Medical reimbursement in Germany

Although there are some similarities between the public and private health insurance systems, how they reimburse medical expenses is a key difference.

The public health insurance system (GKV)

Reimbursement is straightforward for people with public health insurance because their doctor will bill their health insurance provider (Krankenkasse) directly. People with public health insurance do not have to pay when visiting their doctor – but they do have to make small co-payments for certain healthcare services, including:

  • €5-10 per prescription
  • €10 per day in hospital
  • €5-10 per day of nursing care

The public system also tends to cover fewer treatments and services as standard. For example, people with public health insurance often take out additional private insurance policies (Zusatzversicherungen) to cover dental care, vaccinations and homeopathy.

The private health insurance system (PKV)

In the private system, you pay your doctor directly for their services. Don’t panic! If you choose a reliable and efficient Krankenkasse, you can have eligible expenses reimbursed before the bill is due. Just be sure to check with your provider that a treatment is eligible before you go ahead – otherwise, they may not cover the cost.

Private insurance providers usually cover more treatments and services than public providers, sometimes including non-prescription medications, private hospital rooms, and even IVF. Private insurance premiums are also less expensive than in many countries, and your employer will still contribute up to half the cost.

However, if a deal seems too good to be true, it probably is – it might involve painfully high co-payments or drastic premium increases. Super-cheap premiums are a red flag!

What makes ottonova special?

ottonova is Germany’s first fully digital private health insurance provider. This means you can manage your healthcare at your convenience using the ottonova app. Once we have approved a treatment, you can ask your doctor to proceed. When they issue their bill, simply use the document upload function in the ottonova app – and we’ll start processing it straight away!

FAQ

Is the tariff tax deductible?

You can claim a part of the costs for private health insurance as ‘Vorsorgeaufwendungen’ expenses in your tax return, this is what the Citizen Relief Act (Bürgerentlastungsgesetz) has been saying since 2010, namely the part that is considered basic coverage. We certify how high this portion is each year and you do not have to calculate it yourself. The basic share corresponds to the benefits of the public health insurance.

How does the daily sickness allowance work?

The daily sickness allowance is an important insurance. When you get ill for a prolonged time and you cannot work, you normally lose your income. A daily sickness allowance insurance can help balance out this loss of income. The quantity of the daily sickness allowance is based on your net income and complements the additional money provided by the social security system.

As an employee, you are always guaranteed a wage continuation up to the 43rd day you’re ill with one illness. For this reason, it is practical to plan for your daily sickness allowance to start from the 43rd day.

For freelancers and self-employed professionals, the public wage continuation doesn’t apply – so therefore it’s even more advisable to plan for an insurance against the loss of potential income after the 43rd day.

Do you pay me back money if I don´t make usage of the insurance?

At the moment we do not offer any money back if you don´t make usage of the insurance, as we want you to go and have your annual check-ups. However, we offer reward points via our Health X program.

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