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The call for a modern digital customer journey is getting louder for health insurance companies

A legal regulation in the German Social Code (Sozialgesetzbuch, SGB) meant that the electronic patient file became obligatory from 1 January 2021. But the electronic patient file is only the beginning. Statutory health insurance companies are working on more topics to provide digital care to their policyholders through e-health products, such as electronic prescriptions or electronic notifications of incapacity to work, and are positioning themselves as digital health insurance companies.

This puts pressure on private health insurance companies and creates a need for action so they don’t lose touch with statutory health insurance companies. Moreover, if these private health insurance companies don’t take the step towards going digital, they risk damaging their reputation.

2022 will also increase the pressure as this is when electronic prescriptions will be introduced. Although the application is voluntary for private policyholders, it is safe to assume that a large number of policyholders will want to use the e-prescription service and that doctors and pharmacists are also in favour of a solution.

With so many options on the table, health insurance companies will also have to keep their focus. I do this with my blog post by focusing on the electronic patient file (ePA).

But for what purpose was the ePA introduced and what benefits does its introduction bring for private health insurance?

What is the aim of the ePA?

The electronic patient file is designed to ensure greater transparency and better health care. Doctors and therapists in the health care system have all findings, doctor’s letters, therapy measures and medication plans bundled in one place. This enables targeted action, especially in emergencies. In addition, repeat examinations are avoided because all of the necessary information – for example on blood values – can be called up in the file.

I’d like to present a few examples of the benefits for private health insurance companies that come from the basic functions and extensions of the ePA.

Customer safety and satisfaction thanks to secure emergency data

For many policyholders, coverage is the primary consideration when choosing an insurance policy. Using electronic patient files is focusing more attention to this customer need.

The policyholder’s emergency data is stored in the ePA. Should a medical emergency arise, the paramedics or doctors can access this data and treat the policyholder, factoring in any intolerances or interactions. This reduces consequential damage and means the policyholder receives better care.

Avoiding repeat examinations

The ePA enables every doctor to take a close look at the examinations that have already been performed and the respective results, and carry out and document the necessary treatments. As a result, policyholders receive a higher quality of care and repeat examinations can be avoided in many areas, as can the associated costs. Second opinions can be obtained based on the documentation without having to repeat time-consuming examinations or examinations that are strenuous for the policyholder.

Insurance companies thus reduce their benefit expenses and offer better care to their policyholders.

Targeted care and value-added offers for policyholders

The insurance company creates targeted care offers for its policyholders in conjunction with the patient data. Letters and notices about care options are published in the app and linked to a calendar function. This makes the insurance app with the ePA the central health app.

Artificial intelligence (AI) helps the app to recognise needs based on the treatments and diagnoses stored in the ePA and to recommend suitable health promotion programmes. Sports and nutrition offers are also integrated into the care options to promote a health-conscious lifestyle of the policyholders.

This prevents future illnesses and also reduces the insurance company’s expenditure on benefits – championing prevention instead of cure through the insurance app and the ePA.

Process automation

Submitting and verifying settlements often involves a lot of bureaucracy for the policyholder and the insurance company. Manually checking documents such as regulations is completely eliminated. AI can automate these verification and settlement processes, too. This eliminates the problems created by poor-quality copies or illegible photos submitted via mobile phone. Forwarding invoices directly via the service provider would be an excellent way to streamline the entire process even further.

The ePA data also simplifies and streamlines health questions for a new insurance policy as the check can be automated.

First steps towards introducing the ePA by the Association of Private Health Insurance Companies

Private health insurance companies became aware of the issue of the ePA in 2020, when the Association of Private Health Insurance Companies (PKV Verband) joined gematik GmbH as a partner in the introduction and operation of the telematics infrastructure.

The features developed by gematik are expected to be available to all statutory and private policyholders equally. The PKV Verband is determined to work with the other partners to promote the use of electronic patient files for the benefit of all policyholders in Germany. Digital health care (e-health) is expected to become an important part of medical care in Germany.

The PKV Verband has taken its first steps in this regard. It’s now up to the insurance companies to continue on this path. Over the next few years, it will become clear whether private health insurance companies will be able to keep up with statutory health insurance companies or whether they will lose out in the electronic health market.


The ePA will change the workflows and processes in the healthcare sector and take the digitalisation of the healthcare system in Germany to the next level. For private health insurance companies, this must be supported and promoted by the introduction of an ePA, as there is already demand for other products, such as the electronic vaccination certification. Without this step, private health insurance could suffer a loss of importance.

Would you like to learn more about exciting topics from the world of adesso? Then check out our latest blog posts.

Picture Robert von Seggern

Author Robert von Seggern

Robert von Seggern has been working in the insurance industry for 20 years - for adesso as a senior consultant. His work focuses on business analysis and test management in the insurance sector. In addition, he is intensively involved with company health insurance and possible developments.

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