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Hallesche Beihilfetarif CAZ: the policy wording in full
Beihilfetarif für ambulante und zahnärztliche Behandlung, Kur und Rehabilitation in den Stufen 10 bis 50 Prozent, mit eigenem Heilmittelverzeichnis und Rechnungshöchstbeträgen beim Zahn in den ersten vier Kalenderjahren; stationäre Leistungen und Anschlussheilbehandlung sind nicht enthalten.
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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 Hallesche Beihilfetarif CAZ.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Versicherungsfähig sind Personen mit Anspruch auf Beihilfe im Sinne einer …“ | I., page 1 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „Tarifstufe CAZ.50 50% des Rechnungsbetrages Tarifstufe CAZ.45 45% des Rechnungsbetrages“ | II., page 2 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | yes | „Der Erstattungsprozentsatz des Tarifs CAZ (siehe Abschnitt II.) darf zusammen mit dem …“ | IV., page 9 |
| Adjustment to a changed allowance rate or loss of the allowance without new health check (deadline) | yes | „Der Versicherungsnehmer ist verpflichtet, Erhöhungen des Beihilfebemessungssatzes dem …“ | IV., page 9 |
| Change of reimbursement level on retirement (for example from 50 to 30 per cent) | yes | „Eintritt des Versorgungsfalles 50% der erstattungsfähigen Aufwendungen. Danach …“ | I., page 1 |
| 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 | „Hierzu gehören Beratungen, Besuche, Behandlungen, Untersuchungen, Wegegebühren …“ | III. 1.1, page 2 |
| Medicines and dressings (including non-prescription) | yes, up to the sum insured | „1.6 Arznei- und Verbandmittel“ | III. 1.6, page 2 |
| Naturopaths and natural therapies (annual maximum) | yes, up to the sum insured | „Sonderleistungen und Wegegebühren bis zum jeweiligen in dem GebüH“ | III. 1.2, page 2 |
| Therapies (physiotherapy, occupational therapy, speech therapy) | yes, up to the sum insured | „Die Aufwendungen sind bis zu den im Heilmittelverzeichnis (Anhang 1) genannten Preisen …“ | III. 1.5, page 2 |
| Therapies only up to the amounts eligible for the allowance | not addressed | ||
| Medical aids with an open catalogue | yes | „Erstattungsfähig sind Aufwendungen für Hilfsmittel (sächliche und technische Mittel …“ | III. 1.8, page 2 |
| Glasses and contact lenses (amount and period) | yes, up to the sum insured | „Brillengestell bis zu 180 €“ | III. 1.7, page 2 |
| Hearing aids (amount per ear and period) | not addressed | ||
| Outpatient psychotherapy (rate, approval) | yes, up to the sum insured | „1.10 Psychotherapie“ | III. 1.10, 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 | „Erstattungsfähig sind auch Aufwendungen für Einzel- und Mehrfachimpfungen, die von der …“ | III. 1.9, page 3 |
| Home nursing and palliative care | yes, up to the sum insured | „Erstattungsfähig sind Aufwendungen für ärztlich verordnete häusliche Krankenpflege“ | III. 1.16, page 5 |
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „Fahrten und Transporte zum und vom nächst erreichbaren geeigneten Arzt, Krankenhaus …“ | III. 1.3, page 2 |
| Fertility treatment (conditions, number of attempts) | yes, up to the sum insured | „Zum Zeitpunkt der Behandlung hat die Frau das 40. Lebensjahr noch nicht vollendet.“ | III. 1.13, page 4 |
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 | yes, up to the sum insured | „Nicht aus diesem Tarif erstattungsfähig sind stationäre Anschlussheilbehandlungen und …“ | III. 1.21 Nr. 2, page 7 |
| Spa and sanatorium treatment (subsidy, interval between two stays) | yes, up to the sum insured | „sich aus 30 € je Tag, entsprechend der“ | III. 1.21 Nr. 1, page 7 |
| 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 | „Hierzu gehören allgemeine, prophylaktische, konservierende und chirurgische Leistungen“ | III. 2.1, page 8 |
| Dentures (crowns, bridges, prostheses) | yes, up to the sum insured | „Hierzu gehören prothetische Leistungen, Zahnkronen jeder Art, Zahnbrücken und Stiftzähne“ | III. 2.2, page 8 |
| Implants (number per jaw, link to cases eligible for the allowance) | yes, up to the sum insured | „Bei Zahnersatz in Form von Implantaten ist dem Versicherer vor Behandlungsbeginn …“ | III. 2.3, page 8 |
| Material and laboratory costs at the tariff percentage | yes | „einschließlich der jeweils zugehörigen zahntechnischen Leistungen und Materialien.“ | III. 2.2, page 8 |
| Orthodontics (children, adults) | yes, up to the sum insured | „kieferorthopädische Maßnahmen, funktionsanalytische und funktionstherapeutische Maßnahmen“ | III. 2.2, page 8 |
| Caps on dentures in the first policy years | yes, up to EUR 2,000 | „2.000 € im 1. Kalenderjahr 4.000 € im 1. bis 2. Kalenderjahr 6.000 € im 1. bis 3 …“ | III. 2.3, page 8 |
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 | „Die Versicherung nach Tarif CAZ endet mit Ende des Monats, in dem der Beihilfeanspruch …“ | I., page 1 |
| 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.
Despite care, a value may be misread;
legally only the wording of your own contract in the edition stated there applies.
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Policy wordings and provider
- Legal entity
- Hallesche Krankenversicherung auf Gegenseitigkeit
- Distribution
- brokers and direct
- Tarif CAZ, Teil III der Allgemeinen Versicherungsbedingungen (PM 69u) Edition: Fassung Januar 2027 (PM 69u 06.26) 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 Hallesche Beihilfetarif CAZ and available as plain text.
Volltext Hallesche Beihilfetarif CAZ Beihilfeversicherung · As text (Markdown) Hallesche Beihilfetarif CAZ Beihilfe cover