EKPOIZO / Exorbitant increases in health insurance – The unfair practices of the companies

Important increase at complaints pertaining to its field private insurance complains the “Consumers Association – The Quality of Life” (I’M COOKING) speaking of exorbitant increases of health insurance premiums.

In particular, EKPOIZO by publishing and relevant complaints emphasizes that at a time when the consumers are affected from accuracyare asked to pay from 12% to 15% higher premiums mainly in old contracts with lifelong the long duration.

As the Consumers Union complains with said increases in long-term contracts the insurance companies they aim in “annulment of the above contracts, Promoting the annually renewable contractsin which they do not undertake no commitment for height of premium and area of benefits».

In addition, a frequent phenomenon, it is mainly in investment and pension plansthe lack of pre-contractual information by the certified insurance intermediaries.

“In particular, consumers receive the text of the pre-contractual information at the same time as they sign the contract. This policy has the effect of consumers to do not take notice in advance for the terms and content of the contract, but also the future risksin order to weigh the benefits and have a clear picture” emphasizes EKPIOZO.

As for the refusal of insurance companies to compensate their consumers with regard to the coverage of surgical operations or diagnostic tests, citing pretentious arguments, EKPPIZO states that it is often claimed that the materials of no interventions included in list of benefits which cover, resulting in compensate only a part of them, while the insured had from the beginning inform for operation without n insurance to express something objection. Also, they only give verbal pre-authorization and revoke it after the operation.

Finally about unfair and deceptive tacticsthe Consumers Union emphasizes that insurance companies “offer investment programs with the pretext her insurance coverage providedwhich are opaquecreate expectations in consumers and they do not respond in reality.

» This results in the consumers to be in confusionas it were the terms of engagement are not accurateare not regularly informed about their performance and in case of termination by the insured, the contract contains disproportionate obligations in favor of the insurance company, especially in the first years of the investment”.

Also, according to EKPOIZO, it is observed big deviation between prices where they pay the insured at privately hospitals for hospitalization expenses and fees in general, and those that apply to public insurance.

An illustrative example, h use of disposable sanitary materialwhich is charged exorbitantly compared to market prices.

Finally, the Consumers Union calls the co-authors ministries and them authorities to proceed immediately to amendment of legislative frameworkin order to eliminate the abusive practices of insurance companies, in systematic checksand in creation price comparison tool.

Indicative cases of complaints made public by EKPOIZO:

1. “I protest the 12.5% ​​increase in insurance premiums in the year 2024 in no. …. individual life insurance policy’.

2. “From 01/09/2011 the increases reached approximately 10% per year and in fact this percentage continued on all the annual anniversaries of my insurance policy up to today with the result that the premiums have reached the amount of 2196.09 euros per year, from the amount of 953.54 euros per year that was when the insurance was taken out on 14/03/2010.

Since 2011 I have been asked to pay a high premium beyond what is reasonable and what has been agreed between us, which was unilaterally set up by your company. In fact, especially in the last 4 years, I cannot calculate and adjust the premiums to my fixed expenses.”

3. “I am complaining about the increase in insurance premiums in my contract “Hospital …. lifetime, start date 05/16/2011. Specifically:

In the year 2023 the imposed increase was 10%. In the year 2024 a new additional increase of 11.7% is imposed. And as can be seen from 2023 to 2024 as a whole the increase reached the enormous percentage of 22.6%”.

4. “The Insurance Company still does not make public what are the “objective factors” on which the adjustment of the insurance premium depends (and which should be able to be checked and confirmed by anyone, either the insured or a public auditing body). And this while invoking the “principle of transparency”!

This systematic refusal of the insurance company to reveal where this year’s large increase was based is beginning to enter the borders of the suspicious.

The answer as it is formulated gives the impression that the insurance company considers that its obligation is exhausted by informing the insured about the increase. No. He has an obligation to justify it. Specifically, not with generalities and vagueness as in paragraph 2 of your answer.”

5. “Since May 28, 2019, an investment insurance policy has been concluded between me and the company ….. through an insurance intermediary with program title ….. and Policy number ….. The issuance of the policy should have been preceded by an application. But this was presented when the contract was delivered, it was attached to the contract with application number ….. and with the same date as the beginning of the contract. From the beginning of the contract until today, i.e. during a period of five years, the agreed annual installments have been paid continuously by me, which keep the contract in force, as provided for in its terms.

But both from the beginning of the contract, as well as during it, I have found and continue to find that it is an unequal agreement that contains abusive, onerous and hidden terms, for the so-called “insured/policy party”. There are conditions that the company does not even observe, regulations that are invoked without being contained in the written contract, but during development, are presented by the company as “interpretations” and have as their sole purpose the unilateral serving of the company’s interests”.

6. “With the birth of our child in …. given to us by the insurance company …. free 6 month insurance policy. On 2/5/2024, the infant was admitted to … due to illness from Covid-19 and despite the telephone assurance from an employee of the company, after the end of the infant’s hospitalization, the insurance company informed me about the non-coverage of the related costs. I replied to them stating the facts and they informed me through “Proof of Submission” that they will respond within 50 days.’

7. “On October 9, 2023, Monday, I was admitted to the private clinic ….. to perform the surgical treatment ….., I know that 80% of the operation is covered by my insurance company ….., while the remaining 20% ​​is covered by the compensation of the EOPYY and I cover the rest personally. Then and after repeated reassuring phone calls in mid-February, I received an informational note from the clinic informing me of the following:

• The total cost of his hospitalization amounted to €17,124.98
• The insurance company participated with the amount of €6,755.98
• EOPYY participated with the amount of €1,030.56
• I was given a discount of €499.99
• The amount I have to cover individually is €9,338.44!!!

….. Sometime in January, I received a call from the surgeon informing me that the insurance company appears to be denying reimbursement. I immediately inform my insurance advisor, who reassures me…Finally, on Wednesday 28/2/2024, I receive an email from the insurance advisor informing me, to my great surprise, of the reasons why the implant in question is not covered.”

EKPIZO’s announcement in detail:

“In E.K.POI.ZO. in the last eight months complaints in the private insurance sector have shown a significant increase. Among other things, they report exorbitant increases in health insurance premiums, especially on old policies (life or long-term), ranging from 12% to 15%, at a time when consumers are hit by accuracy and declare an inability to meet the specific rate of increase!

Major problems and consumer complaints:

1. Adjustment of insurance premiums

– Increase in insurance premiums, especially in lifetime or long-term health insurance contracts, ranges at the upper limit of the index of the Foundation for Economic & Industrial Research (IOBE), with cases even exceeding it. In particular, the IOBE index for the two years 2021-2022 increased by 14.0%, while without the effect of age it increased by 8.2%. The insured are in the unpleasant position of either accepting the increases in order to keep their policy in force, with serious financial implications for their budget, or of terminating their lifetime insurance contract.

The above practice clearly shows the intention of the insurance companies to proceed with the cancellation of the above contracts, promoting the annually renewed contracts, in which they do not undertake any commitment regarding the amount of the insurance premium and the extent of the benefits.

It is a fact that this policy is contrary to the general concept of protecting the institution of insurance. Given that health is one of the most important social goods and access to health care is a fundamental right of consumers, the latter look to a long-term relationship with a view to covering future health problems, but also to a future financial planning to their benefit .

– E.K.POI.Z.O has expressed its strong opposition to the new legislation (P.D. 13/2022) regarding the imposition of the Single Health Index (SHI) of IOBE as a benchmark for insurance premium increases.

– In addition, the index in question, while it should be immediately available and controllable by the insured, is calculated based on a complex and difficult to understand methodology that requires the execution of continuous mathematical operations by the consumer, while at the same time it includes data and conditions of the insurance market that require familiarity with special insurance knowledge.

– Finally, the annually exported EDY is approved by the Minister of Development and Investments (art. 6 §3 PD 13/2022), however, no corresponding initiative has been taken until today.

2. Lack of pre-contractual information

It is a frequent phenomenon, especially in investment and pension plans, that the certified insurance mediators lack pre-contractual information. In particular, consumers receive the text of the pre-contractual information at the same time they sign the contract. This policy results in consumers not being informed in advance of the terms and content of the contract, but also of the future risks, in order to weigh the benefits and have a clear picture.

3. Denial of compensation

Insurance companies often use pretentious arguments in order for the consumer not to be compensated in terms of coverage of surgeries or diagnostic tests. For example, they often claim that the materials of the operations are not included in the list of benefits they cover, with the result that they compensate only a part of them, while the insured had informed about the operation in the first place without the insurance company expressing any objection. Also, they only give verbal pre-authorization and after the operation they revoke it, etc.

4. Unfair Trade Practices. Misleading consumers in relation to the programs offered.

– Insurance companies offer investment programs under the guise of providing insurance coverage, which are opaque, create expectations in consumers and do not correspond to reality. This results in consumers being confused, as the terms of commitment are not precise, they are not regularly informed about their performance and in the event of termination by the insured, the contract contains disproportionate obligations in favor of the insurers, especially in the first years of the investment .

– There is also a large discrepancy between the prices paid by the insured in private hospitals for hospitalization expenses and fees in general, and those applicable in public insurance. An illustrative example is the use of consumable sanitary material, which is charged exorbitantly in relation to the prices applicable in the market.

Given that life and health insurance is a social good, which should be available on fair and transparent terms so that the insured can enjoy its benefits,

E.K.POI.ZO. calls:

1. The relevant Ministries and Authorities to proceed immediately:

– In the amendment of the legislative framework, in order to eliminate the abusive practices of the insurance companies regarding the exorbitant increases in insurance premiums. The adjustment of insurance premiums must be done with objective, clear, widely accessible and controllable criteria by the insured, as required by the principle of transparency, through reliable, independent and impartial public tools and indicators and not private ones, such as the IOBE.

– In systematic audits, both of the insurance companies and of the insurance intermediaries, for the correct observance of the legislation and the imposition of sanctions in cases of its violation.

– To create a Price Comparison Tool, in order to capture and compare the offered programs of the companies, in the context of optimal consumer information.

2. The Insurance Companies:

– To immediately abandon the tactic of exorbitant and unjustified increases in insurance premiums, especially in lifetime or long-term health contracts, which aim to abolish them at the expense of the insured.

– To inform transparently about the way the adjustments are calculated.

– Eliminate abusive, opaque and difficult to understand terms in insurance contracts, so that the insured is sufficiently informed and in a simple and comprehensible manner about his rights and obligations.

– To provide pre-contractual information, so that the insured is given the opportunity to choose the best program for him.

– The special training obligations for insurance intermediaries must be strictly observed, in order to provide legal and tailored information according to the consumer’s profile.

– To update at least once a year on the annual performance of the investment insurance programs and the benefits in force.

Finally, we invite all consumers to complain to E.K.POI.ZO. any problems they face with insurance companies.

ANNEX

Indicative Cases of Complaints:

1. “I protest the 12.5% ​​increase in insurance premiums in the year 2024 in no. …. individual life insurance policy’.

2. “From 01/09/2011 the increases reached approximately 10% per year and in fact this percentage continued on all the annual anniversaries of my insurance policy up to today with the result that the premiums have reached the amount of 2196.09 euros per year, from the amount of 953.54 euros per year that was when the insurance was taken out on 14/03/2010.
Since 2011 I have been asked to pay a high premium beyond what is reasonable and what has been agreed between us, which was unilaterally set up by your company. In fact, especially in the last 4 years, I cannot calculate and adjust the premiums to my fixed expenses.”

3. “I am complaining about the increase in insurance premiums in my contract “Hospital …. lifetime, start date 05/16/2011. Specifically:

In the year 2023 the imposed increase was 10%. In the year 2024 a new additional increase of 11.7% is imposed. And as can be seen from 2023 to 2024 as a whole the increase reached the enormous rate of 22.6%”.

4. “The Insurance Company still does not make public what are the “objective factors” on which the adjustment of the insurance premium depends (and which should be able to be checked and confirmed by anyone, either the insured or a public auditing body). And this while invoking the “principle of transparency”!

This systematic refusal of the insurance company to reveal where this year’s large increase was based is beginning to enter the borders of the suspicious.

The answer as it is formulated gives the impression that the insurance company considers that its obligation is exhausted by informing the insured about the increase. No. He has an obligation to justify it. In particular, not with generalities and vagueness as in paragraph 2 of your answer”.

5. “Since May 28, 2019, an investment insurance policy has been concluded between me and the company ….. through an insurance intermediary with program title ….. and Policy number ….. The issuance of the policy should have been preceded by an application.

But this was presented when the contract was delivered, it was attached to the contract with application number ….. and with the same date as the beginning of the contract. From the beginning of the contract until today, i.e. during a period of five years, the agreed annual installments have been paid continuously by me, which keep the contract in force, as provided for in its terms.

But both from the beginning of the contract, as well as during it, I have found and continue to find that it is an unequal agreement that contains abusive, onerous and hidden terms, for the so-called “insured/policy party”. There are conditions that the company does not even observe, regulations that are invoked without being contained in the written contract, but during development, are presented by the company as “interpretations” and have as their sole purpose the unilateral serving of the company’s interests”.

6. “With the birth of our child in …. given to us by the insurance company …. free 6 month insurance policy. On 2/5/2024, the infant was admitted to … due to illness from Covid-19 and despite the telephone assurance from an employee of the company, after the end of the infant’s hospitalization, the insurance company informed me about the non-coverage of the related costs. I replied to them stating the facts and they informed me through “Proof of Submission” that they will respond within 50 days.’

7. “On October 9, 2023, Monday, I was admitted to the private clinic ….. to perform the surgical treatment ….., I know that 80% of the operation is covered by my insurance company ….., while the remaining 20% ​​is covered by the compensation of the EOPYY and I cover the rest personally. Then and after repeated reassuring phone calls in mid-February I received an informational note from the clinic informing me of the following:

1. The total cost of his hospitalization amounted to €17,124.98
2. The insurance company participated with the amount of €6,755.98
3. EOPYY participated with the amount of €1,030.56
4. I was given a discount of €499.99
5. The amount I have to cover individually is €9,338.44!!!

….. Sometime in January, I received a call from the surgeon informing me that the insurance company appears to be denying reimbursement. I immediately inform my insurance advisor, who reassures me…Finally, on Wednesday 28/2/2024, I receive an email from the insurance advisor informing me, to my great surprise, of the reasons why the implant in question is not covered””