Those who exercise regularly and go to the doctor should be rewarded with discounts and vouchers. This is what a Generali insurance tariff provides – and which has been examined by the highest civil court.
Vouchers for jogging, discounts for preventive medical examinations – for years, consumer advocates have been criticizing a program run by the insurer Generali that rewards policyholders with vouchers and discounts for health-conscious behavior.
The Federal Court of Justice (BGH) has taken a close look at the so-called telematics tariff in occupational disability insurance – and has now backed the insured in the dispute over some regulations. The most important questions and answers at a glance:
What is a telematics tariff?
Telematics tariffs are tariffs in which the behavior of an insured person is tracked, for example via an app. The amount of the insurance premium is then determined on the basis of this data. “Such programs are known so far mainly in car insurance, which evaluate driving style,” says Stephen Rehmke, spokesman for the board of the Association of Insured Persons (BdV). “Insurers record the behavior of their customers, analyze the data and reward reduced risks with discounts on premiums.” The tariff in question, on the other hand, targets the health and fitness data of the insured person and thus a “very personal area of life,” says Rehmke.
Which tariff was at issue at the BGH?
In this specific case, the BdV has filed a lawsuit against a tariff offered by the Generali subsidiary Dialog Lebensversicherungen, which requires membership in the Generali health program. Insured persons collect points when they do sports or go to the doctor, for example. The data is recorded via an app, and vouchers and discounts from partner companies are offered as a reward for a health-conscious life. Depending on the number of points, insured persons also receive the status “bronze”, “silver”, “gold” or “platinum” – which in turn affects the amount of the insurance premium to be paid. Those who achieve platinum or gold status pay less than last year, Generali told the dpa. Customers will be informed of any changes to the premium to be paid.
What do consumer advocates criticize?
The BdV has opposed several of the tariff’s provisions and criticized them for being non-transparent, among other things. For example, consumers “cannot find out exactly which specific behavior leads to which actual discounts,” says BdV board member Rehmke. It is also concealed that the so-called surplus participation of the insured may not be paid out despite health-conscious behavior if the insurer does not generate sufficient income. It is also unfair that corresponding activities are not taken into account if the fitness data is delivered too late – “regardless of whether the customer missed this or the insurer’s technology failed,” says Rehmke.
How did the court decide?
The Karlsruhe judges found that the criteria by which the discounts through a so-called surplus participation were granted were not sufficiently explained to the consumer. The corresponding clause was non-transparent and therefore ineffective.
In addition to the profit-sharing clause, a regulation on the transmission of health data was also the focus of the proceedings. It was unfair that the tariff did not take into account corresponding health-conscious activities if the fitness data was delivered too late – “regardless of whether the customer missed it or the insurer’s technology failed,” said Rehmke. Here too, the BGH followed the BdV’s view. The insured was unfairly disadvantaged and the clause was ineffective.
What does Generali say?
After the announcement, Generali stressed that its Vitality health program itself was not the subject of the decision and was not fundamentally questioned by the BGH. “In this respect, the ruling confirms the principle of freedom of contract, according to which everyone can freely decide how and with whom he or she insures himself within the framework of existing laws,” said the company. The two clauses criticized in the proceedings will be adjusted accordingly and the company will write to the almost 100 customers affected, according to its own information.
Source: Stern
