Controversy over supplementary health insurance

Vzajemna, Slovenia's largest voluntary supplementary health insurance company, was planning to increase premiums for people over the age of 60 from August 2004. The move was strongly opposed by the ZSSS trade union confederation, among others, and was eventually suspended by the company. The context is that a planned scheme to equalise the differing costs of companies offering supplementary health insurance has yet to be introduced by the government.

Vzajemna (Vzajemna zdravstvena zavarovalnica, Vzajemna) is the largest voluntary supplementary health insurance company in Slovenia. On 1 August 2004, it was due to raise the insurance premiums for voluntary supplementary health insurance by 13.5% for 383,000 insured people who are over the age of 60. Vzajemna says that this measure is necessary because of a loss of SIT 1.4 billion (EUR 5,830,000) in the first five months of 2004, which is primarily the consequence of the high share of pensioners among its insured members. Without an equalisation scheme for levelling out differences among insurance companies concerning the costs of healthcare (see below), Vzajemna can not cover the costs of its members. An additional reason is aggressive marketing by competitor insurance companies among younger people. Another factor is that the Insurance Supervision Agency (Agencija za zavarovalni nadzor, AZN) does not impose equal obligations to maintain reserves on competitor insurance companies as it does on Vzajemna.

In order to cover the difference between the share of healthcare costs paid by compulsory insurance and the full price, people may take out voluntary supplementary health insurance in Slovenia. Almost all people who, under the compulsory insurance rules, are not entitled to the full coverage of expenses have taken out such voluntary supplementary insurance. This means that it has become a universal voluntary insurance, in a context of gradual and regulated reduction of public financing in this area (SI0311103F).

Vzajemna was Slovenia's first voluntary health insurance company, established in November 1999, as a result of legislation separating voluntary and compulsory health insurance. In 2003, it had over 1.1 million members with supplementary health insurance and more than 80% of the market share in this area. Vzajemna has an annual income from premiums of approximately EUR 230 million. Its name is the word for its basic operating principle, mutuality - Vzajemna is a mutual insurance company and financial profit is thus not its main business or organisational goal. The total surplus accumulated by Vzajemna is intended for the benefit of its subscribers in the form of periodic bonus distributions, and for creating reserve funds to ensure Vzajemna's stable business operations and solvency on a long-term basis.

The voluntary health insurance provided by Vzajemna includes:

• complementary health insurance, ensuring full coverage of 'co-payments';

• supplementary health insurance schemes (A and B);

• medical assistance abroad; and

• a scheme to integrate foreign people into the compulsory health insurance scheme.

ZSSS position

The Union of Free Trade Unions of Slovenia (Zveza svobodnih sindikatov Slovenije, ZSSS) stated in June 2004 that the proposed rise in the supplementary health insurance premium only for people over the age of 60 represented discrimination against older people and would have the greatest effect on older and poorer people. ZSSS saw this as an example of capital dictating which basic human rights and social values will and will not be preserved in Slovenia. It argued that the state tolerates major differences in the conditions of operation of the Slovenia's various supplementary health insurance companies, and that this threatens the social security of ZSSS members, most of whom have voluntary supplementary health insurance with Vzajemna.

To prevent rises in contributions such as that planned by Vzajemna, ZSSS demands that the government prepares promised equalisation schemes to level out the differences among insurance companies concerning the costs of healthcare services. In April 2003, the government and social partners signed a 'social agreement ' for 2003-5, which included a commitment to take into consideration the principles of solidarity and equality when drawing up regulations on health insurance ([](D:My DocumentsCurrent2003)