In-patient supplementary health insurance
The inpatient supplementary health insurance is one of the private supplementary health insurances and extends the insurance cover for persons with statutory health insurance (GKV). The conclusion of the inpatient supplementary health insurance is tied to requirements:
- The insurance can only be taken out for legally compulsorily insured persons or persons with voluntary statutory health insurance, whereby recipients of free medical care are equated with this group of persons and can also take out insurance.
- The state of health of the insured person must be sufficiently good at the time the contract is concluded.
Insurance-specific feature
As a rule, private supplementary health insurance cannot be taken out for people with private health insurance . Supplementary inpatient health insurance, on the other hand, is offered by some health insurances as a supplement to an existing private full health insurance , provided that this insurance only provides for the reimbursement of expenses for general hospital services in the case of inpatient treatment. This makes it possible to significantly improve insurance coverage in the inpatient area without having to change the actual main tariff. This variant is usually much cheaper.
Legal requirements
There are no special legal requirements for using the inpatient supplementary health insurance . The cost reimbursement principle required for outpatient residual cost insurance is not applied. The stationary cost items are automatically in standard benefits and optional benefits divided.
The basic idea of inpatient supplementary health insurance
Actual status
Compared to private patients, cash patients are subject to a number of regulations and restrictions that define the options for inpatient treatment (standard benefits).
These include, for example:
- no free choice of hospital. The treatment takes place i. d. Usually in the local hospital.
- Treatment by the doctor on duty.
- no accommodation in a single or double room.
- Billing according to the cash register fee schedule ( EBM ) and not according to the private fee schedule for doctors (GOÄ )
In particular, the significantly reduced doctor's fee, which is set as part of the EBM, is one of the decisive points for the colloquial "two-class medicine".
Potential for improvement
Statutory health insurance patients who take out in-patient supplementary health insurance will henceforth be granted optional private medical services . This includes the free choice of hospital as well as accommodation in a single or double room .
The most important feature, however, is the increase in the billing limits for doctors' fees . The inpatient supplementary health insurance implements a fee billing within the framework of the doctors' fee schedule (GOÄ) without the restrictions that the health insurance bill would entail (standard benefit). This means that the full medical fee can be claimed up to the maximum rates of the fee schedule and all other recognized and available treatment methods can be used. Complete, private medical treatment is now available to the patient himself. He enjoys all the advantages of a "real private patient" and can have his treatment carried out by the chief physician , selected specialists or specialists .
In special, medically necessary cases and after consultation with the private insurance company, medical costs above the maximum rates of the doctors' fee schedule are sometimes covered (fee agreement). The respective insurance conditions of the individual insurance providers regulate further details.
Tariff structure & insured benefits & replacement benefits
The scope of the insured benefits varies depending on the insurance tariff concluded. Details regulate the valid insurance conditions. Different calculation methods are used to design the tariffs .
Scope of benefits of an inpatient supplementary health insurance
Insured benefits (standard tariff)
- Free choice of hospital
- Accommodation in a twin room
- Billing according to the doctors' fee schedule (possibly only up to the maximum rate)
Insured benefits (premium tariff)
In the premium tariffs, the services of the standard tariffs are expanded as follows:
- Accommodation in a single room
- Billing according to doctors' fee schedule up to the maximum rate
- Billing of individual fee agreements
Compensation for non-use of the insured benefits
Under certain circumstances it may happen that the private medical optional services cannot be provided by the hospital or the patient willingly forego them. In this case, the policyholder i. d. Usually a so-called daily hospital replacement allowance. A fixed daily rate is defined depending on the type of insurance benefit not claimed. This definition can also be found in the valid insurance conditions.
Billing procedure
Way of bills
In addition to the electronic health card, owners of in-patient supplementary health insurance receive an additional health card (from the supplementary health insurance provider). Both insurance cards are shown or scanned in at the hospital.
The services are billed directly between the hospital and statutory health insurance (standard benefit) and between the hospital and private insurance provider (optional benefits). In turn, the payments are made directly to the hospital by the service providers. An advance payment on the part of the patient is not required.
Contribution calculation
The contributions to inpatient supplementary health insurance are calculated either according to the type of non-life insurance or the type of life insurance.
Type of damage insurance
With this form, the contribution is not based on the age of entry of the insured person. As a rule, age groups are defined (e.g. starting age from 30 to 45) for which a certain contribution rate is set. As long as the insurance customer is within the contribution group, the corresponding contribution applies to him. If the insured person exceeds an age group, the contribution for the next higher age group automatically applies.
advantages
- The contributions in the lower age groups are very cheap.
disadvantage
- This type of calculation provides for fixed contribution jumps.
- No aging provisions are made.
Type of life insurance
The calculations according to the type of life insurance include the exact entry age of the insured person and lead to an age-related contribution. This is not automatically adjusted over the years , but remains at the calculated amount. At the same time, aging provisions are accumulated.
Trustee Procedure
Regardless of the type of calculation, contributions can also be adjusted due to increased health costs. As part of the so-called trustee procedure, an insurance company can or must increase the contributions if the expenditure on insurance benefits exceeds the premium income within certain limits.
Individual evidence
- ↑ Examples of tariff-specific hospital replacement daily allowance. Retrieved May 3, 2016 .