Private health insurance (PKV)

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The private health insurance is the hedge with a privately organized insurance company. Persons for whom there is no compulsory insurance in the statutory health insurance can insure themselves privately. This is the case for workers whose monthly gross income for the year 2017 exceeds 4,800 euros or 57,600 euros per year. The self-employed, freelancers, civil servants and, under certain conditions, students can take out private insurance regardless of their income.

Full insurance, partial insurance and supplementary insurance

Family members must always be self-insured. In the case of private health insurance, a distinction is made between a full insurance, which covers the entire medical expenses, a partial insurance for the pro-rata coverage of the medical expenses and a supplementary insurance to the statutory health insurance to cover additional risks.

PKV: recording

In order to ensure that all persons who are not insurable in the statutory health insurance system are actually insured in the event of illness, private health insurers must offer so-called basic rates. Suppliers must include every applicant who is not insured by law - irrespective of their state of health.

The contribution rate is limited to the average maximum amount of the statutory health insurance. The range of services likewise corresponds approximately to that of the statutory health insurance. If the legislator reduces the services specified there, the basic tariff will be reduced accordingly.

For the standard rates, private insurers may accept or decline their members according to their admission conditions if the health status of a patient does not correspond to the conditions of the respective insurance. After admission, however, a termination is except for a few exceptions (pre-contractual violation of the advertisement or suspension of contributions) excluded.

PKV: contributions

While the contributions to the basic tariff are set by law, in private health insurance they depend solely on individual characteristics. Depending on age, gender and health status, the contribution varies for each insured person. The costs for the insurance are divided between the employee and the employer, whereby the employer has to pay a maximum of half the maximum contribution of the statutory health insurance. Depending on the insurance and tariff, there is also the possibility that up to six monthly contributions will be reimbursed annually if medical services are not used.

The insurance company reserves for old age so that benefit reductions can not be expected. Nevertheless, contributions can be increased to a certain extent.

Unlike legally insured persons, privately insured persons must first advance the costs of outpatient treatment and then pass on the bills to their health insurance in order to be reimbursed for the costs. Inpatient treatment is usually charged directly to the hospital.

PKV: benefits

The scope of service depends on the chosen tariff. While basic protection (PKV basic rate) is comparable to the benefits set out in the Social Security Code, top rates may include extras such as free choice of doctor and hospital, single or twin room, chief physician treatment or reimbursement of dentures.

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