As a body responsible for providing health and long-term nursing care insurance on a basis of social solidarity, the BMW BKK is tasked with preserving or restoring the health of its insurees or improving their health status and with providing nursing care for those who, due to the severity of their need for such care, are dependent on the support provided by the community of the insurees.
The benefits and other activities are funded out of the contributions levied on the employers and the BMW BKK’s members.
In order to perform these tasks and duties, which are stipulated by law, the BMW BKK processes the relevant data. This data is obtained from you either on the strength of your duties to cooperate as stipulated by law (see, among other references, § 60 and following sections of SGB Book I) or on the basis of your specific consent. In conformity with the provisions of the German Social Code, the BMW BKK also receives data from third parties (e.g. from your employer or organisations/persons providing services). Any withholding of necessary cooperation on your part can have negative consequences for you in relation to the provision of benefits (refusal or withdrawal of benefits under the insurance scheme).The benefits and other activities are funded out of the contributions levied on the employers and the BMW BKK’s members.
With regard to your health insurance, the legal basis for data processing is § 284 SGB Book V, and with regard to your nursing care insurance, § 94 SGB Book XI. The BMW BKK is also entrusted with the performance of tasks and duties under other statutory regulations, which also require the processing of personal data.
These include, in particular:
- Verification of the existence of an insurance relationship and of membership of the BMW BKK, including the data required for initiating and creating an insurance relationship.
- Issue of the electronic health card.
- Establishment of the obligation to contribute and the amount of the contributions, as well as responsibility for funding and payment of them.
- Review of the obligation to provide benefits and the provision of such benefits to insurees, including the circumstances in which the provision of benefits may be restricted, as well as identification of the payment status and performance of the procedures relating to cost refunds, refund of contributions, and establishment of the bounds of capacity to pay.
- Support for the insurees in the event of medical treatment errors.
- Assumption of treatment costs for persons not liable for health insurance pursuant to § 264 SGB Book V in return for refund of costs.
- Involvement in the Health Insurance Medical Service (“Medizinischer Dienst der Krankenversicherung).
- Accounting and settlement with service providers, including review of the lawfulness and plausibility of cost statements.
- Monitoring of compliance with contractual and statutory duties on the part of suppliers of aids.
- Monitoring of the cost-effectiveness of service provision.
- Accounting and settlement with other funding agencies.
- Conduct of claims against third parties for refund of costs and payment of compensation.
- Preparation, agreement and implementation of morbidity-orientated remuneration contracts.
- Preparation and performance of pilot schemes, contracts relating to forms of integrated care and provision of highly specialised services on an outpatient basis, including the conduct of cost-effectiveness and quality audits.
- Performance of structural risk adjustment as well as preparation and implementation of structured treatment programmes, including the recruitment of insurees for participation in them.
- Conclusion and implementation of agreements on nursing care rates, remuneration agreements, and performance and quality agreements.
- Consultancy on prevention and rehabilitation measures as well as consultancy on participation and also nursing care services and aids.
- Coordination of nursing aids, nursing care consultancy and the performance of tasks at the long-term nursing care operation centres.
- Performance of discharge and sickness benefit case management.
- Compensation for employer’s expenses in the case of sickness and maternity.
- Combating misconduct in the health system (Section 197a SGB Book V).
The BMW BKK additionally processes data on the basis of express declarations of consent (Art. 6 (1) a GDPR).