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ALTE OLDENBURGER Beihilfetarif AA 20 bis A 50: the policy wording in full
Ambulanter Beihilfetarif mit den Stufen AA 20 und A 20 bis A 50, Sehhilfen und Vorsorge bis 160 Euro zum Tarifsatz und Höherversicherung ohne Risikoprüfung binnen 6 Monaten bei geringerem Beihilfeanspruch.
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Everything about this policy
What the policy covers: 70 points, each with its clause
Quotes are shortened.
The full German wording of each point is on the German page for ALTE OLDENBURGER Beihilfetarif AA
20 bis A 50.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Krankheitskostentarif für die ambulante Heilbehandlung für Beamte, Personen mit …“ | Tarifkopf, page 2 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „Nach den Tarifstufen AA 20 – 20% A 35 – 35% A 20 – 20% A 40 – 40% A 25 – 25 % A 45 – …“ | A, page 2 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | yes | „Der Versicherungsschutz soll dem Beihilfeanspruch so angepasst sein, dass der …“ | C, page 3 |
| Adjustment to a changed allowance rate or loss of the allowance without new health check (deadline) | yes | „Verringert sich der Beihilfeanspruch oder fällt er weg, so kann eine entsprechende …“ | C, page 3 |
| Change of reimbursement level on retirement (for example from 50 to 30 per cent) | yes | „Darüber hinaus endet die Versicherung nach der Tarifstufe AA 20 – unbeschadet der §§ 13 …“ | B, page 3 |
| Valid for the allowance rules of the federation and all federal states | not addressed | ||
| Tariff or dormant cover for recipients of free medical care (police, fire service, armed forces) | yes | „für Beamte, Personen mit Anspruch auf Heilfürsorge und beihilfeberechtigte Angestellte …“ | Tarifkopf, page 2 |
| Admission under the industry opening scheme (no exclusion, surcharge at most 30 per cent) | not addressed | ||
| Free choice of doctors, dentists and hospitals | not addressed | ||
| Reimbursement above the maximum rate of the fee schedule | not addressed |
Outpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Outpatient medical treatment at the tariff percentage | yes | „Als ärztliche Leistungen gelten Beratungen, Hausbesuche, Operationen sowie sonstige …“ | A 1, page 2 |
| Medicines and dressings (including non-prescription) | yes, up to the sum insured | „Als Arzneimittel gilt auch Verbandmaterial. Zu den Arzneimitteln gehören jedoch nicht – …“ | A 3, page 2 |
| Naturopaths and natural therapies (annual maximum) | not addressed | ||
| Therapies (physiotherapy, occupational therapy, speech therapy) | yes, up to the sum insured | „Heilmittel sind physikalisch-medizinische Heilmaßnahmen durch Angehörige staatlich …“ | A 4, page 2 |
| Therapies only up to the amounts eligible for the allowance | not addressed | ||
| Medical aids with an open catalogue | yes | „Hierunter fallen technische Mittel, die körperliche Behinderungen unmittelbar mildern …“ | A 6, page 2 |
| Glasses and contact lenses (amount and period) | yes, up to EUR 160 | „bis 160,– EUR jährlich, darüber hinaus zu einem Drittel der tariflichen …“ | A 7, page 3 |
| Hearing aids (amount per ear and period) | yes, up to the sum insured | „Erstattet werden auch Aufwendungen für das Ausleihen von Hilfsmitteln (bis max. zur …“ | A 6, page 2 |
| Outpatient psychotherapy (rate, approval) | yes, up to the sum insured | „Voraussetzung ist, dass der Versicherer vor dem eigentlichen Behandlungsbeginn – nach …“ | A 1, page 2 |
| Psychotherapy limited to a number of sessions | not addressed | ||
| Check ups and vaccinations (also beyond statutory programmes) | yes, up to EUR 160 | „bis zu 160,– EUR je Vorsorgeuntersuchung, darüber hinaus zu einem Drittel der …“ | A 8, page 3 |
| Home nursing and palliative care | yes, up to the sum insured | „Der Versicherer erstattet Aufwendungen für ärztlich angeordnete medizinische …“ | A 11, page 3 |
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „Erstattungsfähig sind Transportkosten durch anerkannte Rettungsdienste zur …“ | A 1, page 2 |
| Fertility treatment (conditions, number of attempts) | yes, up to the sum insured | „sonstige Untersuchungen und Behandlungen einschließlich reproduktionsmedizinische …“ | A 1, page 2 |
Inpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General hospital services (shared room, ward doctor) | not addressed | ||
| Two bed room as optional service | not addressed | ||
| Single room as optional service | not addressed | ||
| Treatment by senior consultant of choice | not addressed | ||
| Optional hospital services at 100 per cent where the employer does not grant an allowance for them | not addressed | ||
| Treatment in private clinics without public contract | not addressed | ||
| Hospital daily allowance or substitute allowance when optional services are not used | not addressed | ||
| Follow up treatment and inpatient rehabilitation | not addressed | ||
| Spa and sanatorium treatment (subsidy, interval between two stays) | not addressed | ||
| Inpatient psychotherapy and psychiatry (days, prior approval) | not addressed |
Dental
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Dental treatment and prophylaxis | not addressed | ||
| Dentures (crowns, bridges, prostheses) | not addressed | ||
| Implants (number per jaw, link to cases eligible for the allowance) | not addressed | ||
| Material and laboratory costs at the tariff percentage | not addressed | ||
| Orthodontics (children, adults) | not addressed | ||
| Caps on dentures in the first policy years | not addressed |
Supplement and allowance gaps
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Supplementary tariff for costs the allowance does not or only partly recognise | not addressed | ||
| Supplement pays only after a decision of the allowance office | not addressed | ||
| Compensation of the cost dampening lump sum or the allowance retention | not addressed | ||
| Reimbursement of fees above the rate eligible for the allowance | not addressed | ||
| Extra costs abroad above the domestic allowance rates | not addressed | ||
| Cover abroad for temporary stays (duration, worldwide or Europe) | not addressed | ||
| Repatriation from abroad | not addressed |
Trainees, admission and waiting periods
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Trainee tariff with reduced premium (without or with low ageing reserves) | not addressed | ||
| Maximum age or duration for the trainee tariff | not addressed | ||
| Conversion to the regular tariff after training without new health check | not addressed | ||
| General waiting period | not addressed | ||
| Special waiting periods (childbirth, psychotherapy, dentures, orthodontics) | not addressed | ||
| Waiver of waiting periods (transfer from statutory insurance, appointment as civil servant, medical exam) | not addressed | ||
| Cover for newborns without health check and waiting period | not addressed | ||
| Exclusion or surcharge for pre existing conditions | not addressed |
Contract and premium
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Annual deductible per insured person | not addressed | ||
| Premium refund for claim free years (monthly premiums, guaranteed or performance based) | not addressed | ||
| Check ups and dental prophylaxis without loss of the premium refund | not addressed | ||
| Dormant cover (free medical care, service abroad, leave, parental leave) | not addressed | ||
| Insurer waives ordinary termination | not addressed | ||
| Continuation as full cover at 100 per cent on leaving the civil service | yes | „jedoch nicht mehr als zur vollen Kostendeckung unter Berücksichtigung des …“ | C, page 3 |
| Premium adjustment rules (triggering factor) | not addressed | ||
| Direct billing with the hospital | not addressed |
Austria and Spain
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Group tariff for public servants for private ward cover alongside the statutory scheme | not addressed | ||
| Reimbursement of the statutory treatment contribution | not addressed | ||
| Insurer under agreement with MUFACE, ISFAS or MUGEJU (term of the agreement) | not addressed | ||
| Provider catalogue (doctors and clinics per province, care levels by municipality size) | not addressed | ||
| Change of insurer or to the public system (ordinary change windows per year) | not addressed | ||
| Treatment outside the catalogue (life threatening emergency, refused service) | not addressed | ||
| Care through the public system in rural municipalities | not addressed |
Evaluated by NAMMERT from published policy wordings.
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Policy wordings and provider
- Legal entity
- ALTE OLDENBURGER Krankenversicherung AG, ALTE OLDENBURGER Krankenversicherung von 1927 Versicherungsverein auf Gegenseitigkeit
- Distribution
- available through brokers
- AVB Tarif AA 20 bis A 50, ambulante Heilbehandlung für Beihilfeberechtigte Edition: 01/2020 Copy hosted by an intermediary, not by the insurer
Full text of the wording
The full text exists only in German.
It is printed on the German page for ALTE OLDENBURGER Beihilfetarif AA 20 bis A 50 and available
as plain text.
Volltext ALTE OLDENBURGER Beihilfetarif AA 20 bis A 50 Beihilfeversicherung · As text (Markdown) ALTE OLDENBURGER Beihilfetarif AA 20 bis A 50 Beihilfe cover