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Versicherungskammer Bayern Bayerische Beamtenkrankenkasse Ergänzungsbausteine: the policy wording in full
Ergänzungsbausteine BeihilfeKlinikPlus, BeihilfeZahnPlus und BeihilfeErgänzungPlus zum Tarif BeihilfeCOMFORT für Wahlleistungen im Krankenhaus, zahntechnische Kosten und weitere Restkosten nach Beihilfe und Haupttarif.
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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 Ergänzungsbausteine.
Basics and link to the state allowance
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (civil servants, judges, pensioners, dependants, trainees) | not addressed | ||
| Reimbursement levels matching the allowance rate (for example 20, 30, 50 per cent) | yes | „Der Tarif BeihilfeKlinikPlus kann, abhängig vom Beihilfeanspruch, in verschiedenen …“ | BeihilfeKlinikPlus, 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 | 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 | yes | „einer gültigen Honorarvereinbarung über die Höchstsätze der GOÄ hinaus“ | BeihilfeErgänzungPlus, page 3 |
Outpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Outpatient medical treatment at the tariff percentage | not addressed | ||
| Medicines and dressings (including non-prescription) | yes, up to the sum insured | „verordneten nicht verschreibungspflichtigen Arzneimittel“ | BeihilfeErgänzungPlus, page 3 |
| Naturopaths and natural therapies (annual maximum) | yes, up to the sum insured | „bis zu den Höchstsätzen der GebüH“ | BeihilfeErgänzungPlus, page 1 |
| 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 | yes | „Verbleibende Kosten für beihilfefähige Hilfsmittel“ | BeihilfeErgänzungPlus, page 2 |
| Glasses and contact lenses (amount and period) | yes, up to EUR 100 | „100 Euro für Sehhilfen innerhalb von zwei Kalenderjahren“ | BeihilfeErgänzungPlus, page 3 |
| Hearing aids (amount per ear and period) | yes, up to EUR 1,500 | „Summenbegrenzung aus dem Haupttarif für Hörhilfen von max. 1.500 Euro je Ohr“ | BeihilfeErgänzungPlus, page 3 |
| Outpatient psychotherapy (rate, approval) | not addressed | ||
| Psychotherapy limited to a number of sessions | not addressed | ||
| Check ups and vaccinations (also beyond statutory programmes) | yes, up to EUR 100 | „Vorsorgeuntersuchungen bis zu 100 Euro im Kalenderjahr“ | BeihilfeErgänzungPlus, page 3 |
| Home nursing and palliative care | not addressed | ||
| Travel and transport costs (ambulance, journeys to outpatient treatment) | not addressed | ||
| 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 | „berechenbare Unterkunft im“ | BeihilfeKlinikPlus, page 1 |
| Single room as optional service | yes | „Differenz der Kosten zwischen Ein- und Zweibettzimmer“ | BeihilfeErgänzungPlus, page 3 |
| Treatment by senior consultant of choice | yes | „berechenbare ärztliche Behandlung (Chefarzt etc.) bis zu den Höchstsätzen der GOÄ“ | BeihilfeKlinikPlus, page 1 |
| 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 | yes, up to EUR 50 | „Euro pro Tag bei Verzicht auf privatärztliche Behandlung“ | BeihilfeKlinikPlus, page 1 |
| Follow up treatment and inpatient rehabilitation | yes, up to the sum insured | „nschlussheilbehandlung und medizinischer Rehabilita“ | BeihilfeKlinikPlus, page 1 |
| Spa and sanatorium treatment (subsidy, interval between two stays) | yes, up to EUR 40 | „in Höhe von 40 Euro für maximal 28 Tage in 3 Kalenderjahren“ | BeihilfeErgänzungPlus, page 3 |
| 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 | yes | „Material- und Laborkosten bis zu 6.000 Euro im Kalenderjahr“ | BeihilfeZahnPlus, page 2 |
| Orthodontics (children, adults) | not addressed | ||
| Caps on dentures in the first policy years | yes, up to EUR 2,000 | „in den ersten zwei Kalenderjahren auf 2.000 Euro (Ausnahme: Unfall)“ | BeihilfeZahnPlus, page 1 |
Supplement and allowance gaps
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Supplementary tariff for costs the allowance does not or only partly recognise | yes | „und der Leistungen des Tarifs BeihilfeCOMFORT für verbleibende Kosten“ | BeihilfeZahnPlus, page 1 |
| Supplement pays only after a decision of the allowance office | yes | „Der Tarif leistet unter Anrechnung der Beihilfeleistungen“ | BeihilfeZahnPlus, page 1 |
| Compensation of the cost dampening lump sum or the allowance retention | no | „Kostendämpfungspauschalen seitens der Beihilfe leistet der Tarif nicht“ | BeihilfeZahnPlus, page 2 |
| Reimbursement of fees above the rate eligible for the allowance | yes, up to the sum insured | „einer gültigen Honorarvereinbarung über die Höchstsätze der GOÄ hinaus“ | BeihilfeErgänzungPlus, page 3 |
| Extra costs abroad above the domestic allowance rates | yes, up to the sum insured | „bis zu 56 Tagen“ | BeihilfeZahnPlus, page 2 |
| 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) | 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 | 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
- Bayerische Beamtenkrankenkasse Aktiengesellschaft
- Distribution
- through tied agents
- Tarifdetailblatt Beihilfe Ergänzungsbausteine Edition: 339227; 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
Ergänzungsbausteine and available as plain text.
Volltext Versicherungskammer Bayern Bayerische Beamtenkrankenkasse Ergänzungsbausteine Beihilfeversicherung · As text (Markdown) Versicherungskammer Bayern Bayerische Beamtenkrankenkasse Ergänzungsbausteine Beihilfe cover