Versicherung2000
Pro con overview
The following list, divided into individual areas, shows you the main differences between private health insurance and statutory health insurance.
Scroll the page down to go directly to a specific comparison:
outpatient treatment
doctor choice
GKV: Only registered contract doctors with health insurance approval
PKV:free choice under everyone resident doctors.
naturopath
GKV : No benefits for naturopaths
PKV : Alternative practitioner services are usually also insured
co-payments
GKV :
- Doctor visits: EUR 10 per quarter
- Dental visits EUR 10 per quarter
- (other) specialist visits without referral: EUR 10
Exceptions to co-payments:
- The co-payment is limited to 2% (for the chronically ill to 1%) of the gross income
- No additional payment for children and young people under the age of 18.
PKV : full Reimbursement of all medically necessary medications and treatments.
visual aids
GKV : Restrictions on services from 2004
An example: Adults only receive statutory benefits for visual aids in exceptional cases. Children and young people up to the age of 18 are still entitled to glasses or contact lenses.
PKV : Spectacle lenses are also paid for in high quality (e.g. with super anti-reflective coating, with tinting, plastic lenses). Spectacle frames up to EUR 150.00. Contact lenses are almost always reimbursed.
hospital treatment
GKV
The doctor must take into account a hospital comparison list during admission. If another hospital is chosen, the additional costs could possibly be passed on to the patient in whole or in part. The deductible for hospitalization is:
EUR 10 additional payment per day for a maximum of 28 days per calendar year from the age of 18....
PKV
Free choice of hospital
Free choice of doctor, including senior consultant
Free choice of room size: single, double or multi-bed room
dentures
GKV
Statutory health insurance reimburses only 50% of the costs incurred for standard health insurance plans. (Up to 65% for regular check-ups)
Dental implants, functional diagnostic measures in connection with diseases of the temporomandibular joint and additional costs for dentures, which are more expensive than necessary, must be borne by the person with statutory health insurance.
Dentures from 2005:
Dentures must be insured separately - either with the statutory health insurance company or with a private health insurer. The insured person must pay the contribution for this alone. So far, the employer has contributed 50% to the contribution for dentures.
PKV
Depending on the insurer and tariff, up to 100% of the denture costs are insured. High-quality materials, eg gold and ceramics, functional diagnostic measures and dental implants
sick pay
GKVt
Sickness benefit (also for voluntarily insured members) is only 70% of the gross salary and may not exceed 90% of the net salary. A sickness benefit payment that is above the contribution assessment limit of EUR 4,050.00 is not permitted. The benefit period is limited to 78 weeks. Serious loss of income can result.
Sick pay from 2006:
From 2006, the GKV-insured must pay for the sick pay alone. So far, the employer has shared 50% of the sickness benefit contribution. The special contribution for sickness benefit will be 0.5% of the contributory earnings.
PKV
The net income can be insured without a time limit.