Information on data processing and your rights
Your data is in safe hands with AOK Nordost. AOK Nordost has an obligation to protect personal data (Section 35 of Book I of the German Social Code (Sozialgesetzbuch I – SGB I)). The EU General Data Protection Regulation (GDPR), which enters into force on 25 May 2018, further strengthens your rights as a customer. The following information provides an overview of the collection and processing of your data and the rights related thereto.
Why do we process your data, and on what legal basis?
AOK Nordost, as a provider of solidarity-based health and care insurance, has the task of preserving, restoring or improving the health of its policy holders, as well as providing assistance to those in need of care who rely on solidarity support owing to the level of their need for care.
The benefits and other expenditure are financed by collecting contributions from employers and members.
In order to fulfil these statutory tasks, AOK Nordost processes the data required for this purpose. This data is collected from you on the basis of statutory duties of cooperation (see, e.g. Section 60 et seq. SGB I) or on the basis of consent. AOK also receives data from third parties in accordance with the SGB (e.g. from your employer or care providers). Your failure to cooperate could adversely affect you when it comes to the provision of benefits (refusal or withdrawal of benefits).
For health insurance, the legal basis for data processing is Section 284 SGB V; for care insurance, it is Section 94 SGB XI. In addition, AOK Nordost is assigned tasks on the basis of other statutory provisions for which personal data needs to be processed.
In particular, this includes:
- setting up the insurance contract and membership, including the data required for initiating an insurance contract
- issuing the electronic health card
- establishing the obligation to contribute and the contributions, responsibility for the contributions and payment of the contributions
- assessment of the obligation to pay and provide benefits to the policy holder, including the requirements for benefit restrictions, determination of co-payment status and carrying out of cost reimbursements, reimbursements of contributions and determination of the limit
- assisting the policy holder in the event of malpractice
- assumption of treatment costs for individuals not required to have insurance in accordance with Section 264 of SGB V against reimbursement of costs
- involvement of the Health Insurance Medical Service (Medizinischer Dienst der Krankenversicherung (MDK))
- settlement with care providers, including checking the lawfulness and plausibility of the invoice
- monitoring of compliance with the contractual and statutory obligations of providers of aid
- monitoring of the cost-effectiveness of the provision of benefits
- settlement with other funding agencies
- settlement of claims for reimbursement or compensation against third parties
- preparation, agreement and execution of morbidity-orientated remuneration agreements
- preparation, execution of pilot projects, contracts for integrated forms of care and for the outpatient provision of highly specialised services, including the execution of performance and quality audits
- implementation of the risk adjustment scheme, as well as the preparation and implementation of structured treatment programmes, including recruiting policy holders to participate in these programmes
- conclusion and execution of nursing care rate agreements, remuneration agreements and performance and quality agreements
- consulting on measures for prevention and rehabilitation, and consulting on participation, as well as benefits and help with care
- coordination of nursing care, care consulting, and fulfilment of duties at care support points
- performance of discharge and sickness allowance case management
- acquisition of new members
- reimbursement of employer’s contributions in the case of illness or maternity
- combating of misconduct in healthcare (Section 197a SGB V)
- research projects
In addition, AOK Nordost processes data on the basis of express declarations of consent (Art. 6 (1) a) GDPR).