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Versicherungskammer Bayern Bayerische Beamtenkrankenkasse BeihilfeCOMFORT: the policy wording in full
Beihilfetarif der Bayerischen Beamtenkrankenkasse für ambulante, stationäre und zahnärztliche Leistungen zum versicherten Prozentsatz ohne Selbstbehalt, ohne Wartezeiten und mit offenem Heil- und Hilfsmittelkatalog.
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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 Versicherungskammer Bayern
Bayerische Beamtenkrankenkasse BeihilfeCOMFORT.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | yes | „Personen mit Beihilfeanspruch und beihilfeberücksichtigungsfähige Familienangehörige“ | Versicherungsfähig, page 1 |
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „kann, abhängig vom Beihilfeanspruch, in verschiedenen Tarifstufen abgeschlossen werden“ | Tarifbezeichnungen, page 1 |
| Total reimbursement from allowance and insurance capped at 100 per cent of costs | not addressed | ||
| 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) | not addressed | ||
| Valid for the allowance rules of the federation and all federal states | yes | „Tarifstufen BC SB Hessen“ | Tarifstufen, 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 | no | „bis zu den Höchstsätzen der GOÄ (3,5 facher Satz)“ | Ambulante Leistungen, page 2 |
Outpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Outpatient medical treatment at the tariff percentage | yes | „Tarifleistungen werden zum versicherten Prozentsatz erbracht“ | Tarifleistungen, page 1 |
| Medicines and dressings (including non-prescription) | yes, up to the sum insured | „Arznei- und Verbandmittel“ | Ambulante Leistungen, page 2 |
| Naturopaths and natural therapies (annual maximum) | yes, up to the sum insured | „bis Höchstsätze GebüH und darüber hinaus nach Hufelandverzeichnis“ | Alternative Heilmethoden, page 2 |
| Therapies (physiotherapy, occupational therapy, speech therapy) | yes, up to the sum insured | „Heilmittelkatalog bis zu beihilfefähigen Höchstsätzen des Bundes“ | Heilmittel, page 2 |
| Therapies only up to the amounts eligible for the allowance | yes | „Heilmittelkatalog bis zu beihilfefähigen Höchstsätzen des Bundes“ | Heilmittel, page 2 |
| Medical aids with an open catalogue | yes | „Hilfsmittelkatalog“ | Hilfsmittel, page 2 |
| Glasses and contact lenses (amount and period) | yes, up to EUR 500 | „bis zu 500 Euro Rechnungsbetrag in zwei Kalenderjahren“ | Hilfsmittel, page 2 |
| Hearing aids (amount per ear and period) | yes, up to EUR 1,500 | „bis zu 1.500 Euro Rechnungsbetrag je Ohr“ | Hilfsmittel, page 2 |
| Outpatient psychotherapy (rate, approval) | yes, up to the sum insured | „50 Sitzungen im Kalenderjahr“ | Psychotherapie, page 2 |
| Psychotherapy limited to a number of sessions | yes | „50 Sitzungen im Kalenderjahr“ | Psychotherapie, page 2 |
| Check ups and vaccinations (also beyond statutory programmes) | yes, up to the sum insured | „Vorsorgeuntersuchungen nach gesetzlich eingeführten Programmen ohne Alters- und …“ | Vorsorgeuntersuchungen und Impfungen, page 2 |
| Home nursing and palliative care | yes, up to the sum insured | „Behandlungspflege ohne Begrenzung“ | Häusliche Krankenpflege, page 2 |
| Travel and transport costs (ambulance, journeys to outpatient treatment) | yes, up to the sum insured | „Fahrtkosten bis 50 Euro zur ambulanten Heilbehandlung“ | Fahrt- und Transportkosten, page 2 |
| Fertility treatment (conditions, number of attempts) | yes, up to the sum insured | „3 Inseminationen und 3 In-Vitro Fertilisationen“ | Künstliche Befruchtung, page 2 |
Inpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General hospital services (shared room, ward doctor) | yes | „Allgemeine Krankenhausleistungen“ | Stationäre Leistungen, page 3 |
| 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 | yes, up to the sum insured | „Privatkliniken günstigste Zimmerkategorie“ | Stationäre Leistungen, page 3 |
| 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 | „Anschlussheilbehandlung und medizinische Rehabilitation“ | Stationäre Leistungen, page 3 |
| Spa and sanatorium treatment (subsidy, interval between two stays) | yes, up to the sum insured | „Keine Erstattung für Unterbringung und Verpflegung“ | Ambulante Kuren, page 3 |
| Inpatient psychotherapy and psychiatry (days, prior approval) | yes, up to the sum insured | „Stationäre Psychotherapie“ | Stationäre Leistungen, page 1 |
Dental
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Dental treatment and prophylaxis | yes, up to the sum insured | „Leistungen inkl. Professionelle Zahnreinigung“ | Zahnleistungen, page 3 |
| Dentures (crowns, bridges, prostheses) | yes, up to the sum insured | „Brücken mit Verblendungen, Veneers“ | Zahnersatz, page 3 |
| Implants (number per jaw, link to cases eligible for the allowance) | yes, up to the sum insured | „einschließlich Knochenaufbau“ | Zahnersatz, page 2 |
| Material and laboratory costs at the tariff percentage | yes | „Preis- und Leistungsverzeichnis“ | Material- und Laborkosten, page 4 |
| Orthodontics (children, adults) | yes, up to the sum insured | „muss vor Vollendung des 18. Lebensjahres begonnen werden“ | Kieferorthopädie, page 4 |
| Caps on dentures in the first policy years | none | „Summenbegrenzung erfolgt im Ergänzungsbaustein“ | Zahnstaffel, page 4 |
Supplement and allowance gaps
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Supplementary tariff for costs the allowance does not or only partly recognise | yes | „BeihilfeCOMFORT (SB) + BeihilfeKlinikPlus + BeihilfeErgänzungPlus“ | Kombinationsmöglichkeiten, page 1 |
| 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 | no | „bis zu den Höchstsätzen der GOÄ (3,5 facher Satz)“ | Ambulante Leistungen, page 2 |
| Extra costs abroad above the domestic allowance rates | not addressed | ||
| Cover abroad for temporary stays (duration, worldwide or Europe) | yes | „Vorübergehender Auslandsaufenthalt bis zu 12 Monate weltweit ohne besondere Vereinbarung“ | Ausland, page 2 |
| Repatriation from abroad | yes, up to the sum insured | „zu 100 Prozent unabhängig vom versicherten Prozentsatz“ | Rücktransport aus dem Ausland, page 3 |
Trainees, admission and waiting periods
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Trainee tariff with reduced premium (without or with low ageing reserves) | yes | „Besondere Bedingungen für Beamte auf Widerruf“ | Tarifbezeichnungen, page 1 |
| 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 | none | „Keine Wartezeiten“ | Wartezeiten, page 2 |
| Special waiting periods (childbirth, psychotherapy, dentures, orthodontics) | none | „Keine Wartezeiten“ | Wartezeiten, page 2 |
| 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 | none | „BeihilfeComfort ohne Selbstbehalt (BC)“ | Tarif, page 1 |
| 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 | yes | „einschließlich Impfstoff gemäß STIKO“ | Vorsorgeuntersuchungen und Impfungen, page 2 |
| 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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Policy wordings and provider
- Legal entity
- Bayerische Beamtenkrankenkasse Aktiengesellschaft
- Distribution
- through tied agents
- Tarifdetailblatt BeihilfeCOMFORT Edition: 339225; 08/18 Copy hosted by an intermediary, not by the insurer
Full text of the wording
The full text exists only in German.
It is printed on the German page for Versicherungskammer Bayern Bayerische Beamtenkrankenkasse
BeihilfeCOMFORT and available as plain text.
Volltext Versicherungskammer Bayern Bayerische Beamtenkrankenkasse BeihilfeCOMFORT Beihilfeversicherung · As text (Markdown) Versicherungskammer Bayern Bayerische Beamtenkrankenkasse BeihilfeCOMFORT Beihilfe cover