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 take out private insurance. This is the case for workers whose monthly gross income for the year 2017 exceeds 4, 800 euros or 57, 600 euros per year. 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 covering the entire medical expenses, a partial insurance for the pro-rata coverage of medical expenses and a supplementary insurance to the statutory health insurance to cover additional risks.
In order to ensure that all persons who are not insurable in the statutory health insurance are insured in the event of illness, private health insurers must offer so-called basic rates. Suppliers must include every applicant who is not legally insured - irrespective of his state of health - in this basic tariff.
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 legislature reduces the services specified there, the basic tariff will be reduced accordingly.
For the standard rates, private insurers may accept or refuse their members according to their admission conditions if the health status of a patient does not meet the conditions of the respective insurance. However, after admission, termination is excluded except for a few exceptions (pre-contractual violation of the advertisement or suspension of contributions).
While the contributions to the basic tariff are set by law, private health insurance alone depends 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 must 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 refunded 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 forward the bills to their health insurance in order to be reimbursed for the costs. Inpatient treatment is usually charged directly to the hospital.
The scope of service depends on the chosen tariff. While the Basic Protection (PKV Basic Rate) is comparable to the benefits set out in the Social Security Code, the top fares can include extras such as free choice of doctor and hospital, single or twin room, chief physician treatment or reimbursement of dentures.