The Health Insurance checklist. What you should know about private health insurance and note

The Health Insurance checklist. What you should know about private health insurance and note

Millions have private health insurance: short-term appointments and short waiting times, medical treatment at the highest level, high co-payments for dental prostheses and a satisfaction rate of over 90% – a tangible added value of private health insurance. The decisive factor, however, is that unique tariffs can be set up to provide tailor-made health care. In order to choose the best and most cost-efficient tariff for you, there are a few aspects to consider before choosing a private health insurance provider.

Checklist to buy Health Insurance

The following checklists will help you to find good insurance and, by asking specific questions (checklist 2), to select only those benefits that are actually needed. Later adjustments are flexible depending on your life situation.

Checklist 1: These key aspects help you to find a good provider.

generally applies to the search/first contact: ask anonymously!
In the case of pre-existing conditions, which must be indicated anyway in the context of a health examination, prospective customers should first contact anonymously in order to be advised. Otherwise, it could be that one is rejected at a later time. The state of health, the age at entry and the desired scope of benefits are decisive for the amount of the contribution. The amount of earnings has no influence on the contributions, which is very advantageous for self-employed persons.

choose a ‘healthy’ insurance company:

The decision in favor of private health insurance is of a sustainable nature; it, therefore, needs to be well thought out (also because reserves are built up for premium relief in old age). The advantages and disadvantages of both insurance systems should be considered with personal weighting. In any case, an insurance company should be chosen that has a steady influx of new, young policyholders, which offers the prospect of stable premiums in the long term (a look at the annual report is recommended).

Contributions in recent years: Recognizing trends, not just current status

Many interested people make the mistake to see only the current article. More important, however, is the development in recent years, as this allows meaningful conclusions to be drawn about future developments (keyword: contribution stability). A good provider scores with stable contributions that offer the prospect of long-term predictability and affordability.

Compare benefits with a view to personal needs:

A concrete monthly contribution only becomes meaningful if one compares the associated services of different providers. What about co-payments and deductibles? Where do I get the most daily sickness benefit in the event of illness for the lowest costs? Are premium refunds offered?

What does a single room cost, including chief physician treatment in hospital?

What services are offered in the area of alternative healing methods etc.?

What influence do which benefits have on the monthly contribution?

A professional consultation can quickly show what direct cost influence certain services have. In this respect, the opportunity should be seized to actively ensure cost efficiency and only secure meaningful benefits in view of life circumstances (a later upgrade is still possible).

With which provider/rate can I best implement my life planning?

When choosing a rate, you should also take into account your life circumstances. A good provider should have a tariff in his portfolio that can be flexibly combined with different phases of life. For example, with regard to family planning, it should be possible to suspend contributions during parental leave.

Reimbursement of contributions for unused benefits

This is a financially very advantageous aspect of private health insurance, with significant differences depending on the provider and tariff. A comparison will therefore literally pay off!

Service, advice and uncomplicated cost reimbursement
For many insured persons, in addition to health care, the service offered by a provider is also very important: Which personal counseling options are offered? What services are available (e.g. when can the service hotline be contacted)? Is there a personal contact person near me? Are medical bills reimbursed quickly and easily? A glance at the corresponding assessment forums can provide some initial clues. But it is more important to get a personal impression of yourself.

The wide range of tariffs offered: an optimal solution for every insurance requirement

Ideally, a private health insurance company should have newer tariffs in its portfolio in addition to tariffs that have long been established on the market, so those tariff adjustments can be made at a later date if necessary. In principle, it is always cheaper to optimize the tariff with the current provider instead of changing the provider completely.

We need to think long-term and already have the retirement age in mind: Offers for contribution relief
Contribution stability must also mean that contributions remain stable at high retirement age. Therefore, a tariff should be chosen that contains a further relief component beyond the statutory reserves. In this respect, a good tariff must be affordable now and be able to build up effective reserves for the retirement age.

Checklist 2: Questions on the selection or design of a tariff with personal weighting

Above all, the questions at the back allow us to guarantee a tailor-made scope of insurance. Ideally, interested parties should use these questions to prepare themselves for a highly recommendable consultation.

What do I want in private health insurance: basic or comfort cover?
Of course, this question depends on your age and general state of health. Young insured persons usually need a smaller scope of benefits, whereby self-employed persons should not do without the daily sickness benefit in particular. Comfort benefits such as head physician treatment or cures naturally cost more, but they also offer tangible added health value. The basic tariff of the PKV is, by the way, the same with all offerers, it is comparable with the power spectrum of the GKV. The insurance benefits are expandable in many respects.

Personal and family life situation/planning?

It should be borne in mind that each member of the private health insurance scheme must make their own contribution, there is no provision for family insurance as in the statutory health insurance scheme. Therefore, financial aspects should also be considered and calculated on a long-term basis. However, premium adjustments are always an effective means of actively reducing costs.

Examine your own willingness to pay a deductible

When concluding a tariff, the deductible can also be chosen flexibly. In this way, the monthly premiums can be reduced significantly in some cases. Specialist advice should be provided here in order to establish a meaningful cost/benefit ratio. Privately insured employees receive a subsidy from their employer (usually 50%), but the excess must be borne by the insured person.

This is what everything revolves around in private health insurance: What about one’s own state of health?
Especially in the case of pre-existing conditions, it is advisable to obtain various offers anonymously. This shows how the risk assessment to be carried out can be reflected in sometimes very different contributions. In principle, it should be borne in mind that the insurance costs will be higher in the case of pre-existing conditions, as the corresponding insurance risk for the provider is higher. It is important that all relevant questions on health status are answered in full. Otherwise, the insurer can refuse certain benefits in the event of illness.

The following questions, structured according to insurance areas, are intended to allow an approximation to the individually required scope of insurance:

outpatient health care:

– Should the costs for preventive medical check-ups be included in the tariff?
– Are practical medical services desired?
– Are reimbursements for visual aids and remedies desirable (the amount can usually be chosen flexibly)?
– Should private medical services also be replaced which exceed the usual maximum rate (= 2.3 times the fee scale for doctors)?-
– Are restrictions on benefits accepted if specialists are consulted without the prior visit of the family doctor (primary physician procedure)?
– To what extent should concrete benefits be reimbursed? (personal weighting is very important here!)

Inpatient treatment (benefits for hospital stays):

– Should daily hospital allowance be agreed?
– Is value placed on a single room and treatment by the chief physician?
– Should in-patient private medical treatment be reimbursed if it exceeds the maximum rate of 2.3 times the fee scale for doctors? Or should benefits be insured which exceed the standard rate by a factor of 3.5 or more?

Dental Treatment/Dentures:

– Which minimum reimbursement rate is desired for dental treatment?
– Are restrictions on dental prosthesis services or certain annual fixed amounts accepted?
– Which reimbursement rate is desired for orthodontics and dentures?
– Is a reimbursement of the fees above the standard maximum rate of the dentist’s fee schedule desired?

Nursing care insurance:

– Should benefits also be insured which exceed the legally prescribed insurance cover?
– If so, what benefits are specifically desired/sensible?
– Daily sickness benefit insurance: an indispensable option for self-employed persons (payments in the event of illness)
– How much should daily sickness benefit be paid (the daily rate should be as realistic as possible in order to be able to cover all running costs despite a lack of income)?
– When should daily sickness benefit be paid (from day 43 of sick leave or earlier from day 15)? It is also worth comparing different providers here: How does the amount of the daily sickness benefit affect the contribution? From which day can the money be drawn flexibly?

– Cures and remedies or aids:

– Should spa services be insured? If so, to what extent?
– Are reimbursements for remedies and aids necessary? If so, to what extent?

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