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Hospital: What you should look out for with private supplementary insurance


Single room and treatment from experts: Supplementary hospital insurance can be useful, especially in the case of complicated ailments. But there are pitfalls.

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Single room in hospital: more comfort is expensive


Alexander Bernhard / iIMAGO / Shotshop

There are two main reasons for purchasing additional private hospital insurance. First, the reason: a good insurance that offers access to the top medical experts. With which you can always go to the same doctor if you are really sick. And secondly, the convenient reason: You can secure a single or at least double room in the hospital - depending on the tariff - so that you can sleep better and have more privacy. In times of corona, maybe also because you are afraid of infection in the room.

More than six million people with statutory health insurance have signed such a contract, reports the Association of Private Health Insurers (PKV).

However, the protection is not cheap.

50 euros a month are due quickly if you want to conclude a proper contract and are no longer forty.

600 euros a year for additional insurance.

Older people pay significantly more.

The corona year in the hospital

In the Corona year 2020, once again more people made it through to take out such additional insurance.

Industry leader Debeka reports growth, also Allianz and Generali.

The year was already very positive for the health insurers' balance sheets.

While the number of insured persons and thus the number of payers grew, the costs fell significantly: Because many normal operations had to be postponed because of the risk of infection and the general overload caused by the intensive care treatment.

As a result, significantly fewer patients came to the hospital: the number of admissions to hospitals fell by almost 2.5 million, the number of operations fell by 690,000 - that was around eleven percent.

And that includes the almost 180,000 corona patients.

In fact, insurers such as Debeka, HUK and Allianz are reporting declining spending, at Debeka even by eight percent.

Despite the pandemic, premiums in the insurance line are currently not increasing.

Be insured long-term or short-term

My colleagues from Finanztip have examined the range of supplementary hospital insurance.

Result: There are a number of tariffs that are worthwhile.

In principle, there are two types of insurance:

  • Option one

    creates provisions for old age in addition to the additional costs for current treatment in the hospital. So that the insurance remains reasonably affordable even in retirement. If you want such additional insurance in the long term, I always recommend it.

    If you don't want to sign up until you are in your mid-sixties, with good contracts you pay twice as much as if you start in your mid-thirties: 80 instead of 40 euros per month. Of course, this assumes that you still get a contract when you are sixty. The insurers also ask health questions - and not everyone gets a contract.

  • Option two

    waives the provisions and calculates from the start with regularly increasing contributions. This can be your option in two cases: First, if you are unsure whether you will be able to pay the premiums for supplementary insurance in old age. The contributions in old age are always significantly higher than they are today and your pension is likely to be significantly lower than your current income. Or secondly, if you only want to have this kind of protection for a manageable period of time in life. For example women who naturally want the best possible care for the birth of their children. Attention, some tariffs stipulate a waiting period of eight months for paying in the event of a delivery, so those interested should keep an eye on this.

In fact, the same offers are often available with and without retirement provisions, so you can easily see the price differences.

However, it also happens that a tariff without a provision is automatically switched to a provision after a certain age.

The model therefore only works up to a certain age - with some tariffs only up to mid-forties, with others up to sixty.

What is additional insurance for?

In general, you should carefully weigh up what you want the additional protection for.

The single room may not actually be the most important argument, but it is a price driver for the contributions.

In hospitals, you can usually book a single room on an acute basis when you are admitted.

You don't need insurance for that.

On average, this costs around 111 euros per night in Germany.

If you order a twin room at the briefing, the surcharge is around 50 euros.

The free choice of doctor is more important.

Doctors performed around 6.4 million operations in German hospitals in 2020.

With supplementary hospital insurance, you can look for a specialized clinic with the doctor of your choice in the event of a serious illness or before the operation.

Corresponding databases are available from the Association of Private Health Insurers but also from the VdEk Kassenverband.

These specialists, mostly chief physicians, can bill for their treatment at significantly more expensive rates.

And then extra insurance pays for this expensive treatment.

You already guessed it, there are some tricky billing questions with supplementary hospital insurance:

  • What if you have booked the expensive expert and the single room with your elective doctor contract, but you end up in a double room and hardly ever see the lady during your hospital stay.

    Legally, that's pretty straightforward.

    There is often financial compensation for the non-existent single room.

  • What applies if you are treated in the meantime by doctors other than the doctors you have chosen? The expert must have taken over the essential and difficult part of the treatment herself. Then the anesthetist or radiologist can bill for their part of the treatment privately and more expensively. What is essential? My colleague always says that someone else may sew up after the operation if necessary. However, the expert / head physician must do visits, admission and discharge examinations himself - or a named deputy.

  • What about outpatient surgery? So if you don't have to stay in the clinic overnight. Almost two million operations were performed on an outpatient basis in hospitals in 2017, unfortunately there are no more recent figures. In principle, however, the number of outpatient operations is increasing, and experts in particular believe that they can achieve the surgical goal with smaller operations. Good supplementary hospital insurance actually also pays for outpatient operations.

  • Are you allowed to be treated in purely private clinics? This is an important catch for many supplementary insurances. Because the business model of the supplementary insurer actually provides that the basic hospital treatment service is paid for by your health insurance company and only additional services such as the head doctor are paid for by the supplementary insurance. For this reason, many additional hospital insurers do not pay in private clinics or expect the patient to pay the health insurance portion himself there. If you have a contract, check the terms and conditions and ask before agreeing on treatment.

  • A similar problem exists with hospitals that offer both treatment and rehab. The houses are called mixed institutions in technical jargon. Before you get treatment there, you should clarify with your insurance company that they will also pay you there. Good tariffs often do this, anyway if you are posted in an emergency. If it is not an emergency, be sure to clarify it beforehand.

  • Last point: cosmetic surgery.

    From the point of view of health insurances and supplementary hospital insurances, these are usually not medically necessary.

    The costs for this are then not paid.

    But there are exceptions, for example after breast cancer surgery.

    Some things remain incomprehensible.

    Cosmetic surgery to alleviate psychological complaints, for example, may not be paid for by health insurances, but sticking out ears can.

    Private supplementary insurers can decide differently again.

    Here you also have to ask beforehand.

  • If you have now come to the conclusion that such a private supplementary insurance is something for you, because of the head doctor or the snoring neighbor, just compare.

    Both the services and the prices.

    Most insurers offer a variety of different policies.

    My colleagues looked at almost 50 high-performance tariffs from 19 insurers and selected five out of five different providers as particularly recommendable and inexpensive.

    Stay healthy!

    Source: spiegel

    All business articles on 2021-09-26

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