Cost of Healthcare services covered by the Basic Health Insurance policy are fully reimbursed with the following exceptions:
- For some medication and medical aids, you will have to pay a personal contribution.
- For most costs a deductible (excess) applies. This excess is called Eigen Risico (literally ‘own risk’).
You will need to pay Healthcare costs to the maximum of the annual excess yourself. In case the Healthcare Provider is reimbursed directly by your health insurer, you will be charged by the insurer retroactively for these costs, to the annual maximum of your excess.
This excess does not apply to the cost of:
- Consultations at your GP’s office.
- Natal and Maternity care, although some personal contributions apply.
- All care for children younger than 18 years, including the Dental Care Package.
The mandatory minimum excess is 385 € / year (2021 and 2022). You will never incur costs higher than this for health care covered by the Basic Health Insurance than the amount of excess, except for personal contributions.
You have the option to increase your mandatory excess with a voluntary excess in steps to a maximum of 885 € per year. Your monthly premium will then be lower. Check, however, if it is wise to do so.
Example
- You have only basic health insurance and your excess is 385 €
- You incur the cost of GP annual registration and 2 consultations = 90 € (approx.): These costs are fully covered and not subject to excess
- You incur cost of consultation with a medical specialist and diagnostic tests: 350 €: these costs are covered but subject to excess
- You incur the cost of care received during pregnancy and giving birth. You opted for a hospital delivery. These costs are not subject to excess, but you have to pay a personal contribution for delivery in a hospital without medical necessity: 200 €
- You incur the cost for prescribed medication: 150 €. These costs are covered but subject to excess
- You incur costs for a dental check-up: € 75. These costs are not covered by the basis health insurance.
In this example you end up paying: 385 € + € 200 + € 75 = € 660, because:
- Your full excess of has been used because of the costs for specialist care and medication: 350 € + 150 € = 500 €, which is more than your excess. You pay 385 € and 115 € of these costs is paid by your insurance company.
- Your personal contribution for a hospital delivery of 200 € is not covered by your basic health insurance.
- Your dental check-up of 75 € is not covered by your basic health insurance.