Statutory health insurers & healthcare
Member communication for statutory health insurers – relevant, not creepy
The PBM Campaign Platform accompanies insured members when they join, for preventive care, the bonus programme and life events – by email, letter, landing page and SMS. Individual for every recipient – but only with data that has been approved for this purpose. It does not need diagnoses or billing data for this.
Muster BKK · family insurance applied for first child
What questions do statutory health insurers ask before automating communication?
We hear four questions from marketing, data protection and IT again and again. The answers are mechanisms, not promises.
Marketing & member communication
“We only reach new members when they need something.”
Onboarding as a journey:
Accompany the first 90 days, channel by channel, with reminders and a goal.
Privacy policy
“Am I even allowed to do this with social data?”
Purpose first:
You determine the attributes per list. Every delivery is recorded in the audit log.
IT & outsourcing
“Where is the data, and who sees it?”
Your own installation in Germany:
Single-tenant, hard visibility boundaries, roles and SSO.
Service centre
“The service centre has no time for yet another tool.”
Customer card instead of extra work:
See what an insured member has received. Tasks only when someone requests a callback.
The line to creepiness
What does the PBM Campaign Platform personalise for statutory health insurers – and what does it deliberately not?
Personalisation is based on occasion, life stage and journey behaviour – not medical history. A message should feel like good service, not like a look into a patient file.
| We use for relevance | We deliberately do not use |
|---|---|
| Membership: start, status, family insurance | Diagnoses, ICD codes, findings |
| Age and resulting entitlements (e.g. preventive care) | Medication, hospital and billing data |
| Events the insured member triggers themselves (application, registration) | Periods of incapacity for work, care level |
| Channel consents and objections | Pregnancy, before the insured member discloses it herself |
| Behaviour in the journey (landing page visited, appointment chosen) | Inferences such as “You haven’t seen a doctor for a long time” without consent |
The right-hand column is not a limitation of the software but our recommendation for your choice of attributes. The PBM Campaign Platform only processes attributes that you define and import per list. What is not imported cannot be personalised. Every message can carry a “Why am I receiving this message?” content block – as a global content block, written once, the same everywhere.
“For statutory health insurers, trust is the real currency. Relevance must never put it at risk.”
Fields
- [Membership fields]
- [Channel fields]
- Bonus variant
Field · Bonus variant · 3 variants
FamilyActive in preview
contact.familienversicherte_kinder > 0[Text of the “Family” variant]
Career starters
contact.alter < 27 DefaultDefault
default Preview as
Aylin Demir
[Preview start]
[Text of the “Family” variant]
Journeys from practice · Examples
Which journeys pay off first for statutory health insurers?
Four occasions on which insured members expect guidance. All names and values are examples.
Journey 1
LetterEmailLanding pageNew member onboarding: the first 90 days
- Trigger / occasion
Membership begins. The core system reports the enrolment via API; the journey starts on the same day.
- Segment
mitglied_seit <= 7 daysandstatus = aktiv(rolling: anyone who joins today starts today).- Channels & steps
- Day 0 – welcome letter from the service centre with a personal access code for the landing page “Your first 90 days”.
- Day 3 – email with the same content if email consent has been given.
- Wait for event: landing page login, 10 days.
- No login → one reminder (email, otherwise letter).
- Day 30 – invitation to the bonus programme, variant by life stage (family, career starters, 50 plus).
- Day 60 – note on family insurance as a general content block for everyone.
- Day 90 – exit “completed”.
- Fallback
Without email consent, the entire journey runs by letter. Consent can be given on the landing page; it is documented.
- Personalisation levers
Life stage from age and family status, sender (service centre or a named customer adviser), timing.
- Compliance specifics
Advertising for voluntary additional offers only with consent; keep pure service information separate.
- Goal
Micro – landing page login, email consent given · Macro – enrolment in the bonus programme.
- Metrics
Login rate per channel, share of consents given, bonus enrolments, exit reasons.
Journey 2
EmailLanding pageLetterSMSLife event birth: family insurance and the first year (example: Aylin Demir, 29)
- Trigger / occasion
Aylin Demir applies for family insurance for her newborn. Not the trigger: billing data from the pregnancy.
- Segment
ereignis = antrag_familienversicherung_kindin the last 7 days.- Channels & steps
- Within 3 days – confirmation and congratulations by email (consent given), with a link to the landing page “The first year with your child”.
- Landing page: status of the family insurance, overview of preventive check-ups for the child, family variant of the bonus programme.
- Wait 21 days; if no visit, one reminder by email.
- Month 6 – short reminder about upcoming child check-ups, only if Aylin Demir has not objected to the information.
- Fallback
Without email consent, letter; SMS only with SMS consent.
- Personalisation levers
Occasion, timing, family bonus variant, service centre as sender.
- Compliance specifics
If the family insurance ends unexpectedly, the contact leaves the segment at the next synchronisation. The journey stops – no congratulations reminder at the wrong time.
- Goal
Micro – landing page visited · Macro – family bonus programme activated.
- Metrics
Response time from application, activations, objection rate.
-
Entry
Event: application for child family insurance
-
Gate
Consent per channel
-
Channel branch
Email
Congratulations
Letter
Congratulations
-
Wait for event
LP visit (21 days)
- Sender
- Service centre Muster BKK
-
Yes
Goal · macro
Family bonus activated
No
Reminder
Reminder email
Exit
completed
Your personal overview
Data protection: no data is displayed without date of birth and code.
Ms Demir, your first year with your child
- Family insurance (completed)
- Preventive care for your child
- Family bonus programme
Journey 3
LetterEmailLanding pagePreventive care reminder with a bridge to the bonus programme (ongoing campaign)
- Trigger / occasion
Monthly: insured members reach an age from which they are entitled to an early detection screening.
- Segment
Age and entitlement – no data on previous doctor visits.
- Channels & steps
- Letter or email (depending on consent) with factual information on benefits and procedure.
- Landing page with checklist and an “Already done?” field as a voluntary self-report.
- Self-reported as done → exit “Goal achieved” and note on bonus points.
- Otherwise exactly one reminder after 8 weeks, then a re-entry block until the next entitlement.
- Fallback
Letter is the default channel for insured members without digital consent.
- Personalisation levers
Type of screening, age, timing, tone (factual rather than urgent – the AI tone check blocks “too urgent”).
- Compliance specifics
Organised early detection programmes under Section 25a SGB V are subject to their own requirements: invitation in text form, information on benefits and risks, notice of the right to object. Data on uptake only with consent. Mandatory texts as global content blocks.
- Goal
Micro – landing page visited · Macro – screening reported as done.
- Metrics
Self-reports “done”, reminder effect, objection and unsubscribe rates as an early warning signal of too much closeness.
Journey 4
LetterEmailLanding pageAdditional contribution rises: explain it transparently instead of waiting for a wave of cancellations
- Trigger / occasion
The administrative board decides on a higher additional contribution rate. Single campaign in good time before the month of the increase.
- Segment
Contribution-paying members, divided by member group (employed, self-paying, pensioners).
- Channels & steps
- Factual letter or email: the new rate, what it means for the respective member group, notice of the special right of termination and its deadline.
- Landing page “What changes for me?” with benefits and services by life stage.
- Option “Callback requested” → task for the service centre (the request is the consent to the conversation).
- After 4 weeks – bonus and service information only to members with marketing consent.
- Fallback
Letter for everyone without email consent.
- Personalisation levers
Member group, argument pool (service, bonus programme, family benefits), sender.
- Compliance specifics
Highest priority – other campaigns pause during this time. No rewards for not switching, no retention calls by phone without consent, no disparaging comparisons with other insurers (competition principles). The statutory notification obligation has been abolished (see S6) – the journey remains voluntary transparency.
- Goal
Micro – landing page visited, callback requested · Macro – member stays beyond the end of the special termination period.
- Metrics
Cancellations in the month of effect (visible as exit reason “Left segment”), callback requests, landing page visits per member group.
What sets the PBM Campaign Platform apart for statutory health insurers?
-
Your own installation in Germany.
Single-tenant: no data shared with other companies. Hosting in Germany by default.
-
Consent per channel before every send.
The compliance gate cannot be switched off. An objection stops everything immediately.
-
The letter is not an afterthought. It is a channel.
Personalised PDF per insured member, handed over to the lettershop via SFTP.
-
Relevance instead of volume.
Contact limits across all channels, quiet periods, prioritisation – service messages configurable as an exception.
-
The AI writes. You decide.
Tone check blocks before approval; approval under the four-eyes principle.
-
Everything traceable.
Audit log for every approval and every access; at the push of a button, the platform explains who may see a record.
Send preparation · Batch “Preventive care invitation October”18,240 contacts
- letter only permitted → fallback letter 11,112Why?
- Objection → stopped 96Why?
- Frequency limit reached → postponed 127Why?
This gate cannot be deactivated.
Regulation · As of: September 2026
Which rules apply to communication by statutory health insurers?
Statutory health insurers process social data. This is protected by social secrecy and strictly bound to its purpose. Private health insurers process health data under Art. 9 GDPR and are subject to professional secrecy.
- Social secrecy and purpose limitation: Social data must not be processed without authorisation (Section 35 SGB I), only for the tasks listed in Section 284(1) SGB V, and for other purposes only insofar as the Social Code permits (Section 284(3) SGB V).
- Individual care information: Section 68b SGB V permits information on individually suitable care services. Participation is voluntary, objection is possible at any time; this must be pointed out at the first contact.
- Bonus programmes: To verify bonus eligibility, insurers may process existing data only with written or electronic consent (Section 65a(1) SGB V).
- Advertising: Under the supervisory authorities’ Joint Competition Principles, advertising by email or SMS requires separate consent; so does telephone advertising, including win-back and retention calls.
- Additional contribution: The special right of termination exists until the end of the month for which the increase applies (Section 175(4) SGB V). Since the GKV-Beitragssatzstabilisierungsgesetz (in force 30 July 2026), the separate notification letter is no longer mandatory; a return of the obligation is under discussion.
- Data processing: Before commissioning, the statutory health insurer notifies its supervisory authority; processing must take place in Germany, in the EU or in an equivalent state (Section 80 SGB X).
- Private health insurance: Health data only with a legal basis, usually express consent (Art. 9 GDPR). Service providers must be bound to confidentiality (Section 203(3) and (4) StGB).
What the platform contributes: hosting in Germany · your own installation · consent check per channel · objection stops immediately · audit log · roles with hard visibility boundaries · DPA, TOMs and subcontractor list for your notification.
As of: September 2026. This overview does not replace legal advice.
Does this also work for private health insurers?
Yes. The journeys can be transferred: onboarding after the start of the contract, information on supplementary and optional tariffs by life stage, seasonal notes such as travel cover before the summer holidays. The rule remains: life stage, not medical history. For insurance topics such as premium adjustments, see also our page for insurers.
Where would you like to go next?
- Consent & compliance
- Hyper-personalisation
- Contact frequency management
- Multichannel: email, letter, landing page, SMS
- Use case: new customer onboarding
- Use case: churn prevention
- Playbook: [BLOG: Relevant, not creepy – member communication at statutory health insurers]
Frequently asked questions from statutory health insurers
May a statutory health insurer write to its insured members in a personalised way?
Yes, within limits. Social data may only be processed for the purposes permitted by law (Section 284 SGB V). Permitted, for example, is individual information on suitable care services under Section 68b SGB V – with a right to object. Under the supervisory authorities’ competition principles, advertising by email or SMS requires separate consent. As of September 2026; not a substitute for legal advice.
What data does the PBM Campaign Platform need for statutory health insurer journeys?
Less than many expect: membership data, age, channel consents, events such as an application for family insurance, and behaviour in the journey. Diagnoses or billing data are not needed. You define the attributes per list yourself – what you do not import, the platform cannot use.
How does the PBM Campaign Platform support the notification under Section 80 SGB X?
Section 80 SGB X requires the statutory health insurer to notify its supervisory authority of the data processing in good time before awarding the contract, and requires processing to take place in Germany, in the EU or in an equivalent state. The PBM Campaign Platform runs in Germany by default, as a separate installation per customer. We provide the DPA, TOMs and subcontractor list for the notification.
Does a statutory health insurer still have to inform members by letter when the additional contribution increases?
As things currently stand, it is no longer mandatory: the separate notification letter was abolished by the GKV-Beitragssatzstabilisierungsgesetz, in force since 30 July 2026. The special right of termination under Section 175(4) SGB V continues to apply. Reintroduction of the obligation is being discussed politically. As of September 2026; not a substitute for legal advice.
Is the PBM Campaign Platform also suitable for private health insurers?
Yes. For private health insurers, instead of social data protection, the main rules are Art. 9 GDPR for health data and professional secrecy under Section 203 StGB. The mechanics remain the same: consent per channel, approval before sending, audit log, your own installation with hosting in Germany.
How does the platform prevent insured members from being contacted too often?
With cross-channel contact frequency management: limits per insured member and period, minimum intervals, quiet periods and prioritisation of competing campaigns. The more important message wins, the other waits. An objection immediately stops all running journeys.