benefit is paid in accordance with § § 44 and 45 of the Fifth Book of the Social Code,

11.

the number of days of insurance with entitlement to sickness benefit in accordance with § § 44 and 45 of the Fifth Book of the Social Code.

For the chronological allocation of the information referred to in the first sentence of the first sentence, the date of the regulation shall be decisive for the allocation of the information provided for in the first sentence of the first sentence of the day of the dismis In agreement with the Federal Insurance Office, the top associations of the health insurance companies may provide in the agreement in accordance with § 267 (7) (1) and (2) of the Fifth Book of Social Code that the collection of the data in accordance with the first sentence of 1 No. 7 on a sample (2) The data collected in accordance with paragraph 1 shall be pseudonymated by the health insurance provider before the transfer pursuant to paragraph 4. For purposes other than those referred to in the first sentence of paragraph 1, the data may be used only insofar as this is for the purpose of checking in accordance with § 42 and for the clarification of double insurance relationships referred to in paragraph 5, or for the consideration of subsequent Changes to the transmitted data are required. The pseudonymisation in the health insurance fund and any use in accordance with the second sentence must be made in the form of a copy. An insurance-related combination of the collected data across several performance areas at the health insurance company is inadmissible. The insurance cover may be manufactured by the health insurance companies, insofar as this is necessary for the examinations in accordance with § 42 as well as for the clarification of the double insurance relationships referred to in paragraph 5. The health insurance companies are obliged to provide all the data bases produced by machine-generated risk-structure compensation as well as all the documentation of all the correction reports for the data messages referred to in the first sentence of the first sentence of paragraph 1 to 6. and 8, 9 and 11, in conjunction with paragraph 4, and the data which are based on these reports and which are lawfully stored in the health insurance funds for six years to be stored or stored in an audit-proof and verifiable form; § 3, paragraph 7, sentence 2 and 3 shall apply accordingly. (3) The top associations of the health insurance companies agree in the Agreement with the Federal Insurance Office in the agreement pursuant to § 267 (7) (1) and (2) of the Fifth Book of the Social Code the additional information on the survey referred to in the first sentence of paragraph 1 and the time allocation referred to in the second sentence of paragraph 1, for several Hospital cases relating to calendar years also deviate from the second sentence of paragraph 1, and, also in consultation with the Federal Office for Information Security, the procedure for pseudonymisation. To this end, a key-dependent procedure should be established with an annual key change which ensures that the same pseudonym is assigned to a insured person, irrespective of his or her terminal membership, and that the data of each insured person is assigned to each insured person. to be linked across the reporting periods. The Federal Insurance Office may decide on the uniform technical preparation and the required extent of the data after consultation of the top associations of the health insurance funds. (4) The data collected and pseudonymised pursuant to paragraph 1 shall be transmitted to the Federal Insurance Office by 15 August of the year following the reporting year in accordance with Section 3 (4). The data messages referred to in the first sentence of paragraph 1, points 1 to 6, and 8, 9 and 11 shall be received by 15 August of the second year following the reference year, the data reports referred to in points 1, 2, 8, 9 and 11 of the first paragraph of paragraph 1 of the second and third year shall be sent to the the reporting year shall be corrected by a new reporting year. The transmission of data for the reporting year 2005, which is based on the agreement of the top associations of the health insurance companies in agreement with the Federal Insurance Office in the agreement pursuant to § 267 (7) (1) and (2) of the Fifth Book of the Social Code on a representative sample, shall be carried out no later than 15 August 2007. If the Federal Insurance Office does not transmit data on time or have significant errors, the Federal Insurance Office may reject the data as a whole or in part; instead of the rejected data it may be the data of the previous year. , however, it must take into account the development of the insurance sector and the development of morbidity, as well as an appropriate security withdrawal. The Federal Insurance Office shall inform the Confederation of Health Insurance Funds of the nature and extent of the data which it has rejected and, instead, on the basis of sentence 4. The top associations of the health insurance companies are entitled to store the data in accordance with the first sentence for the performance of their duties under this Regulation, in particular in accordance with § 5 (1) sentence 2 and (6) and § 31 (4) sentence 1, for 32 months. (5) Top association of the health insurance companies, that an insurance pseudonym, to which more than one health insurance company has reported data, has been sent in the sum of more insurance days than the compensatory year has on calendar days, or that different data on the year of birth and sex were provided, he shares the data subject Health insurance companies with the respective insurance pseudonym, the nature of the error and the other health insurance company concerned, in order to clarify the insurance conditions. The top association of the health insurance companies determines the details of the procedure. Unofficial table of contents

Section 31 Selection and adaptation of the classification model

(1) The selection of the insurance classification model according to § 29 sentence 1 no. 1 and its adaptation to the conditions of statutory health insurance shall be carried out in such a way that no incentives for medically unwarranted Performance expansion is created and incentives for risk selection are avoided. The insurance classification model, which is adapted to the statutory health insurance in accordance with the first sentence, is to be filtered on hand from 50 to 80 diseases and designed to be more pro-spectively designed. In the selection of the diseases referred to in the second sentence, diseases with a severe course and cost-intensive chronic diseases are to be considered, in which the average performance expenditure per insured person is the average. The performance of all insured persons shall be taken into account by at least 50 per hundred. The Federal Ministry of Health, on a proposal from the Federal Insurance Office and after hearing the top associations of the health insurance funds, appoints a scientific advisory board to the Federal Insurance Office, which is responsible for the

1.

to submit a proposal for the adaptation of the classification model to statutory health insurance and to propose a procedure for its ongoing care,

2.

up to the 31. (c) to report in October 2007 on the selection of the diseases referred to in the second sentence of the second sentence of paragraph 1, and

3.

the selection of the diseases referred to in paragraph 2 must be reviewed at regular intervals.

In the performance of the tasks set out in the first sentence, the Scientific Advisory Board shall comply with the criteria set out in the first sentence of paragraph 1. In the opinion referred to in the first sentence of the first sentence, the ICD codes and active pharmaceutical ingredients necessary for the identification of these diseases shall also be used for the identification of the corresponding morbidity groups of the selected diseases for all selected diseases. (3) In the scientific advisory body referred to in paragraph 2, persons shall be appointed with a special expertise in relation to the medical, pharmaceutical, medical and medical background classification of insured persons, pharmacological, clinical or statistical questions, as well as with respect to the Development and maintenance of insurance classification models. In order to support the work of the Scientific Advisory Board, the Federal Insurance Office shall establish a branch office. (4) The Federal Insurance Office shall, on the basis of the recommendation referred to in paragraph 2 (2) and (3), submit the sentence referred to in the second sentence of paragraph 1. the diseases to be taken into account, the morbidity groups on the basis of these diseases, the algorithm for the assignment of the insured to the morbidity groups, the regression procedure for the determination of the weighting factors, and the calculation procedure for the determination of the risk surcharges for the following Compensatory year after consultation of the top associations of the health insurance companies until 30 September, and shall announce them in a suitable manner. For the determination of the risk surcharges for the risk characteristics referred to in Article 29, first sentence, point 1, only the morbidity groups defined in accordance with sentence 1 shall be taken into account. The first sentence of paragraph 1 shall apply accordingly. Morbidity groups for disability pensioners are set up for insured persons who, for the most part of the previous year, have received a pension due to a reduction in employment. In the case of the formation of age groups, the Federal Insurance Office may, in agreement with the Association of the Federal Government of the Health Insurance Funds, determine deviating age distances from the first sentence of § 2 (3) sentence 1. The Federal Insurance Office (Bundesversicherungsamt) may, after hearing the Federal Government of the Health Insurance Fund, adjust the provisions of the first sentence of the year when the generally valid coding of the diagnoses or the medicinal product classification is updated. The adjustments referred to in the sixth sentence shall be notified in an appropriate manner. The data messages referred to in § 30 (1) for insured persons within the meaning of the first sentence of paragraph 5 shall not be taken into account in the regression procedure for the determination of the weighting factors and the calculation method for the determination of the risk surcharges in accordance with the first sentence. In agreement with the Association of the Federal Government of the Health Insurance Funds, the Federal Insurance Office may, by way of derogation, delimit the membership groups in accordance with Section 29 (4). For the determination of the allocations to cover the standardized performance expenditure of the health insurance funds for the area of protective vaccinations under the Regulation on the obligation to provide statutory health insurance in the case of protective vaccinations against the New Influenza A (H1N1) of 19 August 2009 (BAnz. 2889) is to be applied in accordance with Section 37 (4). (5) For insured persons who, for the most part of the year preceding the compensatory year, have their residence or habitual residence outside the territory of the Federal Republic of Germany , to identify separate risk groups by age and sex and to identify risk surcharges on the basis of average risk surcharges for all insured persons of the appropriate age and sex groups. In the case of insured persons who, for the most part of the year preceding the year of compensation, have been reimbursed for the medical care sector in accordance with § 13 (2) or § 53 (4) of the Fifth Book of Social Code the risk groups referred to in Article 29 (1) are replaced by a separate risk group; the regression procedure for determining the weighting factors and the calculation procedure for determining the risk surcharges referred to in the first sentence of paragraph 4 shall be equivalent to: , In agreement with the Association of the Federal Government of the Health Insurance Funds, the Federal Insurance Office may make further differentiations within the risk group to be formed in accordance with the second sentence. Where insured persons are to be assigned to both the risk group in accordance with the first sentence and the risk group in accordance with the second sentence, the risk group shall be determined in accordance with the first sentence of sentence 1. The expenditure on expenditure on the risk groups referred to in the first sentence shall be the expenditure incurred by the sickness funds in the annual accounts for services rendered abroad and shall be thereafter, in accordance with the provisions of the accounts framework, which shall: To take into account areas of flat-rate refunds to foreign insurance institutions or reimbursements to employers according to § 17 of the Fifth Book of the Social Code, calculated on the basis of the actual expenses. In agreement with the Federal Insurance Office, the Confederation of Health Insurance Funds may, in agreement with the Federal Insurance Office, make a further or deviating provision of the areas relating to expenses for services abroad. Unofficial table of contents

Section 32 Data declarations for monthly compensation

By way of derogation from § 3 (6), the health insurance funds for the monthly compensation pursuant to § 39 (3) shall apply for expenditure without sickness benefit in relation to the insurance periods of the insured persons for the periods of time.

1.

January to June and

2.

January to December

(reporting periods). The sickness funds shall cover the periods of insurance in accordance with the first sentence for the reference period referred to in the first sentence of 1 to 31 August of the reference year and for the reporting period referred to in the first sentence of 1 (2) to 28 February of the year following the reference year. Federal Insurance Office on the top association of the health insurance companies in a machinable way. The fourth sentence of Article 30 (4) shall apply accordingly. Unofficial table of contents

Section 33 Opinion on allocations to cover expenses for sickness benefit and foreign insured persons

(1) The Federal Insurance Office instructs persons or groups of persons who have special expertise in relation to the insurance classification in accordance with § 31 (4), with the preparation of one or more scientific opinions pursuant to Article 269 (3) of the Fifth Book of the Social Code. (2) The opinions shall submit proposals, such as the allocations to cover the expenses for sickness benefit and the allocations for insured persons, which during the predominant part of the Compensatory year preceding the date of residence or habitual residence outside the territory of the Federal Republic of Germany, they could be determined in a more targeted way. The requirements of § 268 (1), first sentence, points 2 to 4, must be taken into account in the development of the models. It is also necessary to examine the need for a broadening of the data base. (3) In the opinion on the allocations to cover the expenses for sickness benefit, it should first be examined which of the factors determining the level of the sickness benefit. (4) In order to achieve the objective referred to in the first sentence of paragraph 2, the data shall be taken into account in order to achieve the objective referred to in the first sentence of paragraph 2. (4) Opinion on the allocations for insured persons, which during the predominant part of the During the last year of the year preceding the date of residence or habitual residence outside the territory of the Federal Republic of Germany, it shall first be examined which of the factors determining the level of expenditure of a sickness insurance fund in order to improve the target jurisdiction referred to in the first sentence of paragraph 2, and with the help of which data, these determinants are to be taken into account and made to be collected. Proposals to improve the quality, transparency and delimitation of the data will also be submitted. (5) The Federal Insurance Office shall ensure that the investigations referred to in paragraphs 3 and 4 are in each case up to 31 December 2015 have been completed. Unofficial table of contents

§ § 33a to 34 (omitted)

Eighth section
Allocations from the Health Fund (Risk Structure Compensation) from 2009 onwards

Unofficial table of contents

§ 35 Applicable regulations

(1) From the reporting year 2009, the provisions of this Section shall apply to the allocations from the Health Fund and the implementation of the risk structure compensation. The first to seventh sections of this Regulation shall continue to be applied in so far as nothing is determined by the following provisions or in the Fifth Book of the Social Code. (2) For audits up to the year 2008, § 15a shall be applicable in the period up to shall apply as of 31 December 2008. Corrections of the reference years up to and including 2008 and the related data collection shall no longer be carried out as of 1 January 2012. Unofficial table of contents

Section 36 Determination of the amount of the basic flat rate

(1) The basis for the calculation of the basic flat rate shall be the estimated standardized performance expenditure of the health insurance funds in accordance with § 266 (2) sentence 1 of the Fifth Book of the Social Code, which is intended to cover the expenditure incurred by the sickness insurance funds. The shares of the allocations according to § 38 shall be cleaned up, provided that these allocations contain corresponding shares. The adjusted expenditure shall be divided by the estimated sum of the insured persons of all sickness funds. (2) The Federal Insurance Office shall provide in advance the basic flat rate for a compensatory year on the basis of the expenditure for the determination of the (3) The announcement of the basic flat rate determined by the Federal Insurance Office for the following year as well as the values in accordance with § 266 (5) sentence 2 of the German Social Code (Sozialgesetzbuch) Fifth Book of the Social Code takes place annually until 15 November, the notice for the year 2011 will take place until 5 January 2011. The sickness funds shall provide their insured persons with the basic flat rate determined for the following year, including their presentation annually in an appropriate form until 31 December, and the announcement of the basic flat rates determined for the year 2011 shall be carried out by 15 January 2011. (4) For the period from 1 August to 31 December 2009, the basic flat rate shall be determined and made known in a suitable form as follows:

1.

The estimated standardized sickness funds expenditure of the health insurance funds for insured persons who have issued an election declaration in accordance with § 44 (2) sentence 1 (2) or (3) of the Fifth Book of Social Code shall be divided by 5,

2.

the monthly basic flat rate determined in accordance with paragraphs 1 and 2 for the year 2009 shall be increased by the value referred to in point 1.

The basis for the estimated expenditure on sickness funds in accordance with the first sentence is the forecasts of the estimator price in accordance with § 241 (1) of the Fifth Book of the Social Code at its last meeting before 1 August 2009. The basic flat rate determined in accordance with sentences 1 and 2 shall be taken into account for the first time in the monthly compensation in accordance with § 39 (3) of the 30th September 2009. Unofficial table of contents

Section 37 Assignments for other expenditure

(1) The health insurance funds shall receive grants from the Health Fund to cover their standardised administrative costs. The Federal Insurance Office shall determine the amount of these allocations for each health insurance fund in advance for each compensation year on the basis of the average supplementary contribution according to § 242a of the Fifth Book of Social Code relevant values as follows:

1.

The expenses for the administrative costs of all health insurance funds are to be counted together, the expenses incurred by third parties for administrative costs, as well as the amounts of the allocations according to § 38, which are due to administrative costs, provided that these allocations are , shall not be taken into account;

2.

50 per cent of the result referred to in point 1 shall be divided by the sum of the insurance periods of all health insurance funds transmitted by the sickness funds in accordance with Section 30 (1), first sentence, No. 1, and multiplied by the insurance periods of the health insurance fund;

3.

50 per cent of the result according to point 1 shall be divided by the sum of the allocations according to § 266 (2) sentence 1 of the Fifth Book of Social Code for all health insurance funds and with the allocation pursuant to § 266 (2) sentence 1 of the Fifth Book of Social Code to multiply the health insurance;

4.

the amount of the allocation for each sickness insurance fund shall be the sum of the results obtained in accordance with points 2 and 3.

For the purpose of determining the allocations for the compensatory years 2011 and 2012, the administrative expenditure of 2010 shall not be based at most; this shall not apply to the expenditure referred to in Article 291a (7) sentences 4 and 5 of the Fifth Book of Social Code. (2) The percentages referred to in the second sentence of paragraph 1 (2) and (3) shall continue to apply until 31 December 2010. Before the end of this period, the Federal Ministry of Health shall check the financial implications of the application of the percentages referred to in the second sentence of paragraph 1 on the basis of the results of the business and the accounts of the sickness funds prepared for the year 2009. 2 and 3 on the health insurance funds. On the basis of this review, the percentage values will be determined from 1 January 2011 with the consent of the Federal Council. Until the entry into force of the legal regulation in accordance with sentence 3, the Federal Insurance Office shall determine the amount of the monthly allocations in accordance with paragraph 1. (3) By way of derogation from the second sentence of paragraph 1, the Federal Insurance Office shall determine the amount of the allocations in the case of health insurance in advance for each compensatory year on the basis of the values applicable to the determination of the average supplementary contribution according to § 242a of the Fifth Book of the Social Code: the expenditure for the administrative costs of all health insurance funds referred to in the second sentence of paragraph 1, the To share the sum of the insurance periods of all health insurance funds transmitted by the health insurance companies pursuant to § 30 (1) sentence 1 no. 1 and to multiply them with the insurance periods of the health insurance company. The amount of the financial health insurance allocations determined in this way shall be deducted from the costs of the administrative costs of all sickness funds referred to in the second sentence of paragraph 1 of this Article. Paragraph 2 shall apply. (4) The health insurance funds shall receive grants from the Health Fund to cover their standardised expenses in accordance with § 266 (4) sentence 1 (2) of the Fifth Book of the Social Code. The Federal Insurance Office shall determine the amount of these allocations for each health insurance fund in advance for each compensation year on the basis of the average supplementary contribution according to § 242a of the Fifth Book of Social Code relevant values as follows:

1.

The expenses of all health insurance funds for more-and-tested benefits as well as for services to which there is no legal claim are to be counted together, whereby statutes are based on the provisions of § 2 (1) sentence 2 and 3 of the Regulation on the further development of health insurance, expenses for election rates in accordance with § 53 of the Fifth Book of the Social Code and the additional statutory services pursuant to Section 11 (6) of the Fifth Book of Social Code (Social Code) except Consideration shall be given.

2.

The result in accordance with point 1 shall be divided by the sum of the insurance periods of all health insurance funds transmitted by the sickness funds pursuant to section 30 (1), first sentence, no. 1.

3.

The result referred to in point 2 shall be multiplied by the insurance periods of the sickness insurance fund.

(5) The notice of the amount of the allocations provisionally determined by the Federal Insurance Office pursuant to § 266 (2) sentence 1 of the Fifth Book of the Social Code for the health insurance funds, the provisional determined amount of the allocations to cover the Standardised expenses for the administrative costs of all health insurance funds, the provisionally determined amount of the allocations to cover the standardized expenses according to § 266 (4) sentence 1 No. 2 of the Fifth Book of the Social Code of all health insurance funds as well as the sum of the total amount of information transmitted by the health insurance funds pursuant to § 30 (1) sentence 1 Insurance periods of all health insurance funds are made annually until 15 November, the notice for the year 2011 will take place until 5 January 2011. Unofficial table of contents

§ 38 Allocation of structured treatment programmes from 2009 onwards

(1) In order to promote the implementation of structured treatment programmes in accordance with § 137g of the Fifth Book of the Social Code, the health insurance funds from the Health Fund receive allocations for each insured person registered in accordance with § 2 (1) sentence 3. Coverage of the program costs for medically necessary expenses such as documentation or coordination services. If, according to § 137g (3) of the Fifth Book of the Social Code, the Federal Insurance Office cancels the admission of a programme, the allocation according to the first sentence must be repaid. (2) The top association of the sickness funds shall determine the amount of the allocation according to Paragraph 1 and the details of the notification procedure for the insured persons registered. If the provision according to the first sentence does not apply, the Federal Insurance Office shall determine the amount of the assignment and the reporting procedure. Section 30 (2) to (4) shall apply accordingly. Unofficial table of contents

Section 39 Implementation of payment transactions, monthly compensation and cost support

(1) The Federal Insurance Office shall determine the amount of the allocations received by the health insurance funds to cover their expenses in accordance with § 266 (1) sentence 1 of the Fifth Book of Social Code and shall carry out the payment transactions. (2) The Federal Insurance Office the provisional amount of the allocations referred to in paragraph 1 shall be determined for the monthly tee-off procedure and shall inform the health insurance funds of these. The monthly allocations are based on the statement in the first sentence, adjusted monthly to the changes in the number of insured persons. § 3, paragraph 6, sentences 4 and 5 shall apply accordingly. The sum of the monthly allocations to all health insurance funds corresponds to one twelfth of the value in accordance with § 40 (1) (1). For the year 2010, the value in accordance with § 40 (1) (1) shall be increased in accordance with § 40 (3) sentence 1. (3) The Federal Insurance Office shall calculate for each compensatory year for all health insurance funds in each case.

a)

until 15 April of the compensatory year,

b)

up to the 15th October of the compensatory year, and

c)

by 15 April of the year following the compensatory year

the provisional amount of the allocations referred to in paragraph 2 is new, taking into account the current data report in accordance with § 32 and shall inform the health insurance funds; in the case of point (c), the Federal Insurance Office shall also determine on the basis of the current data Quarterly accounts according to § 10 of the General Administrative Regulation on statistics in statutory health insurance the data to be expected in accordance with § 41 (1) sentence 1 and the expected amount according to § 41 (2) provisional new. At the request of a health insurance company, the Federal Insurance Office may, in individual cases, determine the provisional amount of its allocations for the monthly tee-off procedure after hearing the top association Bund der Krankenkassen (Association of the Health Insurance Funds), if the following are: (2), in a significant and demonstrable way, from the results to be expected in the annual compensation according to § 41. In the case of the deviating determination in accordance with the second sentence, the Federal Insurance Office may, taking into account the fourth sentence of Article 30 (4), orient itself on estimates and shall apply an appropriate security deprivation. § 3, paragraph 6, sentences 4 and 5 shall apply accordingly. The allocations for the compensatory year fixed up to the recalculation provided for in the first and second sentences shall be re-determined on the basis of the findings set out in sentences 1 and 2. The Federal Insurance Office shall determine the procedure referred to in paragraphs 2 and 3 after consultation of the top association of the health insurance funds. (3a) The amount of allocations determined in accordance with paragraph 3 exceeds the level of the previously referred to in paragraph 2. the health fund shall pay the excess amount to the health insurance fund. If the amount of the allocations determined in accordance with paragraph 3 is less than the monthly allocations, the difference shall be paid to the health fund. The Federal Insurance Office shall make the due date of the amounts to be paid mandatory with the sending of the date of the date of the date of the date of payment. § 14 (3) and (4) shall apply accordingly, with the proviso that the Federal Insurance Office responsible for payment transactions shall replace the Deutsche Rentenversicherung Bund. Where a sickness fund does not pay the sum of the amount referred to in the second sentence within 14 days after due date to the health fund, the amount still outstanding shall be the amount of the allocations to be paid under paragraph 4 at the level in which the claims are met; shall be charged, starting with the following compensatory month. At the request of a sickness insurance fund, the Federal Insurance Office may distribute the offsetting in accordance with the fifth sentence on the following compensatory months if it finds, on the basis of a sufficient proof provided by the sickness insurance fund, that the Sickness fund existing funds in accordance with § § 260 and 261 of the Fifth Book of the Social Code, taking into account the claims and claims referred to in § 155 (5) sentence 1 (3) and (5) of the Fifth Book of the Social Code, which are not sufficient to: full payment; no later than six months after The payment in accordance with the second sentence must be complete. (4) The Federal Insurance Office pays the allocations for the monthly tee-off procedure in partial amounts, which are in particular at the monthly main maturity times of the Health funds are based on amounts received. The allocations for a countervailing month will be fully up to 15. of the month following this month. (5) The expenditure incurred by the Federal Insurance Office on the basis of the management of the health fund, including expenditure relating to the implementation and further development of the risk structure compensation, shall be: from the income of the health fund according to § 271 of the Fifth Book of the Social Code. Unofficial table of contents

Section 39a Determination of the correction amount

(1) The Federal Insurance Office shall examine in the case of the data reports pursuant to § 30 (4) sentence 1 (first notification) and in the case of the data reports pursuant to § 30 (4) sentence 2 (correction report) of a reference year, whether the requirements of § 268 (3) sentence 1, 2 and 14 of the Fifth Book of the Social Code has been observed. In accordance with § 273 (4) sentence 2 of the Fifth Book of the Social Code, the Federal Insurance Office shall determine the amount of the correction in accordance with the following paragraphs separately for the following paragraphs: First report and the correction report and fix it. (2) The Federal Insurance Office (Bundesversicherungsamt) calculates annual allocations for the affected health insurance fund for the following year for the year under review. For the purposes of the calculation, the rules applicable to the determination of the amount of the allocations in accordance with Article 266 (2), first sentence, of the Fifth Book of the Social Code shall be used with the proviso that the frequency of the risk characteristics referred to in Section 29 (1) shall be applied to the the health insurance concerned shall be determined in accordance with paragraphs 3 and 4. In the case of an initial notification, the adjusted annual allocations shall be deducted from the provisional amount of the allocations determined in accordance with Article 39 (3), first sentence, point (c) (difference in the amount of the initial notification). In the case of a correction message, the adjusted annual allocations are deducted from the allocations determined in accordance with section 41 (3) (difference in the amount of the correction). A correction amount will be determined only if the difference is positive. (3) Can the Federal Insurance Office determine which data has been collected in breach of the provisions of § 268, paragraph 3, sentence 1, 2 and 14 of the Fifth Book of Social Code, this data shall not be taken into account in determining the frequency of the risk characteristics referred to in § 29 (1); this shall not apply to data which have been incorporated into a calculation in accordance with Section 42 (5). According to § 273 (3) sentence 3 of the Fifth Book of the Social Code, the Federal Insurance Office may request further information and evidence for the determination of the health insurance fund concerned. § 30 (4) sentence 5 shall apply. (4) If the Federal Insurance Office cannot determine which data has been collected in breach of the provisions of Section 268 (3) sentence 1, 2 and 14 of the Fifth Book of the Social Code, it shall determine the frequency of the Risk characteristics according to § 29 number 1 on the basis of last year's notice, for which the Federal Insurance Office has not established that the health insurance company concerned has not complied with or only partially complied with the above-mentioned requirements. The Federal Insurance Office may limit the use of the prior-year notification to individual risk characteristics in accordance with Section 29 (1). The interim change in the insurance structure of the affected health insurance company shall be taken into account by an age-and gender-related adjustment of the insurance days per risk characteristic in accordance with § 29, point 1. If the frequency of the risk characteristics in accordance with Section 29 (1) of the first sentence of the previous year has declined on average for all health insurers in accordance with the first sentence of the first sentence, the number of days of insurance in the case of these risk characteristics shall be the number of days of insurance (5) The amount of the correction in the case of an initial notification shall be 10% of the difference referred to in the third sentence of paragraph 2. The correction amount in the case of a correction message shall be obtained by applying a premium of 25% of the difference in addition to the difference referred to in the fourth sentence of paragraph 2. The collection of the surcharge may be waived in whole or in part if the survey according to the situation of the individual case would be uninexpensive. § 39 (3a) sentences 3 to 6 shall apply accordingly. Revenue in accordance with this paragraph and interest income shall be included in the health fund and shall be added to the value in accordance with section 41 (2) (1) in the next annual equalisation. Federal Insurance Office in consultation with the top association of the health insurance companies. Unofficial table of contents

§ 40 Membership-related change of allocations

(1) The Federal Insurance Office shall determine the amount for each health insurance fund in advance for a compensatory year on the basis of the values relevant to the determination of the average supplementary contribution under section 242a of the Fifth Book of Social Code, to change the monthly allocations for each health insurance fund, by

1.

the amount of the estimated annual revenue of the health fund in accordance with Section 271 (1) of the Fifth Book of the Social Code, in respect of the revenue earmarked for the establishment of the liquidity reserve in accordance with Article 271 (2) of the Fifth Book of the Social Code; the expenditure in accordance with § 39 (5), the costs in accordance with § 28q (1a) of the Fourth Book of the Social Code, as well as the costs arising under § 137g (1) sentence 10 of the Fifth Book of the Social Code for the approval of structured treatment programmes Pre-holding costs adjusted

2.

from the value referred to in point 1, the amount of the expected standardized performance expenditure in accordance with the first sentence of § 266 (2) of the Fifth Book of the Social Code plus the amount of the expected standardized other expenditure in accordance with § 270 of the Fifth Book of the Fifth Book The Book of the Social Code of all health insurance funds, adjusted for the shares of the allocations according to § 38, which are based on standardised performance expenditure and administrative costs, provided that such allocations contain corresponding shares,

3.

the result set out in point 2 is divided by the estimated annual average number of members of all health insurance funds and by the number 12, and for each sickness fund, with the number of its members, which is the first of one month in the monthly statistics of the previous month, multiplied.

(2) The announcement of the amounts determined by the Federal Insurance Office for the following year shall be published annually until 15 November, the notice for the year 2011 shall take place until 5 January 2011. (3) For the year 2010 the Federal Insurance Office the amount referred to in paragraph 1 by increasing the value referred to in paragraph 1 (1) by the economic participation of the Federal Government in accordance with § 221a of the Fifth Book of Social Code in the version in force on 1 January 2010. The Federal Insurance Office shall make known the amount determined in accordance with the first sentence in an appropriate form. Unofficial table of contents

Section 41 Annual compensation

(1) The Federal Insurance Office shall determine after the existence of the business and invoice results of all health insurance funds participating in the monthly compensation for the respective expired calendar year (compensatory year)

1.

age-, gender-and risk-adjusted to-and-off-and-off-

2.

the values laid down in Article 37 (1), second sentence, points 2 and 3, and the second sentence of paragraph 4, point 2

new. The sum of the risk surcharges in accordance with § 31 (5) sentence 1 shall be limited to the sum of the performance expenditure in accordance with § 31 (5) sentences 5 and 6. Half of the allocations for the insurance groups according to § 29 (4) is to be determined for each health insurance fund on the basis of the expenses of the health insurance fund for sickness benefit. (2) The Federal Insurance Office shall determine the insurance fund for each health insurance fund. the amount to be changed for each sickness fund in the annual compensation referred to in paragraph 3 by the amount of the

1.

from the value in accordance with § 40, paragraph 1, point 1, the amount of the standardized performance expenditure in accordance with § 266 (2) sentence 1 of the Fifth Book of the Social Code plus the amount of the standardized other expenses according to § 270 of the Fifth Book Social code of the health insurance funds, adjusted for the shares of the allocations according to § 38, which are based on standardised performance expenditure and administrative costs, provided that these allocations contain corresponding shares, and

2.

the average number of members of all health insurance funds is divided by the average annual number of members and multiplied by the average annual number of their members for each sickness insurance fund.

In the annual compensation for the year 2011, paragraph 2 shall be based on the version in force on 3 August 2011. (3) The Federal Insurance Office shall calculate on the basis of the figures determined in accordance with paragraphs 1 and 2 as well as the basic flat rates according to § 36 for each health insurance fund, the amount of the allocations according to § 266 (2) sentence 1 and § 270 of the Fifth Book of Social Code in annual compensation. A common calculation shall be carried out for sickness funds which have been combined with each other during the compensatory year. In the case of health insurance funds, which have been combined with one another in the year following the compensation year, the Federal Insurance Office may, in agreement with the Association of the Federal Government of the Health Insurance Funds, make a joint calculation. (4) The Federal Insurance Office shall notify the values determined in accordance with paragraphs 1 and 2 (2) in an appropriate manner and shall inform the health insurance funds of the amounts determined in accordance with paragraphs 2 and 3. If the amount of the allocations determined in accordance with paragraph 3 exceeds the monthly allocations, the sickness fund shall be responsible for the excess amount. If the amount of the allocations determined in accordance with paragraph 3 is less than the monthly allocations, the difference shall be paid to the health fund. Section 39 (3a) sentences 3 to 6 shall apply mutas. (4a) (omitted) (5) The annual compensation shall be carried out until the end of the year following the compensatory year and in the next annual compensation on the basis of the data declaration pursuant to § 30 (4) sentence 2 second half-sentence. The Federal Insurance Office determines the procedure for the procedure after hearing the Federal Government of the Health Insurance Funds. Unofficial table of contents

Section 42 Examination of data reports

(1) The authorities responsible for the examination in accordance with § 274 of the Fifth Book of the Social Code shall have at least every two years the following data for the health insurance funds in their area of responsibility, in each case related to one of the two most recently pursuant to § 41 completed and corrected compensatory years, to verify the accuracy of the compensatory years:

1.

the data referred to in the first sentence of § 30 (1), 1, 2 and 11 of the data declaration pursuant to § 30 (4), second sentence, second sentence, and the data reported in accordance with Article 38 (2),

2.

the information provided for in the first sentence of § 30 (1) (1) (3) to (6) of the data declaration pursuant to Article 30 (4), second sentence, and the first sentence of § 30 (1) (1) (2), (8) and (9) of the data reporting pursuant to § 30 (4), second sentence, second sentence.

The bodies referred to in the first sentence may, in agreement with the Federal Insurance Office, stipulate that they shall carry out the tests in accordance with the first sentence of the first sentence of 1 and 2 each year. (2) The Federal Insurance Office shall, in accordance with the first sentence of paragraph 1, apply for the tests referred to in the Consultation of the Confederation of Health Insurance Funds and the bodies referred to in the first sentence of paragraph 1 for the respective test cycle, the sampling methodology and in particular the respective procedure for the determination of an appropriate sample size, determined and determined the details of the requirements for the collection of samples. The Federal Insurance Office draws the samples for the respective examination and makes the list of drawn samples available in pseudonymised form to the bodies referred to in the first sentence of paragraph 1. In agreement with the bodies referred to in the first sentence of paragraph 1, the Federal Insurance Office shall determine which of the data available to him, in accordance with the first sentence of Article 30 (1) of this Regulation, shall also be responsible for the sampling examination of the bodies referred to in the first sentence of paragraph 1 for the examination in question. (3) The Federal Insurance Office shall, after consulting the Federal Government of the Health Insurance Fund and the bodies referred to in the first sentence of paragraph 1, determine the nature, scope and format of the data and supporting documents which the health insurance funds shall provide to the health insurance companies. Entities referred to in the first sentence of paragraph 1 shall be submitted. The bodies referred to in the first sentence of paragraph 1 shall immediately inform the Federal Insurance Office, the sickness fund and the top association of the health insurance funds of the result of their examinations. The Bundesversicherungsamt (Federal Insurance Office) shall determine the details of the communication of the test results after consultation of the bodies referred to in the first sentence of paragraph 1. (4) For the correctness of the data reported in accordance with § 38 (2), it shall be considered whether the data for the consideration of the Insurance periods are subject to the conditions laid down in § 3 (3) sentences 7 and 8 with regard to participation in a structured treatment programme approved in accordance with § 137g of the Fifth Book of Social Law. For the purpose of verifying the existence of the conditions set out in the first sentence, the reports of the compensatory year concerned shall be considered, taking into account the documents on which the compensatory year is based, of the previous year ' s financial year, of the previous year. and in the following calendar year. (5) The Federal Insurance Office (Bundesversicherungsamt) calculates the erroneous or non-plausible cases recorded in each of the tests referred to in the first sentence of paragraph 1 on the basis of the relevant sample. Basic population high. The Federal Insurance Office determines the respective high-accounting procedure to be applied in consultation with the Federal Government of the Health Insurance Funds. In this connection, it may also be determined that the extrapolation shall only take place if the erroneous or non-plausible cases exceed a certain quota. (6) The initial determination referred to in paragraph 2 and the first-time provision in accordance with paragraph 5 shall take place on: the basis of a scientific opinion. The Federal Insurance Office instructs a person or group of persons who have special expertise in relation to statistical procedures and knowledge of the insurance classification in accordance with § 31 (4). The opinion shall, in particular, make proposals for the sampling methodology referred to in paragraph 2, for ensuring the sampling quality, for a high-accounting procedure referred to in paragraph 5, and for the further development of these procedures in the following Submit test cycles. Before finalisation of the opinion, the Federal Government of the Health Insurance Funds and the bodies referred to in the first sentence of paragraph 1 shall be heard. (7) The Federal Insurance Office shall determine the amount of the correction and shall make the correction amount based on the respective statement of accounts referred to in paragraph 5. shall be informed by a communication. § 39 (3a) sentences 3 to 6 shall apply accordingly. Revenue in accordance with this paragraph and interest income shall be included in the health fund and shall be added to the value in accordance with section 41 (2) (1) in the next annual balance. Unofficial table of contents

Section 43 Implementation of income compensation

(1) The Federal Insurance Office shall determine the amount of the funds received by the health insurance funds from the income compensation according to § 270a of the Fifth Book of Social Code and shall carry out the payment transactions. (2) The Federal Insurance Office shall determine the the provisional amount of the funds referred to in paragraph 1 for the monthly tee-off procedure and notifies them to the sickness funds; § 39 (2) shall apply mutagenic. The monthly average for each health insurance fund for the respective compensation month is obtained by the expected average contributory income per member of all health insurance funds with the additional contribution rate of the health insurance fund according to § § § § § § § § § § § § § § 1. 242 (1) of the Fifth Book of the Social Code and the number of its members is multiplied. Section 39 (4) sentence 1 shall apply accordingly. The appropriations for a countervailing month will be fully up to 15. of the month following the month of the first payment. (3) The Federal Insurance Office shall calculate, on the basis of the current membership figures, the monthly statistics for the previous month for the first one month. Months of the compensatory year for the dates referred to in Article 39 (3), first sentence, the provisional amount of the funds for each sickness insurance fund. Section 39, third sentence, sentence 5 and paragraph 3a shall apply accordingly. (4) The Federal Insurance Office shall determine after the existence of the business and invoice results of all health insurance funds participating in the monthly compensation for the equalisation year to that in § 41 (5) The date referred to in the first sentence shall be the amount of the appropriations for each sickness insurance fund. Section 41 (4) shall apply accordingly. Unofficial table of contents

Final formula

The Federal Council has agreed. Unofficial table of contents

Annexes 1 to 12 (omitted)