Private vs statutory health insurance: who covers which benefits?

Both private and statutory health insurance often entice with a variety of offers and a wide range of benefits covered. However, if you take a look at the fine print, you will often find that certain benefits are subject to strict conditions. For insured persons, therefore, the question often arises: “Which insurance covers which benefits??” and it applies: private vs statutory health insurance. For whom which type of insurance is suitable, an overview of which benefits are covered as well as further advice on private supplementary dental insurance, has the practice Dr. Jurgen Pink | colleagues summarized for you.


Private vs statutory health insurance: who covers which benefits?


Private vs statutory health insurance: What is the difference??

Private health insurances usually cover a wide range of services and offers. They allow shorter waiting times for a specialist appointment or special treatments with the most modern medical techniques. However, these additional benefits are usually only covered by expensive tariffs.

Regardless of the amount paid in, all insured persons in the statutory health insurance, on the other hand, receive the same coverage of benefits. Since this is based on a solidarity system, additional services have to be covered by private supplementary insurances.

For whom is the statutory health insurance suitable?

Statutory health insurance covers every insured person who is entitled to it. The contribution to be paid is based solely on the income of the insured person. Regardless of salary level or type of employment, statutory health insurance covers the same range of benefits. Children as well as spouses without own income can be additionally co-insured free of charge. Students, self-employed persons and other voluntarily insured persons with low income pay a minimum contribution.

For whom is the statutory health insurance suitable?

Private insurance is only available to civil servants, self-employed persons, students and employees who are above the annual income threshold. However, since it is difficult to switch from private insurance to the solidarity system, a switch to private insurance should be carefully considered. Voluntary statutory health insurance is an alternative.

Private vs statutory health insurance: Who pays for which services??

It is difficult to make an exact comparison of the range of benefits in the question: “private vs statutory health insurance”. While there is usually a fixed benefits catalog per health insurance in the statutory health insurance, private insurers offer customers a variety of different tariffs.

This means that each insured person can choose the type and scope of his or her own benefits. Appropriate contract modules cover services such as treatment for comprehensive dentures, dental cleaning and high-quality fillings. Even in the case of private health insurance, complete coverage of all dental costs is only provided in the rarest of cases. Most tariffs provide for a cost coverage of about 50 to 80 percent; the remaining part must be paid by the patients themselves as a deductible.

Statutory health insurance also covers a wide range of services; insured persons are only entitled to those services that are necessary, sufficient and appropriate and the services must not be uneconomical. It follows that there is only a right to the respective cheapest material and the treatment must be carried out within a certain time frame, because otherwise it would become uneconomical. Caries removal, filling of holes, simple types of root canal treatment and other measures are covered, but with sufficient, appropriate materials and under a certain time pressure. Converted into school grades, this means about a 4. Periodontal treatment and annual tartar removal are also covered by statutory health insurance. Who decides for a treatment with higher-quality materials and/or wishes that the dentist takes the time, which he really needs to solve the problem in the long term and qualitatively high-quality or to supply must carry the appropriate difference themselves. Cosmetic treatments or dental prostheses are not usually covered by statutory health insurers.

There is the possibility of increasing the scope of benefits covered by statutory health insurances. This includes taking out supplementary insurance and keeping a bonus booklet. For example, anyone who has an individual prophylaxis carried out by a dentist can then have a stamp put in their bonus booklet from their health insurance company. A complete bonus booklet can mean a fixed cost subsidy of 75% from the health insurance company, which reduces the own contribution to treatments a little. Another possibility to increase the co-payment of treatments is the private supplementary dental insurance. These participate in costs that health insurance companies do not cover. Insured individuals can expect 70%-90% coverage here, depending on their insurance plan. However, supplementary insurance policies also vary widely and the differences and pitfalls can only be identified in the fine print.

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