Policyholders with old, lifetime health plans are emerging from court with significant victories and compensation after facing steep, opaque premium increases imposed by insurers.
Two recent and particularly significant rulings by the Three-Member Athens Court of Appeal, reported by Euro2day.gr, confirm the direction of case law in favour of policyholders. The courts have recognised as unfair and void the general terms and conditions (GTCs) that allow the cost of hospital insurance policies to be adjusted opaquely.
As well as awarding policyholders compensation for the premium “overcharges” they wrongly paid, both rulings are notable for the court’s use of the Health index in ELSTAT’s General Consumer Price Index as a benchmark for calculating the unfair charges. The index has recorded modest annual increases, and even declines in some years.
The court also rejected the use of the IOBE index, as proposed by an insurer.
The ELSTAT index and age
Lawyers say the basis for calculating future premium increases has now been settled: calculations will use ELSTAT’s new index, provided for by Law 5170/2025. In its first publication so far, it showed small overall increases, though these rise considerably when the age factor is added.
In any event, policyholders with old contracts have the right to challenge increases they have paid in the past and seek compensation through the courts.
On another major point of friction between policyholders and insurers — age-related increases — the two rulings share the view that age-based adjustments are in principle legitimate, but only when they are based on clear, predetermined tables known in advance.
Such adjustments become unfair when combined with a single, indivisible premium for several people covered by a family policy, or when used as a pretext for unilateral increases beyond those expressly and quantifiably set out in the contract.
The court’s ruling on increases to the excess — the amount policyholders pay themselves towards their hospital care — is also particularly significant. Several insurers imposed these increases alongside premium rises, leaving policyholders paying more and more for less and less cover.
Opaque premium adjustments
The first case, which led to ruling 4478/2026 by the 13th Division (Ordinary Procedure) of the Three-Member Athens Court of Appeal, concerns two insurance policies taken out in May 1994, covering a policyholder and his wife. The policyholders were represented by lawyer Dimitris Spyrakos, a former secretary-general for consumer affairs and rapporteur on the Katseli law.
The policies initially set annual net premiums at 181,250 drachmas. In the appendix “Full Hospital Care – Hospitalisation Card”, Article 6 set out the mechanisms for increasing premiums. The clause had two parts:
- Article 6.a, which provided for premiums to be adjusted according to age bands, with specific tables and percentages included in the policy.
- Article 6.b, which gave the insurer the right to make general changes to premiums on any renewal date.
Seeking to pre-empt possible legal problems following a relevant ministerial decision in 2008, the insurer sent policyholders a letter attempting to “specify” the criteria in Article 6.b. It said adjustments would depend on the cost of hospital care, the ratio of claims paid to premiums collected, and statistical data. It set an annual “cap” of 7.5%, unless the consumer price index was higher.
Although the policyholder paid the amounts without complaint for several years, he eventually challenged them in 2014 after seeing the increases spiral, reaching annual rates of 26.15% and later 39.14%.
A clause ruled void
The Athens Court of Appeal ruled that the insurer’s attempt to specify the criteria in a letter did not remedy the invalidity of clause 6.b. The criteria, including the ratio of claims to premiums across the insurer’s portfolio and its “experience”, were vague and unclear.
The insurer effectively retained absolute discretion to raise premiums, leaving consumers unprotected against unilateral decisions, in breach of the principle of transparency and the provisions of Law 2251/1994 on consumer protection (Article 2, paragraphs 6 and 7).
The ruling also noted that, for using these opaque terms, the General Secretariat for Consumer Affairs had fined the insurer €200,000 in 2024. The fine was upheld with final effect by the Athens Administrative Court of Appeal.
Unlike clause 6.b, which was struck down as unfair, the court did not declare void clause 6.a, which provided for age-based adjustments. It ruled that the age bands were accompanied by specific tables, known in advance and clearly defined.
This makes age-based adjustments legitimate because they meet the test of predictability, provided they are not mixed with opaque premiums and unclear general expenses.
Calculations and compensation
To calculate the premiums actually payable, after removing the unlawful increases under clause 6.b, the court turned to the “Health” sub-index of ELSTAT’s General Consumer Price Index, using a supplementary interpretation of the contract based on good faith.
The Court of Appeal made a particularly significant legal observation, noting that the need to make the method of adjustment objective is confirmed by the passage of Law 5170/2025 (Article 25).
The new law introduces an Annual Adjustment Index published by ELSTAT to replace the vague terms used in the past, providing a fair framework. The court’s decision to use ELSTAT data and reject any other opaque index is therefore fully in line with the legislature’s intent.
After removing the unfair increases and applying the ELSTAT index, the court calculated the precise amounts that should have been paid for the policy years 2012 to 2024. The difference was substantial:
- For the claimant’s policy, the insurer was found to have collected €12,125.63 more than was legally due, including VAT.
- For his wife’s policy, the insurer had unlawfully retained €9,586.48.
In total, the insurer was ordered to repay the policyholder €21,712.11 as unjust enrichment, with interest from the date the claim was served.
Non-pecuniary harm and the excess
The second ruling, issued by the 14th Civil Division of the Three-Member Athens Court of Appeal, concerns a life insurance contract with supplementary cover for hospital expenses, taken out in February 2011.
The policy was for life and initially provided for a semi-annual premium of €311.36, made up of a fixed amount for basic life cover and an adjustable amount for hospital expenses.
The issue, however, lay in the general terms and conditions in Appendix D, specifically Article 10, which gave the insurer the right to adjust unilaterally both the premium and the excess payable per hospitalisation.
Article 10 was divided into two paragraphs. The first concerned age-based adjustments, which the court said suffered from a serious lack of transparency. A single premium was set for the main policyholder and their dependants (their children), with no clear breakdown of the amount attributable to each person.
It was therefore practically impossible to apply the percentage adjustment in the age table transparently and in a way that could be checked, since the consumer did not know what part of the premium was increasing because of their own age and what part because of their children’s ages.
The second paragraph of Article 10 listed six criteria under which the insurer reserved the right to make an additional premium adjustment on the basis of a “fair assessment”. These included factors such as:
- Changes in the cost of hospital care (room rates, diagnostic tests, medicines and so on).
- Changes in the cost of scientific methods of diagnosis and treatment.
- Changes in actuarial assumptions based on statistical data and the experience of the insurer or international organisations.
IOBE index rejected
The Court of Appeal ruled that these terms were manifestly unfair and absolutely void under Law 2251/1994 on consumer protection. The criteria were considered vague, general and dependent solely on the insurer’s unilateral assessments.
As the ruling notes, the principle of transparency requires a general term to be worded clearly, so that policyholders can determine in advance the conditions under which, and the extent to which, they will face additional costs. By contrast, this term left the premium indeterminate, allowing the insurer to set it as it saw fit and seriously disrupting the balance of contractual rights.
After striking down Article 10, the court had to fill the resulting legal “gap” in the contract concerning the basis for calculating increases. It did so through a supplementary interpretation of the contract (Article 200 of the Civil Code), seeking the arrangement the parties would have agreed on in line with good faith and commercial practice. The insurer proposed using the single health index set in December 2020 by the Foundation for Economic and Industrial Research (IOBE).
The court, however, categorically rejected the IOBE index. According to its reasoning, good faith requires the use of a predictable and objectively verifiable criterion that has already been disclosed to the consumer, enabling them to anticipate the cost of the contract.
The IOBE index, as a later tool introduced in 2020, did not exist when the disputed earlier adjustments were made and had not been officially approved by Presidential Decree 13/2022, so it could not be applied retrospectively.
Instead, the court ruled that the parties’ actual intention would have been to use the “Health” sub-index of ELSTAT’s General Consumer Price Index. It found this to be the most suitable, accessible and objective tool for the period in dispute.
Based on the movement of this index, which was negative in several years — including -2.85% in 2014 and -2.18% in 2018 — the court calculated the premium that should have been paid from the 2011-2012 policy year through to 2024-2025.
Excess frozen and compensation awarded
The difference was substantial. The policyholder had been required to pay a total of €9,721.80, whereas the amount due under the lawful calculation, based on the ELSTAT index, was €7,526.95. The difference in net premiums was therefore €2,194.85.
The court added the 10% insurance premium tax (€219.48) that had been withheld, ordering the insurer to repay a total of €2,414.33 as unjust enrichment.
Equally significant was the court’s decision to strike down the clause allowing the excess to be adjusted unilaterally. The Court of Appeal ruled that continual increases in the excess undermine the substance of insurance cover, creating the paradox of policyholders paying ever higher premiums for less cover as the initial costs they must pay themselves keep rising.
The court rejected increases to the excess, ruling that the premium increases were sufficient for the insurer, and froze the excess at its original level of €3,857. This does not affect the calculation of the compensation due to the policyholder, but is of particular importance for the future: in the event of hospitalisation, the excess — the amount the policyholder pays out of pocket — will remain fixed at the level originally set.
Finally, the court made a significant finding against the insurer: its conduct in knowingly applying a void and unfair general term and condition constituted a tort. It therefore awarded a further €500 in compensation for the non-pecuniary harm suffered by the consumer.