Our guide explains what a good private health insurance plan covers in Germany. Whether you’re an expat or a local resident, discover the perks of choosing private health insurance in Germany.

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You decided to take out private health insurance after weighing the pros and cons of public and private health insurance. But before you get private insurance, you must know what good insurance in Germany should cover.

There are many private health insurance providers in Germany. And it makes it confusing which provider or insurance policy to choose.

Moreover, taking private health insurance is a lifelong decision. Thus, it becomes critical for you to understand the essential services your insurance policy should offer. 

In this guide, we’ll see what a good private health insurance policy in Germany covers.

Essential Services

1. Private health insurance plans should cover the doctors’ fees

German federal law regulates the doctors’ fees. The German government created the fee schedule for doctors (GOÄ) and dentists (GOZ).

They are called the following in German.

• Gebührenordnung für Ärzte (GOÄ)
• Gebührenordnung für Zahnärzte (GOZ) 

The fee schedule regulates the costs of private medical and dental services. A good private health insurance scheme reimburses the standard or the maximum GOÄ/GOZ rate.

The standard rate is 2.3 times the GOÄ/GOZ fee. The maximum rate is 3.5 times the GOÄ/GOZ fee.

We do not recommend private insurance plans that reimburse less than the standard rate.

Moreover, if you want to be treated by a specialist, private clinics, or abroad, your health insurance policy should reimburse more than the maximum rate.

2. Do you want to live abroad?

Your private health insurance should cover the medical treatment costs outside Germany if you want to live abroad. 

If your private insurance plan doesn’t cover the medical costs incurred abroad, you must pay them from your pocket.

Moreover, the treatment costs should not be limited to the country’s local rates. The reason is it’s hard to define what the standard treatment cost is in a country. And this leads to disputes with your private health insurance company.

Thus, if you want to live abroad, ensure your private insurance covers the medical bills outside Germany.

3. Freedom to select the doctor

You must go to the general practitioner (Hausartz) in Germany for the initial consultation. The general practitioner then decides whether a visit to a specialist is required.

You need a receipt (Überweisungsschein) from the Hausartz to visit a specialist in Germany. It is called the primary doctor principle (Primärarztprinzip). 

The primary doctor principle is valid for everyone insured under statutory health insurance. However, if you want the freedom to go to a specialist directly, you must ensure your private health insurance plan includes it.

The same goes for treatments by the head doctor in the hospital or treatments like physiotherapy or speech therapy. Your insurer will cover the costs of these treatments if it’s in the contract. 

4. Deductible and Reimbursement limits of your private health insurance plan

Check the deductible and reimbursement limits of your health insurance. A deductible is the amount you pay. The insurer covers the rest.

When searching for a private insurance policy, you can choose a deductible. The lower the deductible, the higher the insurance premium.

But a higher insurance premium is not an issue if you are employed. It’s because your employer pays half of the insurance premium.

Thus, you should consider taking an insurance policy with a lower deductible if you are employed.

5. Medicine cost: Does your private health insurance provider cover generic medicines only?

Check if your private health insurance company imposes any limitations on the type of medicine and costs.

Some health insurance schemes cover the costs of generic medicine only. In this case, you don’t get full reimbursement if you buy a non-generic medicine.

It seems like a minor thing. But it’s common for pharmacies only to have non-generic drugs.

So, ensure your private insurance plan covers all types of medicines to avoid surprises in the future.

6. What life support and physical aids do your private insurance cover?

Life support or physical aids are devices or services that make life better.

The aid could be a life support device such as a ventilator or a physical aid like prostheses, artificial eyes, and wheelchairs. The aid could also be an orthopedic aid such as glasses, walking aids, and guide dogs.

The aids can get expensive very quickly. Thus, check the following before signing the private insurance contract.

• What percent of the total aid costs does the insurer reimburse?
• Is there a maximum reimbursement limit? If yes, considering inflation and medical progress, is the limit high enough for 30 years?

You can also rent an aid in Germany. Thus, it’s fine if the insurer reimburses the cost of renting an aid.

You can find the list of aids your private health insurance plan covers in the aid catalog. There are two types of aid catalogs in Germany.

• Closed catalog: In the closed aid catalog, the aids your private insurance covers are fixed. So, you cannot add more aids in the future. Moreover, your health insurance company will not cover the costs of aids not listed in the catalog. You also miss out on medical progress and the latest treatments.
• Open catalog: In an open catalog, the insurer does not list the different types of aids individually. As a result, the costs of new innovative treatments in the future are also covered. 

A private health insurance scheme with an open catalog is preferable. However, open catalog contracts are more expensive.

Many private health insurance companies offer a catalog variant combining closed and open catalogs. The insurer lists some of the aids as they do in the closed catalog. But the insurer keeps open formulations in some places.

7. Dental benefits offered in your private health insurance plan

The private insurance conditions differentiate between dental treatment, dentures, and orthodontics. Sometimes, there are different rules and reimbursement levels for each area.

Look for the following things.

• What is the waiting period? It means how long you must wait till your insurance policy covers the dental costs. Your private health insurance company doesn’t pay your dental bills during the waiting period.
• What percentage of dental treatment costs are reimbursed by health insurers?
• Are the costs of high-quality material covered? 

You can also take supplementary dental insurance in Germany to fill the gaps.

8. Ensure psychotherapy coverage in your private health insurance matches that in public insurance

Private health insurance providers cover psychotherapy if it’s medically necessary. Moreover, health insurers limit the number of sessions insured.

• Statutory health insurance providers in Germany cover between 60 and 160 sessions. So, your private insurance should pay for at least 60 sessions.
• Check the restrictions your insurer puts on the psychotherapy treatment. The fewer the restrictions, the better it is.
• Your insurance plan must cover both specialists and qualified psychologists. The reason is that Germany has more psychologists than specialists. Thus, it’s easier to get an appointment with a psychologist. 

9. What type of therapies should private health insurance cover?

Back and joint pains are very common nowadays. It is thanks to the time we spend sitting on chairs. 

Physiotherapy can help a lot with such pains. Hence, your private insurance scheme must cover physiotherapy and other therapies.

A good private health insurance plan covers the following therapies in Germany.

• Physiotherapy
• Speech therapy
• Occupation therapy
• Podiatry (at least for diabetes)

Ensure that your insurance policy covers the costs of both doctors and therapists. 

10. Is Inpatient care part of your private insurance in Germany?

One of the benefits of private health insurance in Germany is access to private clinics and foreign hospitals. If you want this option, ensure the insurance policy doesn’t limit the reimbursement cost to the German regulations.

The following regulations are in place in Germany.

• Federal Nursing Rate Ordinance (Bundespflegesatzverordnung)
• Hospital Fees Act (Krankenhausentgeltgesetzes)
• Flat rate agreement (Fallpauschalenvereinbarung)

Many specialized clinics like heart centers or hospitals in health resorts offer both normal hospital treatment and rehabilitation. Such hospitals are called mixed institutions.

Private health insurance in Germany doesn’t pay for treatment in such hospitals by default. You must specifically insure inpatient treatments in mixed hospitals.

Moreover, some health insurance providers require you to report the hospital stay within a period. The health insurance benefits are reduced if you do not report within the deadline.

So, having a private insurance plan without a notification period is preferable.

11. What does the “health resort clause” mean in your private health insurance?

Private health insurance companies normally do not cover outpatient treatments in health resorts. The insurer covers the outpatient treatments in the following cases.

• Acute illness
• Accident
• You live in the health resort

A high-performance private health insurance tariff should waive the “health resort” clause.

12. Private insurance coverage outside Germany

Your private health insurance plan covers you in Germany and throughout the European Economic Area (EEA) (Switzerland is not covered).

But if you want to travel or stay in countries outside EEA long-term, you should check what your private health insurer covers.

Stays no longer than 1 month in countries outside the EEA are usually covered. But for longer stays, you have two options.

• Take a good international travel health insurance policy. 
• Take a private health insurance plan that covers long-term stays in countries outside the EEA.

Travel health insurance plans are cheap. Thus, decide what makes sense for you based on your situation.

13. Follow-up treatment/cure/rehab

Normally, statutory pension insurance or statutory accident insurance covers the costs of rehabilitation or follow-up treatment after a hospital stay. Employed people in Germany have statutory pension or accident insurance.

However, self-employed don’t have statutory pension or accident insurance by default. Thus, they should carefully check the “follow-up treatment” clause of the private health insurance plan.

14. Minimum palliative care/hospice services private health insurance should cover

There are times when a serious illness cannot be cured. Or patients don’t want to go through a certain type of treatment. Palliative and hospice services take care of the patient in such situations. 

Hospice services focus on reducing the patient’s pain during their final stages. 

Some private insurance tariffs limit palliative care services. However, the insurer should cover at least inpatient and day-care hospice services.

15. Transport costs covered by private health insurance in Germany

• The cost to transport you to the hospital in emergencies or after an accident should be covered by health insurance. It shouldn’t matter if you get an inpatient or outpatient treatment. 
• Ensure that the private health insurer reimburses all means of transport, for example, an emergency helicopter flight.
• Choose a health insurance plan that doesn’t have restrictions on the transport route.
• Like statutory health insurance, private insurance should also cover the transport costs of dialysis, radiation, and chemotherapy.

16. Daily sickness benefits in private health insurance Germany

Sickness benefit is the daily allowance the health insurance company pays when you are sick and cannot work anymore.

For employed people, the employer continues to pay the salary when you are sick until 6 weeks. After that, the statutory health insurance pays the sickness benefit.

Similarly, you must ensure the private health insurance provider pays the sickness benefit from the 43rd day.

Sickness benefit is more important for self-employed. It’s because sickness pay is usually the only way to recover temporary loss of earnings due to illness.

You can pick the daily sickness allowance and when it should be paid while choosing a private health insurance plan.

Benefits to think about

1. Preventive examinations and vaccination costs coverage by private insurance

Like statutory health insurance, most private insurance providers cover preventive examination costs like early cancer detection. However, the insurer covers the vaccination costs if mentioned in the contract.

The private health insurance plan should at least cover the vaccinations recommended by the Vaccination Commission of Germany (Ständigen Impfkommission (Stiko)).

2. Family coverage under private health insurance

Unlike public health insurance, private health insurance doesn’t cover your family for free. You must take a separate health insurance plan for your spouse and children.

You also pay a monthly premium in private health insurance during parental leave. In statutory health insurance, you don’t pay the premium during parental leave.

3. Single or shared hospital room

Of course, having your own room during the hospital stay is more comfortable. But it doesn’t mean better medical treatment. 

So, it’s great if your private insurance covers single-room costs. However, it should not be a deciding factor when picking private health insurance in Germany.

4. What visual aids does private health insurance cover?

Some private insurance plans reimburse the cost of glasses, contact lenses, or laser treatments (LASIK).

As glasses and contact lenses are inexpensive, they’re not a must in your health insurance coverage.

NOTE: The Federal Court of Justice ruled that LASIK for the correction of ametropia is a “medically necessary treatment due to illness” (BGH March 29, 2017 – IV ZR 533/15). Thus, the insurer must pay for LASIK if the wording “medically necessary treatment due to illness” is in the insurance contract.

You should look for the wording “medizinisch notwendige Heilbehandlung wegen Krankheit” in the insurance contract.

5. Don’t fall for private health insurers’ “premium refund” option

In a premium refund, you get part of your contributions back if you don’t submit invoices to the insurance company.

However, “premium refund” shouldn’t be the decisive factor when choosing private health insurance. It’s because of the following reasons.

• The refund is very low.
• You shouldn’t skip a doctor’s visit to get a refund.

6. Option to change your insurance plan in the future

We don’t recommend taking private health insurance with limited services. It’s because changing your health insurance plan later is tough.

Yes, some private health insurers provide the option to change your insurance plan without a health checkup. But the insurer limits the usage of this option. 

For example, you can change the health insurance plan on fixed dates, age limits, or triggers such as marriage or becoming a civil servant. If you miss the relevant time, the change option expires.

The change option makes sense if you plan to return to public health insurance. In this case, you can convert your private insurance into supplementary private insurance. And your accumulated retirement savings will not be lost.

7. Can I reduce the monthly health insurance premium in old age?

Private health insurance premiums don’t depend on your income. It depends on your age and health instead. 

Thus, the monthly premium increases as you get old.  So, to keep the insurance premium low after retirement, private insurers offer a contribution relief option.

In this option, you pay a fixed amount on top of your regular insurance premium. The private health insurer saves this amount for you. And when you retire, your monthly contribution is reduced by a previously guaranteed amount. 

However, you must continue to pay the contribution relief amount after retirement. Thus, the net reduction in the monthly premium is not much.

You should also calculate the net premium reduction before choosing the contribution relief option.

We recommend you invest your money in the stock market instead. This way, you have better returns, and your investment is not lost when you die or leave the private health insurance.

You can open a free depot account with Scalable Capital* or Finanzen.net Zero* and start investing.