State health insurance in Germany what is deductible – from A to L

Last Updated on June 25, 2022

95 percent of state health insurance services in Germany are defined by law, so all Krankenkassen are the same. These will be all services related to deteriorating health – visits to doctors, necessary surgeries and examinations.

There is no complete list of paid services.

For example, the right to free treatment services for unnecessary interventions is limited – if you get sick as a result of a tattoo or an operation to improve your appearance.

The Krankenkasse can pay voluntarily for a specific service, or it can offer a choice of several additional services that are paid from the general account – Gesundheitskonto (for example, 200 euros per year for glasses, additional examinations during pregnancy and other services).

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Please note that Krankenkassen that have a wide range of additional services also usually have a large individual percentage.

For example, if all Krankenkassen (KK) have an average of 15.7-15.8%, then these KK have 16.1%. If you have a high salary, then you pay for additional services, in fact, at your own expense with these percentages. Therefore, the choice of such KK will be beneficial if the payment for additional services is not limited to a couple of hundred per year and at the same time you really need these services.

What is IGeL

Prophylactic ultrasounds and other examinations that are not associated with specific symptoms are called IGeLindividuelle Gesundheitsleistungen.

The advisability of some IGeLs is estimated by consumer organizations. For example, you can read about a particular procedure on IGel Monitor

Such services have a base cost that can be indexed by a doctor up to 3.5 times.

The difference between IGeL services and standard services is that these services do not need to be as well tested as those included in the catalog. That is, some procedures may be offered, whose effectiveness has not been proven.

All I (not) get paid, from A to L

Navigation:
Acupuncture
Ambulance
Balneo-phototherapy
Bonuses for children
Cancer prevention
Dental control
Dentist – brackets
Dentist – crowns and implants
Dentist – treatment
Glasses
Helicopter, ambulance plane
Homeopathy
Home visit
Hospice
Hospital
Household help
Laparoscopy

Acupuncture

The cost of acupuncture is compensated by the KK in cases of back pain and arthrosis for more than 1 year, provided that the doctor is recognized by the KK. The KK can also pay for acupuncture for knee pain, pregnancy or allergies.

Ambulance

– see Medical transport

Balneo-phototherapy

This therapy, which combines bathing in saline solution and irradiation with light, is paid for by the psoriasis fund.

Bonuses for children

Some Krankenkassen pay for Babyschwimmen (swimming courses for babys), massage, PEKiP (parents-babys groups) and other similar courses. Support can also be provided in the form of a cash bonus if during the first year of life all examinations have been completed and all routine vaccinations have been made. Usually, you should subscribe to bonus programs at the beginning, not retroactively.

Cancer – prevention

see Preventive examinations for adults

Dentist – control

Krankenkassen pay for dental check-ups 2 times a year.

Dentist – brackets

The Krankenkassen pay for problems starting with moderate severity (Fehlstellungen Schweregrad 3, 4, 5). The first two are considered a cosmetic defect and are not covered. Brackets pay up to age 18.

Parents pay 20 percent themselves. If the second child also wears braces, then the proportion is reduced to 10 percent. Upon successful completion of the treatment, this part is also compensated.

To get back the amount paid, you must keep all receipts from the orthopedist and ensure that the braces are worn correctly.

If internal brackets are placed that are not visible from the outside, the difference with ordinary parents is paid by themselves, since this is a purely cosmetic effect.

Dentist – crowns and implants

KK pay 50 percent of the standard treatment. That is, if crowns are usually made in this standart situation, the KK will pay half the cost of the crown. If a bridge is made, then half the cost of the bridge, even if the patient opted for an implant. The share of the KK increases by 20 percent if the patient has regularly visited a doctor for at least 5 years. And if he visited a doctor annually for 10 years, then by 30 percent!

Beneficiaries can expect to receive full reimbursement of standard care.

You can deducte the cost of dentist in tax return.

Dentist – treatment

For posterior teeth, the Krankenkassen will compensate the cost of amalgam fillings, for anterior teeth – composite. It is forbidden to put amalgam on children under 15 years of age and pregnant women, therefore, composite materials for posterior teeth are also reimbursed.

Glasses

The cost of glasses is compensated by KK for children under 18 years old and visually impaired from 6,25 diopters. The frame you pay independently. Also, additional facilities (special glasses for summer or PC) are paid for independently – the KK pays only the base cost.

But you can deducte the cost of glasses for work. Read more about here.

Helicopter, ambulance plane

– see Medical transport

Homeopathy

Some KK pay 100-400 euros for homeopathy or natural medicines. Usually it is necessary that homeopathy is prescribed by a doctor from the list of doctors approved by KK.

List of KK and the amounts they pay.

Home visit

Home visits are the responsibility of the therapist if you have entered into a contract with him – and for this it is enough to visit him at least once. On the other hand, it is the doctor who determines whether you ill enough for home visit.

Most doctors try to reduce the number of home visits, as they are poorly paid and too many home visits can lead to fines from the Krankenkasse.

There is a chance for a home visit at a very high temperature (for adults, we carry children ourselves), limited mobility (usually disability or rehabilitation. Summer tires in winter are not a limitation of mobility), symptoms of a heart attack in the elderly (lack of air, etc.).

Hospice

The state pays a certain amount for each day of stay in the hospice (about 150 euros). Some Krankenkassen pay more (for example, up to 250 euros).

Hospital

You pay 10 euros per day, but not more than 280 euros per year.

The patient can choose the hospital, but the health insurance is not obliged to pay additional costs if they arise due to the fact that the hospital is far away.

Facilities such as a separate room are paid for independently. You can take out additional insurance for them.

Rooming-in – see Staying with a child in the hospital.

Household help (Haushaltshilfe)

Home assistance is paid for sick parents with small children or if there is a family member in need of care. The point is that if the person running the household is sick, then there must be someone who takes care of the house and the children. Help from other relatives is not paid, but if the partner of the sick person is forced to leave work for a while, the loss of earnings is partially compensated.

In any case, you need to ask what and how KK pays, especially if there are several children and the mother is sick, because different KK pay in different amounts and different diseases are considered serious. For example, I know the option of helping with an older child in a family with three children, two of whom are newborn twins.


Do you have any more questions? Use comments ⇓ or private communication form

Laparoscopy

Operations through micro-incisions (minimal-invasiver Chirurgie) are often paid for by the KK, but you need to ask the doctor every time if there is such an opportunity and agree it with the KK.

Next – part 2 M-Y
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