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DKV BeihilfeMed Krankenhaus Tarife BKH1 und BKH2: the policy wording in full
Aufbaustufen BKH2 und BKH1 für Wahlarzt, Zweibettzimmer und Einbettzimmer im Krankenhaus, zu 100 Prozent oder passend zum Beihilfesatz, mit Tagegeld bei Verzicht auf die Wahlleistungen.
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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 DKV BeihilfeMed Krankenhaus Tarife
BKH1 und BKH2.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Versichert werden können Personen, die nach dem Tarif BK bzw. BKA oder BA versichert sind.“ | Teil 1 Tarife BKH2, BKH2A Nr. 3, page 15 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „Tarifstufen BKH2, BKH2A zu 100% Tarifstufen BKH2 50, BKH2A 50 zu 50%“ | Teil 1 Tarife BKH2, BKH2A Nr. 2, page 15 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | yes | „insgesamt auf die Summe Ihrer Aufwendungen begrenzt. Beihilfeansprüche rechnen wir also …“ | Teil 2 Nr. 2.2, page 25 |
| Adjustment to a changed allowance rate or loss of the allowance without new health check (deadline) | yes | „Stellen Sie den Antrag innerhalb von sechs Monaten nach der Änderung, passen wir den …“ | Teil 2 Nr. 19.1, page 30 |
| Change of reimbursement level on retirement (for example from 50 to 30 per cent) | yes | „Die Laufzeit der Tarifstufe BKH2F 20 ist befristet bis zum Eintritt des …“ | Teil 1 Tarife BKH2, BKH2A Nr. 2, page 15 |
| 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 die ein Anspruch auf Leistungen aus der Gesetzlichen Krankenversicherung bzw. ein …“ | Teil 1 Tarife BKH2, BKH2A Nr. 3, page 15 |
| 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 | no | „Die Aufwendungen sind erstattungsfähig, soweit die Gebühren im Rahmen der Höchstsätze …“ | Teil 1 Tarife BKH2, BKH2A Nr. 1.1, page 14 |
Outpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Outpatient medical treatment at the tariff percentage | not addressed | ||
| Medicines and dressings (including non-prescription) | not addressed | ||
| Naturopaths and natural therapies (annual maximum) | not addressed | ||
| Therapies (physiotherapy, occupational therapy, speech therapy) | not addressed | ||
| Therapies only up to the amounts eligible for the allowance | not addressed | ||
| Medical aids with an open catalogue | not addressed | ||
| Glasses and contact lenses (amount and period) | not addressed | ||
| Hearing aids (amount per ear and period) | not addressed | ||
| Outpatient psychotherapy (rate, approval) | not addressed | ||
| Psychotherapy limited to a number of sessions | not addressed | ||
| Check ups and vaccinations (also beyond statutory programmes) | not addressed | ||
| Home nursing and palliative care | not addressed | ||
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „Bis zu einer Entfernung von 100 km können Sie das Krankenhaus frei wählen.“ | Teil 1 Tarife BKH2, BKH2A Nr. 1.5, page 15 |
| Fertility treatment (conditions, number of attempts) | not addressed |
Inpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General hospital services (shared room, ward doctor) | not addressed | ||
| Two bed room as optional service | yes | „Zuschlag für die Unterbringung im Zweibettzimmer.“ | Teil 1 Tarife BKH2, BKH2A Nr. 1.2, page 14 |
| Single room as optional service | yes | „Wir ersetzen die erstattungsfähigen Mehraufwendungen für die Unterbringung im …“ | Teil 1 Tarife BKH1, BKH1A Nr. 1.1, page 16 |
| Treatment by senior consultant of choice | yes | „Wahlärztliche Leistungen. Dies sind gesondert berechenbare Behandlungen durch leitende …“ | Teil 1 Tarife BKH2, BKH2A Nr. 1.1, page 14 |
| Optional hospital services at 100 per cent where the employer does not grant an allowance for them | yes | „Tarifstufen BKH2, BKH2A zu 100%“ | Teil 1 Tarife BKH2, BKH2A Nr. 2, page 15 |
| Treatment in private clinics without public contract | not addressed | ||
| Hospital daily allowance or substitute allowance when optional services are not used | yes, up to EUR 60 | „keine wahlärztlichen Leistungen in Anspruch, zahlen wir ein Tagegeld. Dieses ergibt …“ | Teil 1 Tarife BKH2, BKH2A Nr. 1.1, page 14 |
| 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) | yes | „Bei vorübergehenden Aufenthalten im außereuropäischen Ausland bleibt der …“ | Teil 2 Nr. 5.2, page 26 |
| 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) | yes | „Sie zahlen nur einen Risikobeitrag. Das bedeutet: Es werden keine Rückstellungen für …“ | Besondere Bedingungen für die Ausbildungstarife Nr. 1, page 23 |
| Maximum age or duration for the trainee tariff | yes | „die Versicherungsfähigkeit gemäß Nr. 2.1 nicht mehr gegeben ist bzw. das 39. Lebensjahr …“ | Besondere Bedingungen für die Ausbildungstarife Nr. 2.2, page 23 |
| Conversion to the regular tariff after training without new health check | yes | „Tarif BKH2A im Tarif BKH2 Tarif BKH1A im Tarif BKH1“ | Besondere Bedingungen für die Ausbildungstarife Nr. 2.4, page 23 |
| General waiting period | yes | „Ist dies nicht der Fall, beträgt in diesen Tarifen die allgemeine Wartezeit drei Monate.“ | Teil 2 Nr. 4.2, page 26 |
| Special waiting periods (childbirth, psychotherapy, dentures, orthodontics) | yes | „Für Entbindung, Psychotherapie, Zahnbehandlung und Zahnersatz beträgt die Wartezeit …“ | Teil 2 Nr. 4.2, page 26 |
| Waiver of waiting periods (transfer from statutory insurance, appointment as civil servant, medical exam) | yes | „Wir können die Wartezeiten aufgrund einer ärztlichen Untersuchung erlassen, wenn Sie …“ | Teil 2 Nr. 4.2, page 26 |
| Cover for newborns without health check and waiting period | yes | „Für das neugeborene Kind einer versicherten Person kann der Versicherungsschutz ohne …“ | Teil 2 Nr. 3.3, page 25 |
| Exclusion or surcharge for pre existing conditions | yes | „Für Versicherungsfälle, die vor Beginn des Versicherungsschutzes eingetreten sind …“ | Teil 2 Nr. 3.2, page 25 |
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) | yes, up to the sum insured | „Falls wir für diesen Tarif eine Beitragsrückerstattung in Form der Auszahlung vorsehen …“ | Teil 2 Nr. 10.3, page 27 |
| Check ups and dental prophylaxis without loss of the premium refund | yes | „Ausgenommen sind Leistungen für Vorsorgeuntersuchungen, Schutzimpfungen und …“ | Teil 2 Nr. 10.3, page 27 |
| Dormant cover (free medical care, service abroad, leave, parental leave) | yes | „Sie bzw. die versicherten Personen können darüber hinaus verlangen, dass wir eine …“ | Teil 2 Nr. 20.11, page 31 |
| Insurer waives ordinary termination | yes | „Wir können den Versicherungsvertrag ganz oder teilweise nur im Rahmen der gesetzlichen …“ | Teil 2 Nr. 20.5, page 30 |
| Continuation as full cover at 100 per cent on leaving the civil service | yes | „Die Regelungen gelten entsprechend, wenn der Beihilfeanspruch einer versicherten Person …“ | Teil 2 Nr. 19.1, page 30 |
| Premium adjustment rules (triggering factor) | yes | „Bei einer Abweichung von über 5% können wir alle Beiträge der betroffenen …“ | Teil 2 Nr. 16.1, page 29 |
| Direct billing with the hospital | yes | „wenn wir mit einer DKV-Card die Übernahme von Aufwendungen bei stationärem Aufenthalt …“ | Teil 2 Nr. 9, page 27 |
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
- DKV Deutsche Krankenversicherung Aktiengesellschaft
- Distribution
- through tied agents
- Allgemeine Versicherungsbedingungen (AVB) für das BeihilfeMed Tarifsystem, für Beihilfeberechtigte (B 540) Edition: 7.26 (B 540) 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 DKV BeihilfeMed Krankenhaus Tarife BKH1 und BKH2 and
available as plain text.
Volltext DKV BeihilfeMed Krankenhaus Tarife BKH1 und BKH2 Beihilfeversicherung · As text (Markdown) DKV BeihilfeMed Krankenhaus Tarife BKH1 und BKH2 Beihilfe cover