Insurance broker / Health insurance for German civil servants / Policy wording archive Civil servant health cover
LKH Tarife A, S, Z Beihilfe: the policy wording in full
Beihilfetarife A, S und Z für ambulante Behandlung, allgemeine Krankenhausleistungen ohne Wahlleistungen sowie Zahnbehandlung und Zahnersatz in Stufen von 10 bis 50 Prozent, ohne Heilpraktiker und mit Betragsgrenzen für Sehhilfen, Hilfsmittel und Zahnersatz.
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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 LKH Tarife A, S, Z Beihilfe.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Nach diesen Tarifen sind Personen versicherungsfähig, die im Krankheitsfall einen …“ | A. Versicherungsfähigkeit, page 1 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „Tarife A10, A15, A20, A22, A25, A30, A35, A40, A45, A50“ | A., page 1 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | yes | „Beträgt die Erstattungsleistung zusammen mit den Leistungen aus anderen Tarifen und der …“ | A.I., page 1 |
| Adjustment to a changed allowance rate or loss of the allowance without new health check (deadline) | not addressed | ||
| Change of reimbursement level on retirement (for example from 50 to 30 per cent) | yes | „Versicherungsverhältnisse nach Tarif A22 enden bei Eintritt des Versor-gungsfalles …“ | A. Versicherungsfähigkeit, page 1 |
| Valid for the allowance rules of the federation and all federal states | yes | „Anspruch auf Beihilfe im Sinne des Bundes, der Länder oder Gemeinden“ | A. Versicherungsfähigkeit, page 1 |
| 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 | „Erstattungsfähig sind Aufwendungen für 1. Heilbehandlungen und Wegegeld, 2. ambulante …“ | A.I.1., page 1 |
| Medicines and dressings (including non-prescription) | yes, up to the sum insured | „4. Arznei- und Verbandmittel,“ | A.I.1. Nr. 4, page 1 |
| Naturopaths and natural therapies (annual maximum) | no | „Aufwendungen für Behandlungen durch Heilpraktiker sind nicht erstattungsfähig.“ | A.I.3., page 1 |
| Therapies (physiotherapy, occupational therapy, speech therapy) | yes, up to the sum insured | „Aufwendungen für Heilmittel sind bis zu den beihilfefähigen Höchstbeträgen nach der …“ | A.I.4., page 1 |
| Therapies only up to the amounts eligible for the allowance | yes | „Aufwendungen für Heilmittel sind bis zu den beihilfefähigen Höchstbeträgen nach der …“ | A.I.4., page 1 |
| Medical aids with an open catalogue | yes | „Aufwendungen für medizinisch notwendige Hilfsmittel bis zu einem Rechnungsbetrag von …“ | A.I.5. a), page 2 |
| Glasses and contact lenses (amount and period) | yes, up to EUR 300 | „sind bis zu einem Rechnungsbetrag von 300,- EUR je Kalenderjahr erstattungsfähig.“ | A.I.6., page 2 |
| Hearing aids (amount per ear and period) | not addressed | ||
| Outpatient psychotherapy (rate, approval) | yes, up to the sum insured | „Aufwendungen für Psychotherapie durch Ärzte und psychologische Psychotherapeuten sowie …“ | A.I.2., page 1 |
| Psychotherapy limited to a number of sessions | not addressed | ||
| Check ups and vaccinations (also beyond statutory programmes) | yes, up to the sum insured | „Vorsorgeuntersuchungen zur Früherkennung von Krankheiten nach gesetzlich eingeführten …“ | A.I.1. Nr. 3, page 1 |
| Home nursing and palliative care | yes, up to the sum insured | „Aufwendungen für ärztlich verordnete häusliche Behandlungspflege (z. B. Injektionen …“ | A.I.7., page 2 |
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „sind erstattungsfähig, wenn der Transport bzw. die Fahrt wegen der Folgen dieser …“ | A.I.8., page 2 |
| Fertility treatment (conditions, number of attempts) | yes, up to the sum insured | „Bei Insemination sind nach hormoneller Stimulation maximal drei Versuche, im …“ | A.I.9., page 2 |
Inpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General hospital services (shared room, ward doctor) | yes | „medizinische Versorgung, Unterbringung und Verpflegung als allgemeine Krankenhausleistung“ | B.I.1. Nr. 1, page 4 |
| Two bed room as optional service | no | „Stationäre Krankheitskosten ohne Wahlleistungen“ | B., page 4 |
| Single room as optional service | no | „Stationäre Krankheitskosten ohne Wahlleistungen“ | B., page 4 |
| Treatment by senior consultant of choice | no | „Stationäre Krankheitskosten ohne Wahlleistungen“ | B., page 4 |
| 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 | yes, up to the sum insured | „wird die Obergrenze für die erstattungsfähigen Aufwendungen durch die Entgelte …“ | B.I.1., page 4 |
| 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 | „Im Rahmen einer Anschlussheilbehandlung oder medizinischen Rehabilitationsmaßnahme sind …“ | B.I.2., page 4 |
| Spa and sanatorium treatment (subsidy, interval between two stays) | yes, up to EUR 25 | „Bei stationären Kuren und Sanatoriumsbehandlungen sind die Aufwendungen bis zu dem in …“ | B.I.3., page 4 |
| 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 | „konservierende Leistungen (ausgenommen Kronen, Teilkronen und Inlays)“ | C.I.1. Nr. 2, page 5 |
| Dentures (crowns, bridges, prostheses) | yes, up to the sum insured | „Erstattungsfähig sind Aufwendungen für 1. prothetische Leistungen, 2. Kronen, Brücken …“ | C.I.2., page 5 |
| Implants (number per jaw, link to cases eligible for the allowance) | yes, up to the sum insured | „5. implantologische Leistungen,“ | C.I.2. Nr. 5, page 5 |
| Material and laboratory costs at the tariff percentage | yes | „Erstattungsfähig sind Aufwendungen für zahntechnische Leistungen sowie Material- und …“ | C.I.3., page 5 |
| Orthodontics (children, adults) | yes, up to the sum insured | „7. kieferorthopädische Behandlungen.“ | C.I.2. Nr. 7, page 5 |
| Caps on dentures in the first policy years | yes, up to EUR 3,000 | „Innerhalb der ersten drei Kalenderjahre seit Abschluss des Tarifs werden die unter …“ | C.I.4., page 5 |
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 | not addressed | ||
| 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
- Landeskrankenhilfe V.V.a.G.
- Distribution
- brokers and direct
- Tarife A, S, Z Beihilfe Edition: 05.22 (LKH 2-112 05.22) 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 LKH Tarife A, S, Z Beihilfe and available as plain text.
Volltext LKH Tarife A, S, Z Beihilfe Beihilfeversicherung · As text (Markdown) LKH Tarife A, S, Z Beihilfe Beihilfe cover