Die Techniker Krankenkasse (TK) has terminated the majority of its contracts for general practitioner-centered care (HzV) at the end of 2026. Other insurers, including AOK Plus, are drawing similar conclusions. However, for the affected patients, nothing changes for now. The contracts will continue due to a legal provision until new agreements are reached.
Background
In general practitioner-centered care (also known as the general practitioner program), insured individuals commit to always seeing their general practitioner first for health problems. In return, they usually receive better benefits or financial advantages. Health insurance companies pay participating general practitioners higher fees for this – according to TK, about 30 percent more than in the normal system.
However, a scientific evaluation commissioned by TK concluded that the HzV contracts do not achieve their goals: Neither specialist visits are significantly reduced, nor are hospital stays decreasing.
What changes for patients?
For the approximately one million TK insured individuals currently participating in the general practitioner program, the termination has no immediate impact. Thanks to a legal continuation clause (§ 73b Paragraph 5a SGB V), the existing contracts remain in effect unchanged until new agreements have been concluded with the general practitioner associations.
Patients can therefore continue to participate in the program as usual. Participating doctor's offices will also continue to receive the agreed-upon higher reimbursements until further notice.
Why are the insurers terminating?
TK justifies the termination with the results of the evaluation. General practitioner-centered care has not proven to be an effective management tool. At the same time, the costs for the insurers have significantly increased due to the higher doctor's fees.
Other insurers are also observing the developments critically. Negotiations about the future of general practitioner programs are currently underway in several federal states.
Outlook
The termination is seen as the start of new contract negotiations between health insurance companies and general practitioner associations. The goal is to develop models that are both medically sensible and economically viable. Whether and in what form general practitioner programs will be continued in the future is currently open.
Experts expect intensive negotiations in the coming months. For patients, the care situation remains unchanged until further notice.
FAQ
Will anything change for me as a patient if my insurance company terminates the general practitioner contracts?
No. Due to a legal provision, the contracts will initially continue unchanged.
Why are the health insurance companies terminating the contracts?
Because an evaluation has shown that the doctor-centered care is not achieving its goals (better management, fewer specialist and hospital visits), but the health insurance companies have to pay significantly higher fees.
Can I continue to participate in the family doctor program?
Yes, for now, nothing changes. Participation remains possible until new contracts are negotiated.
Which health insurance companies are affected?
The Techniker Krankenkasse (TK) in particular has terminated large parts of its contracts. Other health insurance companies, such as AOK Plus, are also reviewing or have already initiated similar steps.
What happens in the long term?
New contracts will be negotiated between health insurance companies and family doctor associations. How the family doctor programs will be designed in the future is still open.
