What does state health insurance cover?
In short, pretty much everything except what it doesn't pay for 🙂
We help set up state medical insurance in one of Germany's best public cash desks.
What does state health insurance NOT pay for?
Some psychologist services
If you are undergoing treatment and plan to make adjustments, get a preliminary invoice from your doctor and send it to your insurance company to know for sure which treatment the insurance will cover and what amount you will have to pay yourselves.
Some tests and services during pregnancy, which are not compulsory, are not covered by insurance. For example, a photo of the baby on an ultrasound scan in the womb. First-trimester screening is also not paid for pregnant women.
Vaccinations that are not considered necessary.
Mostly these are cases where people are going on holiday, and they would like (without justified medical confirmation) to get one vaccination or another.
If an employee is going on a business trip, the required vaccinations are paid for by the employer.
Performing abortions, if there is no medical justification, they are not covered by insurance. An exception is rape resulting in the woman becoming pregnant.
Contraceptive medications are only covered by insurance up to the age of 20.
Only if a woman cannot get pregnant for health reasons and «has» to take contraceptives, will they be covered by insurance. Everything else must be paid for out of pocket.
Dental prosthetics
At present, insurance covers no more than 60% of the cost of basic treatments. These are the simplest crowns, bridges and removable dentures. If you want more, the insurance will still only cover 60% of the cost of basic treatments. In other words, you’ll have to pay the difference out of your own pocket. If you have a bonus booklet (see below), this percentage increases to 70% after 5 years and 75% after 10 years. The main thing is not to miss your appointments and to see your dentist at least once a year.
A Bonusheft is a bonus booklet in which the date of a dental check-up is recorded.
If the book is full, you will receive a new one. Keep the old one safe so that you can present it when needed.
Mandatory visits for the bonus booklet:
- For children aged twelve and over — one examination every calendar half-year.
- For adults, at least one examination per calendar year. This applies even if you wear a full denture.
When visiting the doctor, you get a stamp in your bonus booklet. Ask your doctor about the bonus booklet.
General anaesthesia in dentistry
Only in the case of medical necessity based on a doctor's report is the anaesthesia covered in full by insurance. In all other cases, you are charged for the treatment, but not the full anaesthesia. Basic anaesthesia (injections, usually lidocaine or similar)
How can you reduce dental costs? You will find more information in our article at link.
Medical certificates for certain establishments — for example, kindergartens, schools, sports clubs. You pay an average of 15 to 50 euros for such a certificate.
Glasses
Health insurance covers a certain amount towards the cost of children’s glasses. If the cost of your glasses exceeds the maximum amount covered, you will have to pay the remaining amount yourself. Adults pay 100% themselves.
Alternative treatments and natural remedies, if you decide to undergo treatment with an unregistered practitioner. Magnetic therapy, as well as almost all types of acupuncture, are not covered by insurance
Plastic surgery
Special professional teeth cleaning and specific fillings (photopolymer) are not covered by health insurance.
The exception is periodontal disease treatment. Your doctor will tell you.
However, for pregnant and nursing mothers, photopolymer is covered by insurance.
Doctor and hospital appointments
In emergencies you can travel to the hospital/doctor by taxi. In such a situation you need to get a receipt from the taxi driver and send it to the insurance company. It is possible that the expenses will be reimbursed, and it is also possible they won't, because in such cases you could have called a Krankenwagen (patient transport) on the number 19 222 (with the city prefix included) 0711 in Stuttgart). For long-term treatment (chemotherapy, radiotherapy, dialysis), you will be issued a taxi voucher for the duration of the treatment, which you can use to travel to your appointments. Upon discharge from hospital, you also receive a taxi voucher.
Top-up payment for the purchase of certain medicines
Medications on a pink prescription (marked gebührenfrei) are free of charge and fully covered by insurance.
You pay only an extra 5 to 10 euros for each medication (Zuzahlung). Medications without proven effectiveness (dietary supplements or self-prescribed vitamins) are not covered by insurance.
Inpatient treatment in a room of the best category
Initially, accommodation in a three-bed ward is included in the insurance. In some departments, only two-bed wards are available; in this case, this is also covered by the insurance, but if you want a single or two-bed room «just because», or because «the neighbours snore», or you want a two-by-two-metre television, you pay the difference out of your own pocket. Prices can be found out at the hospital. They are often listed on the clinics« websites, and you can decide in advance whether you want such a room. For a planned stay in some hospitals, you can »book" a room a couple of days before you are admitted to an inpatient ward.
Shortly after your discharge from hospital, you will receive a bill for your stay (Zuzahlung) — this is 10 euros per day, for a maximum of 28 days. This means that if you were in hospital for 6 weeks, you will only be billed for 28 days.
Insurance does not cover aesthetic services, lifestyle procedures and «I want this» treatments.
Lifestyle procedures include, for example, laser eye surgery, since vision can be perfectly corrected with lenses or glasses without any loss in quality of life, and laser correction merely changes your lifestyle. Also, if a doctor sees no necessity for carrying out, for example, an MRI, then insurance will not pay for it simply because you think it wouldn't hurt to have one done.
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With our recommendations, we want to help as many people as possible look after their finances. We fund our work through affiliate links. We mark these links with an asterisk (*).
