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BarmeniaGothaer Barmenia Beihilfeergänzungstarife VE und VEL: the policy wording in full
Ergänzungstarif VEL zum Tarif VB, der den nicht beihilfefähigen Teil ambulanter und zahnärztlicher Kosten sowie stationäre Honorare über den Schwellenwerten in den Stufen 30 bis 90 ersetzt; der Tarif VE liegt nicht als Text vor.
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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
Beihilfeergänzungstarife VE und VEL.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Nach dem Tarif VEL können Beihilfeberechtigte und ihre berücksichtigungsfähigen …“ | Versicherungsfähigkeit, page 2 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „nach Leistungsstufe 30 zu 30 %; nach Leistungsstufe 35 zu 35 %; nach Leistungsstufe 40 …“ | 1.22, page 3 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | yes | „Die Leistungen aus dem Tarif VEL dürfen ... bei den übrigen Leistungen die dem Grunde …“ | 1.21, page 3 |
| Adjustment to a changed allowance rate or loss of the allowance without new health check (deadline) | yes | „dass die Leistungsstufe des Tarifs VEL dem neuen geltenden ambulanten …“ | 2.5, page 3 |
| Change of reimbursement level on retirement (for example from 50 to 30 per cent) | not addressed | ||
| 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) | 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) | not addressed | ||
| Naturopaths and natural therapies (annual maximum) | not addressed | ||
| Therapies (physiotherapy, occupational therapy, speech therapy) | yes, up to the sum insured | „b) Heilmittel, und zwar medizinische Bäder, Massagen, Inhalationen sowie Licht-, Wärme …“ | 1.11 b), page 2 |
| Therapies only up to the amounts eligible for the allowance | not addressed | ||
| Medical aids with an open catalogue | no | „c) Hilfsmittel, und zwar - Bandagen“ | 1.11 c), page 2 |
| Glasses and contact lenses (amount and period) | yes, up to EUR 416 | „bis zu einem Rechnungsbetrag von 416,00 EUR für eine Sehhilfe.“ | 1.11 c), 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 c), page 2 |
| Outpatient psychotherapy (rate, approval) | yes, up to the sum insured | „handelt es sich jedoch um psychotherapeutische Behandlung sowie die in diesem …“ | 1.22, page 3 |
| 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 | not addressed | ||
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „d) notwendigen Transport zum nächsterreichbaren Arzt oder Krankenhaus zur …“ | 1.11 d), page 2 |
| Fertility treatment (conditions, number of attempts) | yes, up to the sum insured | „Erstattungsfähig sind die Aufwendungen für Maßnahmen der assistierten Reproduktion“ | 1.15, 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 | yes | „gesondert berechnete ärztliche Leistungen (wenn die Tarifstufe 1 oder 2 des Tarifs VB …“ | 1.12 b), 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 | 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 | 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 | „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 | „Zahnersatz (z. B. Prothesen, Stiftzähne, Brücken, Kronen, Implantate“ | 1.13 b), page 2 |
| Material and laboratory costs at the tariff percentage | yes | „Handelt es sich um Aufwendungen für zahntechnische Leistungen, Edelmetalle und Keramik …“ | 1.13, page 2 |
| Orthodontics (children, adults) | yes, up to the sum insured | „c) Zahn- und Kieferregulierung (kieferorthopädische Behandlung)“ | 1.13 c), page 2 |
| 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 | yes | „Der Teil der erstattungsfähigen Aufwendungen, der nicht beihilfefähig im Sinne der …“ | 1.22, page 3 |
| Supplement pays only after a decision of the allowance office | yes | „Anhand des Festsetzungsbescheides ist der beihilfefähige Betrag und der …“ | 4.19, page 4 |
| Compensation of the cost dampening lump sum or the allowance retention | no | „In den Beihilfevorschriften vorgesehene Selbstbehalte auf beihilfefähige Aufwendungen …“ | 1.21, page 3 |
| Reimbursement of fees above the rate eligible for the allowance | yes, up to the sum insured | „gesondert berechnete ärztliche Leistungen (wenn die Tarifstufe 1 oder 2 des Tarifs VB …“ | 1.12 b), page 2 |
| 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 3 |
| Repatriation from abroad | yes, up to the sum insured | „Bei einem medizinisch notwendigen Rücktransport wegen Krankheit oder Unfallfolge aus …“ | 1.14, page 2 |
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 4 |
| 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 …“ | 4.12, page 4 |
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 | no | „Die Versicherung nach dem Tarif VEL endet mit dem Fortfall der Beihilfeberechtigung …“ | 4.32 a), page 4 |
| 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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legally only the wording of your own contract in the edition stated there applies.
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Policy wordings and provider
- Legal entity
- Barmenia Krankenversicherung AG
- Distribution
- brokers and direct
- Tarife VE und VEL, Ergänzung zu Tarif VB (K 3862) Edition: 01.01.2023 (K 3862 0325) 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 Beihilfeergänzungstarife VE und VEL
and available as plain text.
Volltext BarmeniaGothaer Barmenia Beihilfeergänzungstarife VE und VEL Beihilfeversicherung · As text (Markdown) BarmeniaGothaer Barmenia Beihilfeergänzungstarife VE und VEL Beihilfe cover