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  • Statutory health insurance

Statutory health insurance

BDO has more than 25 years’ experience in the field of social security institutions, and with statutory health insurance in particular. Our clients include general local health insurers, health insurance funds, alternative health insurance funds and various associations.

Our experience is based on a variety of audits of annual financial statements in line with§ SVHV, as well as corporate governance audits and commissioned special audits of statutory health insurance providers. The ability to analyse and evaluate extensive datasets from health insurers supplements our expertise and significantly extends our consulting capabilities.
The Industry Expertise Centre for Insurance and Statutory Health Insurance employs social security coordinators and staff with many years of experience in auditing and consultancy of and for health insurers; their expertise in the fields of general auditing and statutory health insurance is constantly updated through internal and external training.
We are a founding member of Zukunftswerkstatt GKV (Future workshop on statutory health insurance), a forum in which industry trends or required changes are discussed and assessed, and new solutions collected.

Our specialists offer comprehensive auditing and consulting services from a single source. Where needed, they are supported in this by experts from other Industry Expertise Centres with experience in long-standing consultancy for companies and institutions of all sizes and legal forms, and a variety of public-sector and other tax-exempt entities.

Auditing of annual financial statements
We audit the annual financial statements of the health insurer/care fund in line with §31 of the SVHV, applying auditing standards of our professional body, the Institute of Public Auditors in Germany (IDW). The results of the audit are recorded in an audit report.

Corporate governance auditing
Corporate governance auditing mainly focuses on compliance with the principles of orderly management and on accountability requirements as per §194 of the SGB V, including auditing of the internal controlling system. This includes, for example:

  • Auditing the structure/process organisation
  • Auditing realisation of receivables
  • Auditing cash handling security and respecting the ‘two pairs of eyes’ principle
  • Controlling and reporting
  • Outsourcing of tasks

Support within the framework of mergers/cooperation management
Mergers between health insurance companies fundamentally require a strategic and planned approach to identify and resolve problems in advance. We help both in advance (e.g. through a due diligence) and within the framework of the merger process to identify problems and develop potential solutions.
Statutory health insurers cooperate with other statutory health insurers, but also with private health insurance providers. The focus here is on the transfer of knowledge and the potential for customer loyalty. We are happy to provide advice on questions of organisation as well as economic feasibility studies.

Issuing expert opinions on accounting questions
The changes intended by the German act on the further development of organisational structures in statutory health insurance (GKV-OrgWG) (as of August 2008) in the accounting methods of health insurers necessitate a change in those methods. We advise you of the adjustments that must be made in external accounting and accounting-related areas.
We are happy to issue an expert opinion for you in case of questions arising from the still-to-be-enacted statutory provisions on a standard chart of accounts of statutory health insurers, where solutions cannot be derived from legislation or reference works.

Data analysis and data quality
The annual financial statements and financial situation of an statutory health insurer are substantially determined by risk structure compensation and the risk pool and as of 2009 by morbidity-oriented risk compensation and the financial allocations, based on internal cash values and other aspects, derived from this.
We use our software to audit the insurer’s RSA-relevant internal values (e.g. record types) and ensure the validity of the data basis.