The model: You remain a member of your statutory health insurance and additionally take out supplementary health insurance that raises your benefit entitlements to a private level.
As in the case of private comprehensive insurance, you can adapt the supplementary health insurance to your personal needs by choosing an individual tariff. With such a policy, for example, you can fully cushion the co-payments for medication and treatment costs.
With the current cuts in statutory health insurance, the gap between statutory and private patients is widening. Not everyone can switch to private health insurance - but with private supplementary cover in addition to your statutory health insurance, you can close important gaps.
Private supplementary health insurance covers costs that are not or not fully covered by statutory health insurance - e.g. for high-quality dentures, glasses and contact lenses, naturopathic treatments, for preferential treatment in hospital and for medical services abroad.
Whether outpatient, inpatient or dental treatment - which benefits you should additionally cover privately depends on your personal requirements. Take your time to compare - because often the offer made by your health insurance fund is more expensive than the tariff of a private health insurer with the same benefits.
You can choose individually which benefits are important to you. A variety of options are available - with so-called inpatient tariffs, for example, you can insure treatment by a chief physician in hospital, accommodation in a single or double room or the co-payment for spa and hospital stays.
A daily hospital allowance or daily sickness allowance in the event of incapacity for work can also be agreed. The costs for alternative treatments such as acupuncture or homeopathy, for co-payments for medication or for medical aids such as hearing aids can be covered by outpatient tariffs.
In view of the cuts in benefits by the statutory health insurance funds, it also makes sense to cover dental prostheses and visual aids. Supplementary long-term care insurance offers financial protection in the event of long-term care.
Private travel health insurance pays the full costs of treatment abroad and, in an emergency, the expensive transport back home. Depending on the tariff you choose, you can combine all these benefits according to your personal needs.
Alternative insurance options
Those who are compulsorily insured under the statutory health insurance scheme can secure additional benefits for relatively low monthly premiums. For others, private health insurance is the cheaper alternative.
Statutory + supplementary tariff or private full insurance?
This page gives you an overview of the benefits of statutory health insurance, private health insurance and supplementary health insurance.
Statutory health insurance | Supplementary health insurance | Private health insurance | |
---|---|---|---|
In hospital (inpatient) | |||
Hospital selection | Nearest suitable hospital, no private clinics | Depending on the tariff, free choice of clinic. Recommendation: Coordinate with the company beforehand | Free choice, also private clinics. Spa clinics with the consent of the company. Recommendation: Coordinate with the company beforehand. |
Hospital accommodation | Multi-bed room, insured person pays excess | Single or double room insurable without excess | Single or double room insurable without excess |
Attending doctor | Doctor on duty | Depending on the tariff, doctor of own choice (head physician) | Depending on the tariff, doctor of own choice (head physician |
Medical fees for hospital treatments | Physician fees included in the SHI flat rates per case | Depending on the tariff, higher reimbursement than in the SHI system | Depending on the tariff, up to the maximum rate of the private medical fee schedule (GOÄ) |
Services provided by registered doctors | |||
Selection of the doctor | Restricted to panel doctors | Free choice of doctor insurable | Free choice of doctor, unless a general practitioner model has been agreed upon |
Fees for services provided by registered doctors | Essentially reimbursement of flat rates for insured persons | Depending on the tariff, more extensive than GKV, e.g. co-payments and practice fee insurable | Depending on the tariff, significantly higher cost coverage than GKV, reimbursement according to private physician fee schedule (GOÄ) |
Aids (e.g. glasses, hearing aids, prostheses, etc.) | Aids only in simple version, co-payment required. Cost absorption for visual aids only up to the age of 18. | Cover for glasses, contact lenses, hearing aids, etc. up to 100% possible | Cover for glasses, contact lenses, hearing aids, etc. up to 100% possible |
Precaution examinations | Limited preventive examinations, e.g. early cancer detection from 20 for women, from 35 for men | Depending on the tariff, significantly higher scope of benefits than SHI (e.g. tumour markers, ultrasound) | Depending on the tariff, significantly higher scope of benefits than SHI (e.g. tumour markers, ultrasound) |
Psychotherapy | After prior approval by GKV | Depending on the tariff, reimbursement up to 100 | Depending on the tariff, reimbursement up to 100 |
alternative practitioner services | No alternative practitioner services | Treatment by non-medical practitioners is insurable | Treatment by non-medical practitioners is insurable |
Dental services | |||
Tooth treatment | 100% for approved services only | Depending on the tariff, up to 100% for services not reimbursed by the GKV | Depending on the tariff, up to 100% for all benefits |
Dentures | 50 to 65% of the cheapest standard care | Depending on the tariff, up to 100% also for modern and aesthetically high-quality dentures | Depending on the tariff, up to 100% also for modern and aesthetically high-quality dentures |
Dentist fees | According to the valuation standard for dental services (BEMA) | Co-payment of the co-payment of the doctor's bill depending on the tariff up to 100%. | Depending on the tariff, up to the maximum rate of the private medical fee schedule (GOZ) |
The gaps in the range of services provided by statutory health insurance funds are becoming ever larger. In principle, everyone with statutory health insurance can bring their coverage up to the private level by taking out good supplementary cover - regardless of whether they are an employee, worker, self-employed, housewife, voluntary member or compulsory member of a statutory health insurance fund.
If you already have a private comprehensive health insurance policy, the best way to secure extra benefits is to switch to a higher-performance tariff with your private health insurer. Whether and to what extent additional coverage is necessary depends on your individual needs and requirements.
Private supplementary health insurance makes sense for everyone who wants to secure first-class medical services and reduce their financial burden in the event of illness.
The premiums in supplementary health insurance are calculated on the basis of entry age and state of health when the contract is concluded.
So the earlier you take out supplementary private health insurance, the cheaper the premium will be.
Insurers assess health status
However, private health insurers will find out about your state of health before you take out supplementary health insurance. When you apply, you will be asked questions about illnesses in recent years, accidents, hospital stays or dental treatment.
For serious illnesses or illnesses that have not yet been cured, insurers often charge a premium surcharge or exclude individual illnesses from insurance cover. Not every company assesses the risks in the same way - a comparison is definitely worthwhile.
Contributions tax-deductible
Incidentally, expenses for private supplementary health insurance can be claimed against tax: Daily hospital allowance and sickness benefit are considered to be pension expenses and can be deducted as special expenses within limits. The same applies to contributions to supplementary long-term care insurance.
The co-payment of those with statutory health insurance for dental treatment and dentures increases with every new health reform.
The statutory health insurance funds only pay a fixed allowance based on the findings - regardless of whether you opt for the minimum care or want a dental prosthesis that also meets aesthetic requirements.
With private supplementary dental insurance, you can close the gap between the actual costs of dental prostheses and the reimbursement by the statutory health insurance - either proportionally or completely. Depending on the tariff, implants, ceramic inlays and veneers are reimbursed, and costs for tooth and jaw adjustment (braces) can also be fully covered. However, supplementary dental tariffs are not insurable on their own with some providers, but only in combination with basic inpatient or outpatient tariffs.
Current treatments are not covered
Before taking out a supplementary dental plan, the insurer usually requires an examination by the treating dentist, and a premium surcharge is usually levied for missing teeth. Dental prosthesis measures that have already been initiated are excluded from benefits by all providers. In addition, insurers usually only reimburse after a waiting period of 8 months.