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BarmeniaGothaer Barmenia Beihilfetarif VB: the policy wording in full
Beihilfetarif für ambulante, stationäre und zahnärztliche Behandlung mit den Leistungsstufen 10, 20, 30, 50 und Z und drei stationären Tarifstufen, hier in der Fassung für vor dem 01.01.1993 Versicherte.
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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 BarmeniaGothaer Barmenia
Beihilfetarif VB.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Beihilfeberechtigten und deren berücksichtigungsfähige Angehörige versichert werden.“ | Vorbemerkung, page 2 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „nach Leistungsstufe 20 zu 20 %; nach Leistungsstufe 30 zu 30 %; nach Leistungsstufe 50 …“ | 1.22, page 4 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | yes | „Der Versicherungsschutz kann nur soweit erhöht werden, dass er die Verminderung des …“ | 2.5, page 5 |
| Adjustment to a changed allowance rate or loss of the allowance without new health check (deadline) | yes | „Der Versicherer wird einen solchen Antrag annehmen, wenn die Anpassung des …“ | 2.5, page 5 |
| Change of reimbursement level on retirement (for example from 50 to 30 per cent) | yes | „Nach den Leistungsstufen 30 + Z beträgt der prozentuale Erstattungssatz bis zum Erhalt …“ | 4.32 c), page 6 |
| Valid for the allowance rules of the federation and all federal states | yes | „Außerdem können solche Personen versichert werden, die einen Beihilfeanspruch nach …“ | Vorbemerkung, page 2 |
| Tariff or dormant cover for recipients of free medical care (police, fire service, armed forces) | not addressed | ||
| 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 | „Bei einer ambulanten Heilbehandlung, Vorsorgeuntersuchung, Entbindung oder Fehlgeburt …“ | 1.11 a), page 2 |
| Medicines and dressings (including non-prescription) | yes, up to the sum insured | „a) Beratungen, Besuche und Verrichtungen einschließlich Operationen; b) Arznei- und …“ | 1.11 b), page 2 |
| Naturopaths and natural therapies (annual maximum) | not addressed | ||
| Therapies (physiotherapy, occupational therapy, speech therapy) | yes, up to the sum insured | „c) Heilmittel, und zwar medizinische Bäder, Massagen, Inhalationen sowie Licht-, Wärme …“ | 1.11 c), page 2 |
| Therapies only up to the amounts eligible for the allowance | not addressed | ||
| Medical aids with an open catalogue | no | „d) Hilfsmittel, und zwar - Bandagen“ | 1.11 d), page 2 |
| Glasses and contact lenses (amount and period) | yes, up to EUR 416 | „Brillen und Kontaktlinsen, erstattungsfähig sind (auch bei einer Refraktionsbestimmung …“ | 1.11 d), page 2 |
| Hearing aids (amount per ear and period) | yes, up to EUR 1,040 | „Hörgeräte, erstattungsfähig sind die Aufwendungen bis zu einem Rechnungsbetrag von …“ | 1.11 d), page 2 |
| Outpatient psychotherapy (rate, approval) | yes, up to the sum insured | „Für psychotherapeutische Behandlungen werden Leistungen nur gewährt, wenn und soweit …“ | Fußnote zu 1.11, page 2 |
| Psychotherapy limited to a number of sessions | not addressed | ||
| Check ups and vaccinations (also beyond statutory programmes) | yes, up to the sum insured | „Bei einer ambulanten Heilbehandlung, Vorsorgeuntersuchung, Entbindung oder Fehlgeburt …“ | 1.11, page 2 |
| Home nursing and palliative care | yes, up to the sum insured | „Erstattungsfähig sind die Aufwendungen für ärztlich verordnete häusliche Krankenpflege …“ | 1.15, page 3 |
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „notwendigen Transport zum nächsterreichbaren Arzt oder Krankenhaus zur Erstversorgung …“ | 1.11 f), page 2 |
| Fertility treatment (conditions, number of attempts) | yes, up to the sum insured | „Erstattungsfähig sind die Aufwendungen für Maßnahmen der assistierten Reproduktion“ | 1.16, page 3 |
Inpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General hospital services (shared room, ward doctor) | yes | „Erstattungsfähig sind die Aufwendungen für: a) allgemeine Krankenhausleistungen“ | 1.122 bis 1.124, page 2 |
| Two bed room as optional service | yes | „gesondert berechnete Unterkunft und Verpflegung im Zweibettzimmer abzüglich eines …“ | 1.123 c), page 2 |
| Single room as optional service | yes | „Außerdem wird der Differenzbetrag zwischen dem Ein- und Zweibettzimmerzuschlag in …“ | 1.231, page 5 |
| Treatment by senior consultant of choice | yes | „d) gesondert berechnete ärztliche Leistungen; e) notwendigen Transport zum und vom …“ | 1.122 d), 1.123 d), page 2 |
| 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 | yes, up to the sum insured | „Wird bei einer stationären Heilbehandlung die ärztliche Behandlung nicht gesondert …“ | 1.24, page 5 |
| 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 | yes, up to the sum insured | „a) Zahnbehandlung (z. B. Füllungen, Extraktionen, Wurzelbehandlungen, Erkrankungen der“ | 1.13 a), page 2 |
| Dentures (crowns, bridges, prostheses) | yes, up to the sum insured | „b) Zahnersatz (z. B. Prothesen, Stiftzähne, Brücken, Kronen, Implantate“ | 1.13 b), page 2 |
| Implants (number per jaw, link to cases eligible for the allowance) | yes, up to the sum insured | „b) Zahnersatz (z. B. Prothesen, Stiftzähne, Brücken, Kronen, Implantate“ | 1.13 b), page 2 |
| Material and laboratory costs at the tariff percentage | not addressed | ||
| Orthodontics (children, adults) | yes, up to the sum insured | „c) Zahn- und Kieferregulierung (kieferorthopädische Behandlung).“ | 1.13 c), page 3 |
| 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) | yes | „Während der ersten drei Monate eines vorübergehenden Aufenthalts im außereuropäischen …“ | 4.11, page 6 |
| Repatriation from abroad | yes, up to the sum insured | „Bei einem medizinisch notwendigen Rücktransport wegen Krankheit oder Unfallfolge aus …“ | 1.14, page 3 |
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) | yes | „Für Psychotherapie, Zahnbehandlung und Zahnersatz sowie für Zahn- und Kieferregulierung …“ | 4.15, page 6 |
| 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 | yes | „wird auch für solche Versicherungsfälle geleistet, die vor Beginn des ... eingetreten …“ | 4.12, page 6 |
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 | „Der Versicherungsnehmer kann dann im Rahmen von Ziffer 2.5 die Weiterversicherung in …“ | 4.32 a), page 6 |
| 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
- Barmenia Krankenversicherung AG
- Distribution
- brokers and direct
- Tarif VB für Beihilfeberechtigte, ambulante und stationäre Heilbehandlung, Zahnbehandlung und Zahnersatz (K 3351) Edition: 01.01.2023 (K 3351 0625) Original from the insurer (PDF, German)
Full text of the wording
The full text exists only in German.
It is printed on the German page for BarmeniaGothaer Barmenia Beihilfetarif VB and available as
plain text.
Volltext BarmeniaGothaer Barmenia Beihilfetarif VB Beihilfeversicherung · As text (Markdown) BarmeniaGothaer Barmenia Beihilfetarif VB Beihilfe cover