Proposition 52K1662

Projet de loi modifiant, en ce qui concerne les contrats d'assurance maladie, la loi du 25 juin 1992 sur le contrat d'assurance terrestre et la loi du 20 juillet 2007 modifiant, en ce qui concerne les contrats privés d'assurance maladie, la loi du 25 juin 1992 sur le contrat d'assurance terrestre.

General information ¶

Submitted by

CD&V Leterme Ⅰ

Submission date

Dec. 11, 2008

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

private insurance personal insurance insurance health insurance

Voting ¶

Voted to adopt

CD&V LE PS | SP Open Vld MR

Voted to reject

Vooruit N-VA VB

Party dissidents ¶

• Josy Arens (LE) abstained from voting.
• Colette Burgeon (PS | SP) abstained from voting.
• Jean Cornil (PS | SP) abstained from voting.
• Joseph George (LE) abstained from voting.
• Karine Lalieux (PS | SP) abstained from voting.
• Katrien Partyka (CD&V) abstained from voting.
• Luc Sevenhans (VB) abstained from voting.

Contact form ¶

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Discussion ¶

March 12, 2009 | Plenary session (Chamber of representatives)

Full source

The reference to the written report seems very popular. Nevertheless, I took the effort to make a summary of my written report to expose to colleagues the work we conducted in the Economy Committee.

Your committee examined this bill during its meetings of 20 and 27 January 2009 and 3 and 17 February 2009. In his introductory presentation, the Minister recalled that the draft that is presented was drafted in order to implement some fundamental principles, such as:

- the right to pursue individually a collective insurance of which the benefit is lost at the arrival of the pension, for example;

- the guarantee of being able to benefit from a lifetime insurance contract;

- possible pre-existing conditions better taken into account for the benefit of the insured;

- the fact that any premium increases may not exceed an index reflecting the actual cost of the services to be performed, in order to avoid sudden increases with often devastating consequences.

Since the previous provisions have, rightly, raised multiple questions, it seemed important to present this project as such and not – even if it is essentially reparative provisions – in a set of laws of various provisions.

Following the presentation by the Deputy Prime Minister of the main lines of the project, which you will find in detail in my written report, your committee decided to conduct hearings, which it did on 27 January 2009. In particular, she audited representatives of SPF Economie, Kenniscentrum (KCE) and Reacfin (UCL spin-off). She also decided to request written opinions from two patient organisations and Test-Achats.

At the end of these hearings, many questions were raised regarding the determination of the various factors to be taken into account for the establishment of the medical index, the exact role of the KCE in controlling the reliability of the data that will be provided by insurance companies, as well as the risks that remain to be borne by the insurers.

During the general discussion, several points were again addressed, mainly on the proper performance of the KCE’s tasks (recommended in the bill and told us during the hearings that he did not wish to perform them), on the guarantees in relation to the royal decree that will be taken into account by the government in relation to the determination of the parameters related to a medical index, on the control of the reliability of the data provided by insurance companies, on the advanced methodology based on actuarial calculations based on costs and not on price, on the applicability of the rules relating to the adjustments of premiums, on the impact of this project on insured persons over 65 years and on the taking into account of the medical index, technical and demographic developments.

Regarding the increase in previous premiums, the minister, on the basis of the questioning of the members of the commission, explained that it was not possible to provide a solution by law. However, the court or the Ombudsman may constitute an appeal for such situations.

For the future, the interim period lasts until July 2009. A mechanism for indexing premiums may be stopped. As for the KCE, the Minister notes that it has not proposed alternative solutions.

Regarding the increase in premiums for individual insurance, the Minister considers it desirable to work to support a general index. Compared to insurance companies, the Minister provides for an appeal on the smooth index if they do not provide the data requested. This should encourage the sector to be cooperative. The figures are provided by the companies themselves and not by Assuralia, as previously assumed.

The figures will be analyzed, from a accounting point of view, by the CBFA, before being verified in collaboration with the SPF Economy. The control of the CBFA will also be carried out on the basis of reports made by the auditors of the insurance companies.

Index calculation by age classes and contract type may be considered if index differences between the categories are significant. Otherwise, a single index is preferable. The CBFA, the SPF Economy and the department in charge of Health will collaborate on this matter. Contracts may be subject to adjustments until July 2009. The Minister wishes that the possibility of individual adjustments beyond the index is no longer retained and that the index itself is retained.

For everything related to the debate on the constitution of reserves, the minister considers normal that the insured may leave his insurer with his share of reserves, but this debate is probably not to be conducted within the framework of the bill under discussion. He adds that this matter does not appear in the original text, but that the issue needs to be clarified.

As regards the considerations regarding the coverage of hospitalizations for diseases that occur in the first two years of the conclusion of the insurance contract and which can be assumed as already existed at the time of the conclusion of the contract, the Minister proposes that the cases of hospitalization in this context that have been contested be subject to a verification by the SPF Economy. If necessary, adjustments to the law will be considered.

For all questions related to the determination of the index, the Minister proposes to return to the committee before the adoption of the index, to inform it of the index mechanism chosen. In order to collect the data necessary for the establishment of the index, the minister must rely on a law. It will not initiate the data collection procedure before the adoption of this law.

If the medical index is not adopted by 1 July 2009, the consumer price index will be applied as provided by law.

Compared to the methodology, it specifies that the index aims to fix the price, so it makes no sense to use prices to determine it.

During the discussion of the articles, several amendments were submitted.

An amendment aimed at inserting an article 5/1 was filed by Ms. Van den Bossche and Mr. Van den Bossche. by Henry. It aims to provide that the amount of the accumulated aging reserve is returned to the insurer when he terminates his contract, in order to avoid the latter having to start from zero in the constitution of reserves in another company.

Another amendment was submitted by the same authors to Article 6 in order to establish a uniform medical index based on the actual evolution of prices, goods and services representative of those covered by health insurance, and not according to the actuarial method.

Another amendment to Article 6 was deposited by Ms. Jadin and consorts in order for the King to determine, on a joint proposal of the ministers with social affairs and insurance in their attributions and after consultation with the Federal Center for Healthcare Expertise, the method of building the indices. It can also increase the frequency.

Another amendment aimed at inserting an article 6/1 was filed by Ms. Van den Bossche and Mr. Van den Bossche. by Henry. The authors propose to clarify that the relevant data communicated by an insurer to an insurer when concluding a contract concerning his health status may only refer to a diagnosed disease or infection.

In this regard, the wish is formulated that a study is carried out by the SPF Economy to better identify the number of contracts terminated in the first two years of their conclusion. The Minister believes that such a study can be requested from the Ombudsman’s services in a timely manner. Such a study may also be requested at the initiative of the members of the committee, as specified by Mr. The Crucke.

Amendment to Article 7 by Ms. Van den Bossche and Mr. Henry aims to insert a point 1/1, in order to provide that only costs directly related to a disease or disability diagnosed at the time of conclusion of the contract can be excluded.

The Minister stresses that the notion of "directly related" is subject to interpretation and advocates the preservation of the current text.

Another amendment to the same article by Mrs Partyka et consorts aims to postpone by one year the deadlines of the period during which insurance companies are obliged to offer chronic sick or disabled persons hospitalization insurance, as well as the related assessment. Furthermore, given that the assessment will have to cover the existence of an ongoing and significant demand for such health insurance, a two-year effective assessment period is more appropriate.

Ms Jadin and Partyka introduce an amendment to a new article 10/1 which aims to insert a paragraph 2 in paragraph 2 of article 21octies of the law of 9 July 1975 on the control of insurance undertakings. This amendment aims to allow insurance companies suffering exceptional and serious losses to request the CBFA to be able to raise their rates and return to the financial balance. Ms. Jadin adds that this has also been applied for several years for mutualities.

Several members consider that this amendment is problematic in that it allows companies to restore their financial balance on the back of the insured.

The Minister confirms that the same mechanism applies to mutualities in the event of significant and exceptional circumstances and that it does not pose a problem. Tariff increases will be subject to the agreement of the CBFA. Today, the CBFA can demand tariff increases; the amendment provides that this can be requested by the companies, so vice versa.

An amendment creating Article 10/2 by Ms. Van den Bossche and Mr. Henry aims to clearly predict that the supplementary premium belongs to the primary insured and accompanies it when it changes company. The same authors propose by another amendment to increase from 30 to 60 days the deadline for moving from a collective hospital insurance contract to an individual contract. This extension is justified by the difficult circumstances in which people find themselves.

by Mr. Schiltz et consorts submit an amendment to provide that the insured has the right to extend by thirty days the initial period within which he must communicate his decision to continue the contract on an individual basis, provided that he informs the insurer in writing or electronically. The Minister specifies that this right to extend the period will be mentioned in the information to be given to the insurers.

The amendment by Ms. Van den Bossche and Mr. Henry in Article 11 aims to not allow premium increases until June 2009. The following five amendments by Ms Van den Bossche and Mr. Henry wanted to insert new articles aimed at entrusting the Economic Inspection rather than the CBFA with a mission of control and, if necessary, warning and sanction on compliance with the law. The amendments also provide for a procedure for warning the offender of the provisions of this law and an action in cessation.

The Minister specifies that a proposal to adapt the CBFA law will soon be developed and that he has no a priori regarding the instance that will be responsible for consumer protection. However, this is a broad problem that also concerns the banking sector. Therefore, it is not appropriate to address this issue in a reparative law. The multiplicity of actors is not always the best guarantee. A working group has been assigned the task of reflecting on the entire financial architecture and consumer protection will play a major role.

Articles 1 to 6 were adopted unanimously. In Article 5/1, Amendment No. 12 was rejected by 10 votes against 4. Article 6, amended, was adopted by 10 votes against 4. Article 6/1 was rejected by 9 votes against 4 and 1 abstinence.

Article 7 was amended and adopted by 10 votes against 4 abstentions. Articles 8 to 10 were adopted unanimously. Article 10/1 was adopted by 9 votes against 4 and 1 abstinence. Article 10/2 was rejected by 10 votes against 4.

Article 10/3 was adopted unanimously by inserting amendment no. 17.

Article 11 was adopted by 10 votes against 2 and 2 abstentions.

Article 12 was adopted by 10 votes against 4.

Articles 12/1 to 12/5 were successively rejected by 10 votes against 4.

Article 13 was adopted by 13 votes against 1.

The entire draft as amended, with a few legal corrections, is adopted by 10 votes against 4.

Mr. Speaker, I propose to close my report here and to return later to present the considerations of my political group regarding this project.

Mrs. Speaker, colleague Jadin, I give you a little time to breathe. You will come back to that later. I will keep it short and pretty business.

Mr. Jadin has already explained this. The law of 20 July 2007 had the ambition to make the supplementary health insurance accessible and affordable. She has tried to do that in four areas. It introduced the guaranteed lifetime coverage of health insurance, as well as the right to individual continuation of collective insurance, and provided for the protection of insured persons against unrestricted premium increases and a system relating to the accessibility of insurance for chronically ill and disabled persons. These are four aspects that constitute a major change in our health insurance.

That scheme was very ambitious, but it has not proved so easy to implement it. Therefore, we discussed a repair law in the committee. There were still many points of discussion open.

We are not blind to these points of discussion. The main step that needs to be taken in this area is the introduction of a form of index. Thanks to the index, thanks to the standard that is set, premium increases or premium changes are limited within certain standards. However, entering such a standard, such an index, does not prove so easy. For this purpose, a study was ordered. This study was thoroughly explained to the committee.

It was found that there were two possible forms of index for health insurance, on the one hand an index that follows the evolution of healthcare prices and, on the other hand, an index with an actuarial approach that maps the increase in costs for the insurance companies and thus effectively reimburses those costs. Both systems have their advantages and disadvantages. It is clear that the actuarial approach favoured the FOD Economy. The committee was quite divided in this regard, to use a understatement.

In any case, as I said before, there are still a bunch of questions about that index. Eventually, the committee decided to leave that to a KB. That KB should come by July 2009.

Although Open Vld ⁇ still holds a number of questions open and remains vigilant, we will still approve the bill, giving confidence to the two ministers who must sign the KB, namely Minister Reynders and Minister Onkelinx, who must decide together. We will follow here how everything eventually comes to fruition and how the index works. We must give the index and control a chance to do so.

In addition to the index, there are a number of other aspects that remain a sensitive point. The premium increases, especially for older people, turn out to be a big problem. Over the past few months, we have all been charged with a number of scary cases. We must continue to work on this in the coming months. The additional old age premium makes it possible not to exponentially increase a premium at a later age. Today, however, the law does not contain any provision on how the share of the insured may be individualized. This is necessary, however, in order for the insurance to be transferable, so that people can change hospitalization insurance even at an older age.

The purpose of the original law is ultimately that people can move freely in the market and choose the best insurance. There is still a lot of work to be done in the store, and we will also watch this. In the committee, among others by colleague Partyka, a proposal was launched to view this through a code. We will see how we can find a solution to this.

We are critical of these aspects, but still hopeful. We will keep track of 1 July 2009 as the deadline for the first steps on the index, but we will support this proposal and continue to work here in Parliament on a good hospitalization insurance for all.

I would like to speak about this project presented in the Economic Committee by adding the considerations of my political group. It is of course that the MR group and I will support this bill on repair related to hospital insurance. We are pleased that thanks to this text, the 2007 Verwilghen Act can finally become effective because we all know that this legislation in force today, even though it is very interesting in terms of the principles it defends, is legally improved. This cannot be tolerated, otherwise some insurers, although far from being the majority in the market, will continue to rely on these weaknesses.

Today, people who benefit from collective insurance related to their profession will be able to pursue through this law their right to individual insurance in case of loss of work or retirement. The establishment of a new index will limit and control future tariff increases in the head of insurance companies. Thus, we should no longer know the sharp increases in the amount of premiums as was the case in particular in 2007.

Furthermore, the game of competition will be preserved and each company will remain free to keep attractive prices, but it will no longer be able to practice catch-up in any case. From now on, every insured, regardless of their age, will be guaranteed real tariff security. For all these reasons, I am convinced that the text put to vote will bring positive effects in the insurance sector as well as in the head of the insured. That is why I decided to give him my support.

Mr. President, Mr. Secretary of State, dear colleagues, hospital insurance is an important issue as we have had the opportunity to discuss it in the committee.

We have all been alerted by ⁇ difficult human situations of insured persons facing brutal and very significant tariff increases. In some cases, the premiums were multiplied by 3, 4, or even 5 for third or fourth-age people who did not expect at all to have to pay supplements of this order.

This finding reveals the considerable problems created by the 2007 law. The government’s bill is presented to us as a law of reparation. However, in the project we are proposing, the good part is done to the insurers. Based on their costs, they will be able to adjust the tariffs. This point is ⁇ problematic.

It seems to us reasonable to consider that a risk must be borne by the insurer. This is the very principle of this type of activity. Basing tariffs on costs rather than on a price-based index is to a large extent transferring the risk to the insured community. In any case, we have no guarantee at this stage that the proposed system will improve the situation especially because it will depend heavily on the royal decree that will be taken by the government.

We have submitted and signed a number of amendments in the committee. This was mentioned by the rapporteur. Most were rejected.

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Are you referring to the speaker? But that does not shock me.

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I would say the rapporteur.

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It seemed to me that the names of functions were feminised.

It was a wallon decree, not in the House.

This is the Community, Mr. De Croo, not the Region.

It is called Mrs. President, Mrs. Minister.

No to!

Everyone does as he feels.

Most of these amendments were rejected by the majority. However, they aimed to protect citizens at different levels. I will come back.

However, we can thank the majority for the only amendment accepted. This is the one that extends the decision-making period from 30 to 60 days for persons wishing to resume in individual form the coverage they had at their disposal on a collective basis through their employer. This advance seems to us very targeted, but nevertheless useful: it corresponds to people sometimes in a delicate situation, for example, in case of loss of employment.

The amendment adopted after several sub-amendments provides for the doubling of the period from the moment of the notification.

Despite this amendment, the text remains highly unbalanced. That is why my group opposed it in the committee.

This is also the reason why we are submitting several amendments for the second time, in the plenary session, together with our colleagues of sp.a, in particular to allow the insurer, when his contract expires or is terminated, to be able to take the aging reserve constituted by his contributions.

It is clear that, for health insurance, age is an essential data since, statistically, benefits increase significantly. Therefore, it seems to us normal that the insured can dispose of his reserves, in particular to allow him to easily find an insurance at a good price, which meets his needs.

The other amendments will be submitted by Ms. Van den Bossche.

Mr. Speaker, a new element: if we are well informed, it is not you but the President who received yesterday a letter from Test-Achats with, in annex, a petition of 40,000 signatures to reject this project.

It can be said that it is not banal to receive a petition of this order in relation to a project under discussion. The authors list some quite relevant arguments, I think, in relation to the content of the project. They demand that the text be postponed and reviewed again in the committee.

On behalf of my group, I am in favour. Given the receipt of this petition, I think we should resume the discussion because there is no difficulty in putting the work on the profession. This parliament would grow by taking note of the filing of the petition as well as the time of the substantive examination. This is what I suggest the majority to do.

Mrs. Speaker, I would like to begin by pointing out that for our group the starting point is still that the necessary medical costs are covered by social security.

Meanwhile, five million Belgians have additional hospitalization insurance, which, of course, means that the current bill is an important bill.

The draft law ⁇ has positive aspects, but unfortunately there are still many trouble points for which no solution is found.

Mrs Staelraeve has outlined the historical history of the law-Verwilghen, which was an important step in regulating the sector in question.

However, immediately after the approval of the aforementioned law, it turned out that there was a problem. Especially the adjustment of the contracts to a lifetime character created a lot of legal uncertainty and uncertainty. The right of access for chronically ill people was and is still not realized.

In addition, there is another, very large problem, in particular the sharp price increases, especially also for older consumers, which had to do with the fact that the insurers anticipated the lifetime of the contracts.

I would like to summarize the four most important pain points in the bill.

The first pain point is the medical index. The previous speakers have already said something about it. The medical index is essential in the law-Verwilghen and also in the prevailing repair law. It will be elaborated in a royal decree. I would like to emphasize the importance of an objective, simple and operable medical index, which first and foremost protects consumers from excessive or abrupt premium increases. The medical index should also be transparent so that the consumer can effectively verify whether price adjustments are made correctly.

We would like to follow closely in what way a royal decree will be concretized by Minister Reynders and Minister Onkelinx.

The second problem concerns the portability of premiums by employees when leaving a company. Positive is that the draft law adjusts the period within which the employee can continue his insurance individually. Negative, however, is that this design does not provide a solution to the portability of the accumulated reserves, the so-called extra premiums. This is regulated for supplementary pensions. We are convinced that this should be arranged in a separate bill and preferably as soon as possible. It is important to reach a working system through consultation of the social partners and the insurers, by analogy, for example, of supplementary pensions. Important is, for example, a system that ensures the build-up of reserves for workers so that, for example, a worker who is retired can have an affordable insurance, or also the practical organization of that portability. For example, someone who changes jobs: how can he take the accumulated reserves to a new employer.

A third pain point is the right of chronically ill people to hospital insurance. The negative is that this right actually existed only on paper: it was not known. The Conciliation Committee has been established, but is still not active to this day. In addition, I continue to regret that the CBFA, the main insurance supervisory authority, will not be involved in the assessment. Positively, an amendment will extend the trial period until 1 July 2011. This gives the opportunity to effectively realize the right of access for chronically ill people. Everyone must take responsibility: insurance companies must create an offer, the government must ensure the functioning of the mediation committee and the possible publication of the arrangement, and the patient organisations must then check whether there is actually a real demand. At the same time, we should also emphasize the importance of a serious review by 1 January 2011.

A fourth and last pain point – the problem has already been addressed – is that there is de facto an actual insecurity for many older consumers who have faced sudden premium increases. Positive, that was also the purpose of the design, is that it creates legal certainty. Negatively, the long transitional period, almost two years, has resulted in the fact that the insurers have taken the assurance for the uncertain and by means of premium increases, especially for their older customers, have actually raised their customer base.

Many people, we have all been given examples of, could no longer pay the insurance, even though they had paid premiums for years. People of 70, 75, 80 years. The market must play, we all agree on that, but for the people who are older than 65 years, that is ⁇ overwhelming: they can no longer change the firm. A person who pays fifty years of premiums at a certain firm and at 70 years of age receives an unpaid premium, can no longer go to another insurer and can no longer even go to his health fund. The design does not provide a solution to this. As CD&V we have addressed this problem and also very much advocated for solutions. The minimum that the Minister can do is ask the sector in question to develop a solution.

The Minister had already promised this in the plenary session in November 2008. Now, at the discussion in the committee, he has once again indicated that he will urge the sector in writing to work out a solution.

This could, for example, go in the direction of offering an alternative, less covering, but cheaper basic insurance that still ensures that those who are sixty-five and over can also take insurance. There is a willingness in this sense in the sector.

We will approve this bill as the repair is a small step forward in a specific insurance sector that was barely regulated until 2007. Every step is a step forward.

At the same time, we would like to point out that there are still many adjustments needed. First, the right to portability of the accumulated reserves of workers should be regulated in a separate bill.

Second, we must evaluate the problem of the already existing diseases, which was addressed by Test-Acquisition and the patient organisations, when the law will have entered into force.

Third, I keep the minister’s promise to empower the sector to find a solution for those older consumers, who face unpaid premiums as a result of this legislative change.

A code of conduct is a suitable tool for this. The industry is prepared for this. It is up to the Minister to take further steps. I suppose he may have other things in his mind now, but I hope you will deliver him this message.

Mr. President, Mr. Ministers, dear colleagues, it has taken more than a year for the Minister to present to us a bill determining, finally, a health index to allow to frame the scandalous increase in the premiums of hospital insurance. A very long year has passed since we relayed here even in the plenary session the disappointment of patients who have seen their premiums literally fly up to heights hardly imagined.

At Ethhias, some premiums were increased by 73%. At Argenta, the premiums have gone from simple to triple. At AXA, some elderly people were claimed premiums of up to 2,300 euros, while they only paid 430 euros a few months earlier.

It is true that last year, we experienced a drain in private room bills, drain amount all relatively modest with an increase of 9% compared to the previous year. Accounts in the joint chamber remained relatively stable.

All this is far from being able to justify the scandalous rise in premiums that we know. For our part, we see rather a deliberate will in the head of the insurers who have consciously requested very low starting premiums in order to increase them regularly when the patient is no longer in the age to change the insurer.

The Verwilghen Act provided for a consultation on sustainable price variations between the CBFA and the Federal Center for Health Care Expertise. This concertation never took place, which resulted in the total impunity of the insurers with regard to the increases we know!

It would therefore take a year for the minister to propose his draft law which he presented as a law of compensation that would finally allow to fix objectively these tariff increases. At first, we could only be satisfied. It was without counting the study charged with clarifying the constitution of this famous index, study which was entrusted to a company of actuaries working regularly, I would say even almost exclusively, for insurance companies.

Instead of a clear and objective medical index that could have taken the form of an index of the type of "consumer price index", we were facing an actuarial method that we can call anything but understandable to the common mortal. At that time, the Minister gave us the impression that he was not the Minister of Insurance but rather the Minister of Insurance. Once it is not usual...

Let us be clear! It was for us entirely out of question to accept a medical index for insurers and by insurers, insurers who could have hidden behind the law and justify their increases by an index that they themselves would have set up.

How could we give our confidence to a project whose master word was opacity? Opacity of the actuarial method obviously, but also opacity of the figures within the insurance companies alone and therefore largely unverifiable.

Fortunately, and to our great relief, the project has evolved positively. Of course, this is still far from perfect and leaves behind important questions that will imperatively need to be taken as quickly as possible.

The methodology for the development of the index will therefore be fixed by a royal decree which will be taken jointly on the proposal of the ministers in charge of insurance, social affairs and public health. This will allow – we strongly hope – to bring the patient back to the heart of the problems and guarantee balanced, justifiable and objective bonuses.

Mr. Minister, if we have agreed to vote on the bill, it is under the cover of respect for the word given, in this case yours! First, you promised to come and present to us in committee the royal decree as soon as it is fixed. Secondly, you have committed to presenting a differentiated index for double and shared rooms. Indeed, there is no reason that the patient who already makes the effort to go to a double room undergoes the same increases as the patient who prefers the comfort of a single room. Finally, you said that you would consider contracts with reserve constitution with regard to the introduction of age classes in the fixing of premiums.

Others have said it before me, Test-Achats just submitted a petition of more than 40,000 signatures, demanding a more affordable hospital insurance. Although the project is far from perfect, it contains some advances that, at the moment, are essential given the hallucinating increases we are witnessing.

Mr. Minister, we have taken the risk of trusting you on this eminently sensitive topic. We made this bet because, without the vote, you refused to move forward in the constitution of the royal decree. So it is to the patients that we have thought of by making this strong gesture, without forgetting that, for us, social security and solidarity will always come first. However, since we are discussing this bill that holds you so close to heart, Mr. Minister, do not disappoint us! The ball is now in your field. A word is a word.

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. The explanation of the reasons refers to this: we are in front of a law of reparation. Unfortunately, this becomes a habit and arouses criticism because it means that the first law was imperfect and that the work had to be handed over to the profession. This means, in relation to the law that was passed, to see its imperfections, to redefine its objectives and to clarify things.

In the project that the government submits to us, there are indeed advances, positive things and indispensable things. The distinction between a collective contract and a private contract was replaced by a contract related to or not to a professional activity. The establishment of the arrangements for fixing this long-awaited index was equally essential, as was the modification of the dates of entry into force.

As I said in the committee, we are facing an extremely sensitive law because it affects a very large part of our citizens and concerns one of the things that they care most about, health. We have seen, in recent years, the breakdown of insurance premiums and its consequence that a number of people who were subscribers or beneficiaries of these contracts were still unable to pay their premiums. There were also people who, arriving at a certain age or following a disaster, were somehow disengaged from the benefit of contracts or guarantees or were forced to change their subscription conditions, which was unacceptable.

Of course, we must move forward. Of course, inflation or the arbitrary of prices must be stopped. But it must also be kept in mind that, behind the conditions of application of this law, a series of problems that are difficult to understand (symptoms, pre-existing disease, pathological predispositions) exist. These are so many elements that arouse and deserve a broad reflection. As I said during the work, the matter is extremely complex and it is difficult to legislate within the framework of it.

To argue the opposite would be a lie. But, on the other hand, I would have wished that in our discussions, at least before entrusting the development of the future index to a third party, we could determine what we would have wished to be included in that index and what we would have wished not to be included in that index.

It seemed to me — as the State Council said — that the legislator had this power, while effectively leaving to the King and, through the royal decree to intervene, to the one who would build it, latitudes, choices to operate and alternatives between which it would be appropriate to arbitrate.

This is what I wanted to tell you. I took note of what the Minister proposed to return to the committee before the adoption of the index to inform it of the index mechanism chosen. Will we have the choice between several mechanisms, alternatives? Will it be a “key-on-door” for us, arbitrated between the mechanisms that could have been recognized?

I note that the debate is not over. But we must be guided by several concerns:

- ⁇ ining access for all to this type of insurance;

- to ensure that those who have subscribed to them and those who are beneficiaries of them, regardless of their health status to become or become, can continue to benefit from them;

To maintain this assurance, this solidarity. It is behind this that the problem of the reserves that have been constituted plays. We will have the choice between the mechanism of solidarity or individual capitalization. This also deserves another discussion.

We will vote on this project because it contains a series of advances. But I think it is appropriate that we can meet again, give us other appointments to proceed with these arbitrations.

Most of all, however, has been said about this bill. Let me be clear, basically no reasonable person can have anything against the approval of the Reparation Act, a law that wants to give the citizen the right to continue a collective insurance as a private insurance in his own name, a law that wants to guarantee the lifetime hospitalization insurance, a law that wants to provide insured with certain conditions more flexible coverage. The relevant repair law also aims to make the premium increases of the hospital insurance in any case for the coming years affordable for customers.

At first sight there is nothing but good news. I would say, hoera, hoera. Therefore, no reasonable person could do anything other than press the green button. However, my colleagues will abstain. This has all to do with the fact that we find the repair law too late. The government has only reacted very late, we think, to the drastic premium increases of hospitalization insurance.

Due to a lack of consensus and a lack of action, many months were lost. The repair law comes at least a year late.

We will also refrain, ladies and gentlemen, because the repair law typically offers Belgian solutions, partial solutions. Without going into all the pain points of hospitalization insurance and especially of the increase in hospitalization insurance, I would like to note that the sharp price increases of hospitalization insurance are being held accountable by all insurance companies by pointing out the increase in imbalances between income on the one hand and expenditure on the other.

These imbalances are actually based on three data that come back in each study: the aging, the rising hospital costs, and the shrinking legal intervention of the health funds.

As for the first point, the ageing, you all know, as I do, that 80 percent of the medical costs currently – the latest figures suggest that – are made for interventions beyond the retirement age. Given the increasing life expectancy in our regions – our population is thus becoming greener – we can expect an increase in medical costs in the future. How will one incorporate the ageing wave into the medical index? It remains to guess.

The second factor is the rising hospital costs. Where is the logic of the prices for single-person rooms, apart from the fact that the hospitals and doctors are too aware that they can tell them integrally on the insurance companies? The question may be whether the government is exercising adequate control over the hospitals. Of course, this second aspect was also not cited, dealt with or resolved in this repair law. There is also a fundamental debate here.

A third, even more fundamental element is the shrinking legal interventions of the mutualities. I agree with you, ladies and gentlemen, that a lot of approved treatment techniques, a lot of medical materials, a lot of medicines, are not adequately repaid if one chooses a single room. The government is increasingly deciding not to provide any intervention for this treatment or this medicine. This leads to conditions in which the consumer, the citizen, himself, makes up for an ever-increasing portion of the medical invoice and in which eventually everything is transferred to the private hospitalization insurance. Meanwhile, we all know that the average customer pays 27 percent on an average medical invoice. However, it is clear that the less the legal intervention is, the more the customer will have to pay himself and the more he will therefore try to recover through the insurance company.

In other words, these three interconnected problems, which are fundamental in the whole question of health insurance contracts, are not addressed or discussed here at all and are themselves only partially solved. We are critical. It may be clear that we stand behind the principles, but we find that some things are not going far enough and are not resolved.

We are therefore not convinced that the financial problems of hospital insurance, as they have recently come to the surface in all sharpness, will be solved by this repair law. We are especially concerned with older insurers. We will therefore with conviction abstain from voting on this repair law.

This is a repair law, because there is, of course, a lot to repair. There has been a time for everything to be repaired, since the beginning of 2008. Then the hospitalization premiums are beginning to rise. This is not just an increase. That’s time two, time three, time four, sometimes even more than that.

How does this government repair, abundantly late, that unrestricted rise? By saying that this is legal and not even so bad afterwards, at a closer look, and one can continue until July.

That is the repair law. It does not fix what I thought would be repaired, namely the fierce, bruised, immense rises. No, it repairs something else: the insecurity of the insurers about the legality of the increases. That repairs this law, while it simply had to reassure people that no one should cancel their insurance. That law should actually give everyone the certainty that one is entitled to an affordable insurance and, once signed, lifelong. That was the spirit of the law drawn up by Minister Verwilghen at the time.

This repair law just needed a little courage. But I did not find the courage. I have heard that my colleagues in Parliament did not do that either. I’ve also heard colleagues from the majority parties say, “We’re going to have to work on it. We are critical but hopeful. We need a solution, but ⁇ not now. It is not exactly what we wanted, but it is already something. It’s a small step forward, but we want to go much further.”

One and a half years have passed. In that year and a half, the government could have taken every step. She did not do it. In that one-and-a-half year, parliamentarians of the majority could also submit proposals, draft amendments. That has not happened. So if I hear everyone say that it wasn’t exactly what one wanted, then I wonder why you didn’t do anything about it.

We have, of course, submitted proposals, not only because it is our conviction and has always been, but also because we thought in this way to initiate a debate and ⁇ also to make you realize that something needs to happen. We are not alone in this. We are here to discuss the debate that transcends the political boundaries of left and right. It is simply about the affordability of health care and people who take insurance for it.

Test purchase comes with a petition. The Family Union asks you to send this draft back. The Elderly Platform, all the parent associations together, ask that you review it. Are these politically associated movements? Absolutely not. Patient forums are not. They ask you all, each of those consumers individually, from whom you have received emails, to do something about it.

I hear everyone, out of honest shame, admit that it is true that all sorts of things have to happen, but that we already have something in our hands. Well, we have better nothing than this. What the present draft does, in fact, is to determine that all increases, which should not have actually occurred, because Minister Verwilghen had restricted them at the time, were all permitted at a closer look.

I remember April 2008. I searched again for the exact words of the Minister responsible for the matter, Minister Reynders, when I asked him here on the tribune what he would do with the increases and also whether the increases were legal or not. Minister Reynders has answered me that the increases based on the law-Verwilgjhen actually could not simply. He would make a repair law. So I did not have to worry. A few weeks later, the problem would have been solved. He would give clarity.

Now we have clarity. She arrived more than a year late. The clarity we receive is not at all the clarity he had presented to us at the time, is not the clarity that would come, but is the clarity that is possibly an explanation for the fact that even members of parliament of the majority have not submitted any proposals.

The given clarity means that the insurers are told that the increases were not allowed, but that they are now retroactive.

I wonder why you just put yourself down on that. I wonder why the prevailing, terrible laws should be passed here. They are contrary to what most of you think. I ask myself. I do not understand much of it.

I will make another last attempt to convince the Parliament. I am not convinced by the Minister. I am not convinced by his Secretary of State. After all, if the minister does not want, he does not want either.

I have a first letter here. Some letters or emails will also have you received. The letter was written by a 69-year-old retired woman, who stands alone in front of it. Her premium increases from 249 euros to 605 euros.

A second letter was written by a couple with a pension of 1,050 euros. They see their premium rise to 1,500 euros. This is more than a monthly income for those involved.

A third letter was written by a couple of both 75 years old. They paid 430 euros. Now they pay – hold hold – 2,300 euros.

Do you know what they write to me? You know, of course, because you have also received the letters. They say to me, “Woman, we can no longer pay the premium, but do you know what we will do? Each month we will deposit and save the same amount we previously paid for the insurance. We hope that if one of us ever ends up in the hospital, we will have enough of the saved amount. We can no longer pay the premium.”

It is a big problem. It is not a problem of the poor who need to be protected from a system whose entry they cannot find. It is also a problem of a large group of middle-class people, of retirees, of temporary unemployed, of single with children, of people who do not earn pieces of people. For those involved, the increases are a big problem.

The increases are everywhere. This is not a small niche in society.

It is also not fair. These people have sometimes paid a premium for such a hospital insurance for a lifetime. A lifetime of life! They started when they were young and powerful. At that time, they had little chance of illness, hospitalization. Nevertheless, they began to pay, with the reason that they might need it later, on their old days. That they count on it, I think rightly. This Parliament also found that several years ago, when the law-Verwilghen was passed. For the people thought that the insurance company would not suddenly cast them out; they thought that the rise of prices could not happen too abruptly. Therefore, there are now people who have paid year after year when they actually did not need it, and who now suddenly come to stand alone without insurance. Therefore, it is even less fair than any other design in that sense had been.

How ironic it is that the explanation for those rises is a law aimed at avoiding such rises! The increases had to remain limited to the index, the medical index. That medical index is not there yet; we will later give the trust to Minister Reynders to make it on its own, because it is not in the law. Until that medical index, the index of consumer prices was used. A fair deal. There are large insurance companies that do this.

For example, Fortis AG makes price increases based on a self-formed medical index. It is a basket that consists of a number of healthcare costs that people will reasonably have when they are admitted to a hospital. You can also see that although the prices of these insurance companies are rising, steadily, and every time with only a few percentage points, so not bruised, and they are not simply throwing people out. So it can. I sit here to say nothing that cannot. I’m not talking about an ideological proposal, no. It can. Many major insurance companies have done it. They have acted as they should have acted on the basis of the law that still exists as long as the present reparation law has not been approved.

Everyone sees and acknowledges the problem, but the minister couldn’t care less. This is the reason why nothing happens.

What should the repair law do? Reduce the price increases, record the medical index and resolve a number of gaps in the law.

What does the Repair Act do? Regulation of price increases. The price increases may continue for a few months, even. It’s almost a call: “Insurers, if you haven’t raised your premiums yet, you have the time until July 1. Hurry up, because on July 1, it will be over. It’s almost a call. ”It’s almost a call.

And gaps are not entirely written in this law. If that law already repairs something, then it will ⁇ not be for the patients and the insured.

There has been enough time to do it. There have been enough signals given to do something about it, such as political signals. I am not talking only about the political signals of the sp.a. group. There have also been other groups, including members of the majority, who have pointed out the minister, to the mourning, and unfortunately.

Amendments have been submitted. In April 2008, I submitted the first amendment to address this already. April of 2008! A few weeks later it would have been resolved. We have seen it.

There was a repair law that did not fix anything. We submitted eleven amendments and all eleven voted against. I would like to discuss with you what is in those amendments because they are again put to the vote.

I can’t imagine that none of these amendments can get your vote, after all the views I have all heard in the committee, in interviews, in debates, in relation to medium-sized organisations and to interest groups.

The first amendments, on the price increases, are against the regularization of those increases – it was not allowed on the basis of the law-Verwilghen so why should it now? – and, of course, also against the introduction of the possibility that increases may continue until 1 July.

Then, the medical index. The introduction of the medical index is simply based on a basket with relevant care costs, calculated on the index figure of the month preceding the premium expiry day. It is clear in how we can calculate it. It can. The proposal is actually based on what one of the country’s largest insurance companies is doing. As long as that medical index is missing, we reaffirm by this amendment what was already in the law-Verwilghen, namely that the adjustment may only be based on the index of consumer prices.

Regarding the gaps, I hope for a little more attention, because I suspect and fear that you have no margin to move, or take no margin to do so, with regard to the price increases. However, there are a few problems that have also been cited by my colleagues.

There is the problem of the disease that is not known at the time of taking insurance. People are getting insurance, but they are already sick. Those people know that not always, not every disease is already diagnosed at the time you take insurance. You know that an insurance company can exclude you in that case for two years, simply because they may suspect that you already knew something about that disease. The reasoning is that the person concerned had choppin and yet could have known that he or she had a tumor. He or she could not know that because doctors take twelve years to go to university to know it. How should anyone in this hemisphere or beyond know that himself if he is not a doctor? The amendment simply states that you can only take into account the already diagnosed disease before entering the insurance.

I come to the problem for people with a chronic disease or disability. We know that they are excluded from coverage for problems related to that disease or disability. This applies not only to the directly related problems, but also to the indirectly related problems, in other words, as long as any illness can be prevented by the insurer. A simple proposal is that only the diseases and problems directly related to disability or the diseases diagnosed should be excluded.

There is a third proposal, the supplementary premiums, which are paid by the insured, by his employer. What if you change the insurance company? Can this be taken? That would not be a bad idea, says Minister Reynders, but he does not settle it. In other words, those who strongly advocate for the free market and hope that it will also apply to the insurers for the benefit of the consumer, hinder the free market, because those who change the insurer are not sure that they can take the premiums deposited. Understand who can.

Finally, there is the problem of compliance with the law. There is a lack of effective control. The CBFA has a prudential control and must ensure that those companies are creditworthy. She has neither the time nor the staff nor the know-how to do what the Economic Inspection is doing. That is simply checking contracts for their legality, checking whether consumers are treated correctly.

In each of the four amendments, government and parliamentarians, both majority and opposition, replicated that it was all true, that it is indeed a problem, but that the way I want to solve it may not be exactly the way they would do it. What have you all been waiting for to propose your own solution?

I have offered Sp.a’s support for any majority amendment that would provide a solution to that problem. It didn’t have to be an amendment with our name under it. It goes above and beyond the party boundaries. No one did anything. Everyone says that it is a problem and that one has good hopes for it – some of you have repeated it here just then – that he is going to do something else about it. You say to be for, well, show that then.

My conclusion, many of you are worried, genuinely worried, loudly worried, and there is no one doing anything about it. There is a government that does not take a small step forward, but a big step backwards. In the committee, they even allow the MR to do what they do not get regulated in the government, namely to provide a backdoor to insurers to offer premium increases, so that those are possible outside the index to be approved. I understand very little.

I continue to persevere in it, for more than a year, because I think it is of great importance for our society, not only for people who find it difficult to pay bills, but for a very large group of people who cannot face rises x2, x3, x4.

The only thing you can do if you approve such repair law is the next day to ensure that all forms of coverage that are now in a hospital insurance and are not purely intended for comfort, but really go about health care, are housed in the first pillar.

It is not fair that in a hospitalization insurance, which is only affordable for people who have money on surplus, one leaves basic health costs such as implants.

If you approve this today, know one thing. It is then up to all of you to ask tomorrow in the Healthszorgen committee to take all non-specific luxury products from the hospital cover and bring them into the first pillar. For for what you have done otherwise, there is only one word, especially scandalous.

Mr. Speaker, I have trouble with those who are now making trouble about this bill, while they have approved the original law. That is the problem.

The law was passed almost two years ago. Those who now say that there are many problems, did not say that at the time.

This law is a repair law that sets a number of steps forward and which therefore needs to be approved.

The discussion in the committee was conducted extensively. Everyone took the word. The report reflects fully the discussions in the committee.

An important problem is the portability of the accumulated reserves. However, the Minister has said that he will try to find a solution to this.

The second problem is that of premiums for people over 65 years of age. Also there, on the question of the intermediate period before the application of the index, the minister indicated that he commits to work with Assuralia on a code of conduct to avoid increases, while recalling that although some excessive increases have taken place, they remain very minority and concern a very small number of cases.

I think everything has been said. Now it is a matter of voting this law of repair and of implementing all the improvements it contains.

I would like to simply say that it is more frequent that a law is made that needs to be repaired afterwards. We have complained about the gaps in this legislation for more than a year. The law-Verwilghen is a good law which, however, offered a number of possibilities for interpretation. We have already called for a year ago to shorten these possibilities of interpretation. It was quite on time, I think. It is also not our responsibility that nothing has happened over a year. Mr. Clerfayt, you may not know it, but there is a difference between the spirit of the law-Enlightenment and the literal text. The spirit of the law was clear, namely limiting the premium increases. They wanted them to gradually rise and evolve with the increasing duration of health care. That was the spirit, the essence, of that legislation. If a repair law is already needed, then it is to translate that essence into the letter in legal terms, not to reverse the spirit of that law.

Mr. Speaker, the response of the Secretary of State is extremely unconvincing. Many amendments have been submitted. At the majority level, you could have incorporated additional or otherwise written things as early as the bill. You could also have included a number of things that have been discussed in a committee, including voting our amendments or debating on this basis. Nothing of all this could be done!

The problems raised are extremely serious. It is therefore a little easy to start some aspects now and say "we'll see well for the next." This is extremely problematic for people who are experiencing this situation, especially since we have no idea of the timetable of what could eventually be done later.

I also regret that you did not refer to the petition we received yesterday: 40,000 signatures, but it is not anodin! It is as if it did not exist. I really regret it. We would have hoped that this project would return to the committee. We are ⁇ not willing to adopt it as it is. In any case, today we maintain our amendments. Therefore, it is still possible for the colleagues of the majority to support us for all or part of these amendments.