Law for stable contributions in statutory health insurance: Healthcare trades are skeptical.

A new law aims to stabilize contributions to statutory health insurance. The Central Association of Opticians and Optometrists views the regulation critically.

On April 29, 2026, the German Federal Government passed the " Act to Stabilize Contribution Rates in Statutory Health Insurance ." This law restructures the procedure for the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) to determine the fixed contribution amounts . In response to the ruling of the Federal Social Court of April 7, 2022 ( B 3 KR 4/20 R ), a legal basis is established that allows the GKV-Spitzenverband to calculate the fixed contribution amounts using sound business principles . The previous method of calculation was unlawful.

ZVA: "No genuine co-determination"

The Central Association of Opticians and Optometrists (ZVA) is critical of the law : While the new Section 36 of the German Social Code, Book V (SGB V) provides for the involvement of service providers (associations) before the fixed amounts are set, there is no question of genuine co -determination.

Unlike before, the new fixed amounts will no longer be rigid price ceilings for potential contract prices. Instead, they will initially serve as the starting point for price negotiations between health insurers and service providers. Both sides can deviate from this fixed amount by up to ten percent in their favor. However, they bear the burden of proof and substantiation for any deviation claimed in their favor .

Furthermore, the law stipulates that the prices for services covered by health insurance will be reduced by a flat rate of three percent in 2027 and 2028.

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Since this is a regulation that affects all healthcare trades equally and is largely assessed uniformly by the associations, the ZVA has decided on a joint statement from the working group of healthcare trades.

Source: optikernetz.de

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