Choosing the Right Coverage Level in Private Health Insurance
The world of private health insurance (PHI) can be overwhelming, with multiple tariff options offering different levels of coverage. However, PHI provides more comprehensive and superior coverage compared to public health insurance. Depending on the chosen tariff, policyholders can enjoy benefits such as extensive reimbursement for dental prosthetics, private rooms in hospitals, and treatment by chief physicians. Additionally, shorter waiting times are among the advantages of PHI.
Which Services Does Private Health Insurance Provide (PHI)?
Insurance coverage within PHI varies depending on the chosen tariff. Here’s an overview of some of the most important services offered by PHI:
Outpatient Care
- Free choice of doctors, including specialists, without a referral.
- Possibility of treatment by private physicians.
- Reimbursement for treatments by alternative medicine practitioners.
- Coverage for visual aids such as glasses or contact lenses, as well as surgical vision correction.
- Psychotherapy.
- Fertility treatments.
- Outpatient treatment abroad.
Inpatient Care
- Single or double rooms in hospitals.
- Treatment by chief physicians.
- Freedom to choose hospitals, including private hospitals.
- Inpatient treatment abroad.
Dental Treatments
- Reimbursement of up to 100% for dental treatments, including cleanings and prophylaxis.
- Reimbursement of up to 100% for dental prosthetics such as implants, bridges, or crowns.
- Reimbursement of up to 100% for maxillofacial surgical procedures.
- Reimbursement of up to 100% for dental technical services.
Sickness Allowance
- Policyholders receive sickness allowance to compensate for lost income during illness. This is particularly important for self-employed individuals who do not receive sick pay from employers.
Nursing Care Insurance
- Statutory compulsory nursing care insurance is included in PHI coverage.
Other Important Services
- Follow-up treatments, rehabilitation measures, and addiction treatment.
- Preventive health measures.
- Preventive check-ups beyond the statutory health insurance level.
- Medical repatriation from abroad.
- Vaccinations for foreign travel.
The Link Between Tariff Selection and Coverage Level
In PHI, insurers offer different tariffs that vary from provider to provider. The coverage level for policyholders depends on the chosen tariff. Opting for a higher tariff guarantees better benefits such as private rooms in hospitals or higher reimbursement for dental prosthetics.
Essential Services to Include in Your PHI Contract
When choosing PHI for comprehensive health insurance, policyholders typically receive coverage that exceeds the level provided by statutory health insurance. Therefore, there is no need to worry about inadequate coverage with PHI. Here is an overview of services that should be included in any PHI contract:
- Reimbursement of at least the maximum fee rate for physician services (2.3 times the official fee schedule for physicians).
- Free choice of doctors.
- Reimbursement of medication costs without co-pays and coverage for original medications.
- Sufficient coverage for aids such as visual aids, breathing apparatus, or walking aids.
- Comprehensive dental insurance without waiting periods for accidents (usually, there is a waiting period before dental treatments are fully covered, which should be waived in case of accidents).
Are the Benefits Guaranteed for Life?
One of the most significant advantages of PHI over public health insurance is the guarantee of lifelong coverage. With public health insurance, the government determines the range of benefits and costs, resulting in potential additions or reductions of services over time. However, PHI policyholders are assured that the agreed benefits will remain unchanged throughout their lives.
Are You Looking for Direct PHI Advice?
Our independent experts provide honest advice tailored to your individual situation and preferences. We will help you find the best PHI tariff for you. Our services include:
- Addressing your questions about private health insurance.
- Finding the optimal tariff with you.
- Assisting you with switching to PHI.
- Our consultation is independent, free of charge, and non-binding.
The Advantages of Private Health Insurance
PHI offers a range of advantages that public health insurance cannot provide. These include superior healthcare services, shorter waiting times, and a lifelong guarantee of benefits. Additional advantages of PHI compared to public health insurance are:
Higher Coverage Level
The most crucial argument for PHI is its comprehensive coverage. It covers services that are not included in the benefits provided by public health insurance or reimburses higher costs than public health insurance. Examples include expensive dental treatments, treatments by alternative medicine practitioners, and innovative treatment methods that public health insurance does not cover or cover yet.
Flexible Premium Calculation
PHI premiums are determined by the chosen benefits, age, and health condition, rather than income. As a result, individuals with higher incomes can benefit from lower premiums in PHI.
Free Choice of Services
Members of private insurance companies can choose services according to their needs, thanks to different tariff options. It is also possible to switch tariffs within the same insurance provider.
Access to Specialists
Private insurance patients can often get appointments with specialists much faster than those covered by public health insurance. Additionally, some doctors only accept patients covered by private insurance companies.
Special Tariffs for Specific Professions
Self-employed individuals, well-paid employees, civil servants, and students can all get coverage through PHI. Specific professional groups, such as medical professionals, also benefit from tailored tariffs.
Premium Refunds
Under certain conditions, PHI policyholders can receive premium refunds if they have not used any services covered by their insurance.
Lifetime Protection
Private health insurance offers lifetime protection, which is a major advantage over public health insurance. Public health insurance can modify its range of services and costs over time, while PHI policyholders can rely on the agreed benefits throughout their lives.
Full Medication Reimbursement
Private health insurance fully reimburses prescribed medications, with no co-pays required as with public health insurance.
What Criteria Should You Consider When Choosing PHI?
The criteria for choosing private health insurance are individual and depend on each person’s needs and those of their family. Therefore, it is essential to gather all relevant information about the insurer and its offerings before making a decision. A professional consultation, which we offer for free, can provide a comprehensive overview of different tariffs’ pros and cons.
Although there are no universal recommendations for essential services, the following questions should be considered when comparing different insurers:
- Do all services relevant to the policyholder’s needs, such as dental treatments, preventive health measures, alternative medicine treatments, hospital benefit payments, etc., fall within the chosen tariff?
- What reimbursement rate or maximum amount is covered for relevant services?
- How stable are the premiums for PHI?
- Are there any waiting periods for specific treatments, and how long are they?
- Are there any restrictions on choosing doctors?
- Regarding family planning, how comprehensive and cost-effective is coverage for children? Can premiums be suspended during parental leave?
- Are premium refunds available if no services have been used?
- Should reimbursement also be provided when expenses exceed the usual maximum rates?
- Is there an online platform offering services such as digital doctor searches, prescription uploads, or video consultations?
How Can PHI Coverage be Expanded?
Unlike public health insurance, policyholders with PHI have control over their coverage. They can switch tariffs to obtain better benefits or consider purchasing private supplementary insurance. This is particularly beneficial for policyholders with affordable tariffs who can access better services, such as hospital stays or dental treatments, without upgrading to a higher tariff.
It is important to note that upgrading to higher tariffs may not always be possible or may come with restrictions. For example, a new health assessment may be required before switching tariffs. If there has been a significant deterioration in health, certain services may be excluded from higher tariffs.
Do PHI Costs Depend on the Services Provided?
Unlike public health insurance, private health insurance allows policyholders to purchase better coverage by paying higher premiums. With higher premiums, better coverage is guaranteed. In contrast, public health insurance provides the same benefits to all policyholders, with income being the sole factor influencing the amount of premiums.
FAQs about PHI Services
Can Individuals Covered by Public Health Insurance Utilize PHI Offers?
Private insurers cannot accept everyone under contract. However, individuals covered by public health insurance can benefit from PHI services by purchasing private supplementary insurance, such as outpatient and inpatient coverage, hospital supplementary insurance, daily sickness allowance insurance, or dental supplementary insurance.
Can PHI Costs Be Reduced?
Policyholders with PHI have the option to switch to a more affordable tariff or choose a deductible, thereby reducing their monthly expenses. Choosing a deductible is particularly beneficial for policyholders who rarely require medical services. Before choosing a high deductible, it may be advisable to seek advice to obtain a comprehensive overview of the benefits and drawbacks.
Can PHI Reduce Benefits?
Once an insurance contract is signed with a specific coverage level, benefits cannot be reduced. Unlike public health insurance, PHI cannot modify its offer to the disadvantage of policyholders. If policyholders do not terminate their contract, PHI will provide them with the agreed benefits throughout their lives.
For more exciting articles on private health insurance:
- Are the costs of glasses and vision aids covered by PHI?
- What is sickness allowance in private health insurance?
- Are medications covered by private health insurance?
- What are the excluded services in private health insurance?
- Is osteopathy covered by private health insurance?
- Is psychotherapy covered by private health insurance?
- What are private medical treatments?
