Krankenversicherungswechsel-Dokumentationslücken (Health Insurance Switchover Documentation Gaps)

Definition

Effective 01 January 2026, privately insured persons who wish to change health insurance providers must cancel their existing policy by 30 September 2025. A new insurance contract must already be in place before the old policy can be cancelled. This creates a critical documentation window for claims adjusters: if a loss occurred between an old and new policy, the adjuster must correctly identify which insurer bears liability. Manual tracking of switchover deadlines and policy anniversary dates (which may differ from the calendar year) introduces errors. Claims submitted to the wrong insurer, or documented with incorrect coverage dates, trigger denials and require rework. Additionally, if a claim is initially accepted but later discovered to have fallen within a coverage gap, the insurer may demand refund, leaving the claims adjuster and employer liable.

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Claims Adjusting, Actuarial Services.

Affected Stakeholders

Claims Adjusters, Loss Assessment Specialists, Benefits Administrators, Dispute Resolution Specialists

Related Business Risks