Page modified: Saturday, June 24, 2006 09:36:32
Contract design
The insurant can combine different tariffs depending upon his needs individually, in order to find for itself the best solution. With tariff works with module tariffs different ambulatory, dental and stationary tariffs can be agreed upon. With compact tariffs so mentioned ambulatory, dental and stationary achievements are agreed upon as firm insurance benefits, which cannot be arranged individual. Some tariffs contain a self participation. That is called the insurance occurs only then if the annual or monthly physician and medicine costs exceed the amount of self participation. Likewise achievement-kind-referred self participations (e.g. 10% of the medicine costs or 15% of the cure costs) are possible. For certain achievements also upper limits (e.g. eyeglasses to max 300" or orthopedic shoes to 200") can be agreed upon. But the insurance premium is lower or a part of the contributions is returned with these tariffs, if achievements were not taken up.
Who is once privately full-insured, by the legal health insurance companies only then again one takes up, if he again insurance requiring becomes, e.g. by unemployment, however only, if he is old still under 55 years and/or before less than 5 years in the PKV were. (SGB V "§ 6 exp. 3a)
Achievements
Even if the achievements of the PKV vary depending upon society and tariff, ith D becomes. R. some measures refunds, which are not only partially taken over at all of the GKV or. Decisive always is the medical necessity for a treatment and/or a medication.
Is insurable (depending upon tariff)
- In or two-bed room with stationary treatment
- Free choice of the hospital
- Treatment by the Chefarzt
- Artificial dentures (high-quality crowns, fillings and prostheses)
- Orthodontical treatments
- Sehhilfen (eyeglasses, contact contacts)
- Alternative working methods and medicines
- Additional payment-free Massagen and Physiotherapie
- Release from the additional payment with medicines
- Health insurance company comparisons
Beyond that privately Versicherte will profit partially from a preferential treatment, which is not on the one hand because of it that physicians for their achievements may compute higher sentences, on the other hand applies with private patients the restrictions by regulation regulations and budgets of the legal health insurance. Without the incomes from the treatment of privately insured one an economical enterprise of a practice is often hardly possible.
Differences between PKV and GKV
- Relatives of the members without own income are noncontributory coinsured in the GKV. With the PKV is due for each insured person a separate contribution.
- The contributions depend with the GKV proportionally on the pay (wages, content, commission"
) up to the contribution assessment limit. With the PKV the contribution is computed after the personal disease risk (age, sex, occupation, health status).
- Well earning unmarried ones receive into the PKV usually more favorable tariffs than in the GKV.
- Since the income from the treatment of private patients contributes crucially to the economy of a practice or a hospital, it occurs that private-insured with the established physician (e.g. separate consulting hours for private-insured) and in the hospital (e.g. single bed room) preferentially to be treated.
- Some achievements are not only partly paid of the GKV contrary to the PKV or (e.g. not prescription-requiring medicaments, Sehhilfen, artificial dentures).
- All insured ones have into the GKV the performance demand same with same status.
- The achievements of the GKV are specified in the social legislation and not by contract under private law (i.e. the policy can limit the achievements at any time and/or paint in addition, extend individual achievements completely or).
- With the GKV become available new aids by the acquisition of an aid number for the insured ones. Aids are usually in a closed Hilfsmittelkatolog fixed with the PKV. On an extension the Versicherte does not have a requirement.
- Complaints against a GKV take place before the social courts and are free.
- The GKV takes formerly to PKV Versicherte only if these are old under 55 years and sank their income under the contribution assessment limit.
- For PKV Versicherte can change with discontent only with substantial financial disadvantages to another PKV enterprise, because they became older, possibly in the meantime not taken into account had and their age reserve kept disease incidents.
- Can exert influence to PKV Versicherte on the height of their contribution by adjustment of their performance demands and by the height of a any Selbstbehalts. They have thereby at the progressive age the chance not to moderate their by current increases possibly any longer portable contribution loads by achievement renouncement.
See also: Health service, health insurance, private patient
Printer Friendly Format![Bookmark page - Private health insurance [2 / 2]](/site/templates/standard/images/icons/favourites.gif){kind=icon}
Bookmark this page
Back to "Insurance"
Back to top