Insurance broker / Company health insurance in Germany (bKV) / Policy wording archive
Hallesche FEELfree: the policy wording in full
Arbeitgeberfinanzierter Budgettarif FEELfree mit Höchsterstattungsbetrag von 300 bis 1.500 Euro je Kalenderjahr für Sehhilfen, Hörgeräte, Hilfs-, Heil- und Arzneimittel, Heilpraktiker und Zahnleistungen bei 100 Prozent Erstattung (Fassung Januar 2024).
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Everything about this policy
What the policy covers: 68 points, each with its clause
Quotes are shortened. The full German wording of each point is on the German page for Hallesche FEELfree.
Group contract and enrolment
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Minimum number of insured employees for the group contract | not addressed | ||
| Employer funded version (the company pays the premium) | yes | „Versicherungsfähig sind alle Personen, sofern sie als Mitarbeiter/-in in der …“ | I., page 1 |
| Employee funded version on group terms | no | „Versicherungsfähig sind alle Personen, sofern sie als Mitarbeiter/-in in der …“ | I., page 1 |
| Spouses, partners and children can be insured | no | „Versicherungsfähig sind alle Personen, sofern sie als Mitarbeiter/-in in der …“ | I., page 1 |
| Enrolment without health questions | not addressed | ||
| Ongoing treatment and pre-existing conditions covered | not addressed | ||
| Waiting periods | not addressed | ||
| Both statutory and privately insured persons are eligible | not addressed | ||
| Maximum age at enrolment | not addressed | ||
| New employees join without health questions (registration deadline) | not addressed | ||
| Continuation as individual cover on leaving the company | not addressed | ||
| Continuation without new health questions or waiting period | not addressed | ||
| Cover suspended during parental leave, sick pay periods or unpaid leave | not addressed |
Health budget
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Annual budget per insured person | yes, up to EUR 1,500 | „Je nach gewählter Tarifstufe gelten pro Person und Kalenderjahr folgende …“ | III., page 2 |
| Selectable budget levels | yes | „300 € in Tarifstufe FEELfree 300“ | III., page 1 |
| Budget usable freely across all benefit areas of the catalogue | yes | „Der Höchsterstattungsbetrag gilt insgesamt für alle unter II. aufgeführten Leistungen.“ | II.10, page 2 |
| Sub-limits inside the budget (e.g. glasses at most half) | yes | „Erstattungsfähig bis zur Höhe von zusammen insgesamt 180 € pro Person und Kalenderjahr …“ | II.1, page 1 |
| Pro rata budget when cover starts during the year | yes | „Beginnt die Versicherung nicht am 1. Januar eines Kalenderjahres, dann vermindert sich …“ | III., page 2 |
| Carry over of unused budget to the next year | not addressed | ||
| Budget increase after a claim free year or extra budget | not addressed | ||
| Additional benefit beyond the budget in severe cases (e.g. hospital, serious illness) | not addressed |
Outpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Glasses and contact lenses | yes, up to EUR 180 | „Erstattungsfähig bis zur Höhe von zusammen insgesamt 180 € pro Person und Kalenderjahr …“ | II.1, page 1 |
| Laser eye surgery (LASIK and similar) | yes, up to EUR 180 | „Erstattungsfähig bis zur Höhe von zusammen insgesamt 180 € pro Person und Kalenderjahr …“ | II.1, page 1 |
| Check-ups beyond the statutory programme, without age limits | not addressed | ||
| Vaccinations including travel vaccines | not addressed | ||
| Non-medical practitioners and naturopathy | yes | „Erstattungsfähig sind die ambulanten Heilbehandlungen durch Heilpraktiker im Sinne des …“ | II.6, page 2 |
| Osteopathy | not addressed | ||
| Remedies such as physiotherapy, occupational and speech therapy | yes | „Erstattungsfähig sind die Aufwendungen für folgende ärztlich verordnete Heilmittel:“ | II. Heilmittel, page 2 |
| Medicines and dressings including co-payments | yes | „Erstattungsfähig sind die Aufwendungen für ärztlich verordnete Arznei- und Verbandmittel.“ | II.5, page 2 |
| Medical aids such as insoles and braces | yes | „Erstattungsfähig sind Aufwendungen für Hilfsmittel (sächliche und technische Mittel …“ | II. Sonstige Hilfsmittel, page 1 |
| Hearing aids | yes | „Erstattungsfähig sind die Aufwendungen für die Neuanschaffung oder den Ersatz eines …“ | II. Hörgeräte, page 1 |
| Private doctor treatment and fees above statutory rates | not addressed | ||
| Specialist appointment service | not addressed | ||
| Telemedicine and video consultation | not addressed | ||
| Outpatient psychotherapy or psychological counselling | not addressed |
Dental
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Professional dental cleaning | yes, up to EUR 60 | „Erstattungsfähig bis zur Höhe von zusammen insgesamt 60 € pro Person und Kalenderjahr …“ | II. Zahnprophylaxe, page 2 |
| Dental treatment (fillings, root canal, periodontal) | yes | „Kunststofffüllungen, Inlays (Metall/Keramik/Kunststoff) und Wurzel- und …“ | II. Zahnbehandlung, page 2 |
| Dentures (crowns, bridges, prostheses) | yes | „Erstattungsfähig sind die Aufwendungen für Zahnersatz.“ | II. Zahnersatz, page 2 |
| Implants | yes | „Als Zahnersatz gelten Prothesen, Kronen, Brücken, Implantate“ | II. Zahnersatz, page 2 |
| Orthodontics | not addressed | ||
| Graded dental limits in the first years | not addressed |
Hospital
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Single room | not addressed | ||
| Two bed room | not addressed | ||
| Senior consultant or chosen doctor in hospital | not addressed | ||
| Daily hospital cash | not addressed | ||
| Substitute cash if elective services are waived | not addressed | ||
| Free choice of hospital including private clinics | not addressed |
Further modules and services
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Daily sickness allowance | not addressed | ||
| Long term care module | not addressed | ||
| Travel health insurance abroad | not addressed | ||
| Benefit on diagnosis of serious illness | not addressed | ||
| Medical second opinion | not addressed | ||
| Health services for the company (prevention, employee counselling, app) | not addressed |
Contract, premium and claims
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Uniform premium regardless of age and sex | not addressed | ||
| Premium adjustment (trigger and procedure) | not addressed | ||
| Minimum term of the group contract | not addressed | ||
| Notice period for the company | not addressed | ||
| Ordinary right of the insurer to terminate | not addressed | ||
| Reimbursement rate as a percentage of the invoice | yes | „Erstattet werden 100% der erstattungsfähigen Aufwendungen“ | II.10, page 2 |
| Deductible | not addressed | ||
| Statutory health insurance must pay first | not addressed | ||
| Deadline for submitting invoices | not addressed | ||
| Territorial scope (domestic, Europe, worldwide) | not addressed |
Austria and Spain specifics
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Designed for the tax free provision up to 300 euros a year (Austria) | not addressed | ||
| Own provider network (benefits only from network doctors) | not addressed | ||
| Reimbursement option (free choice with refund) | not addressed | ||
| Co-payment per visit or service | not addressed | ||
| Taken out through flexible remuneration (tax free up to 500 euros per person) | 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 bKV-FEELfree (MG 215) Edition: Fassung Januar 2024 (MG 215, 01.24) 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 FEELfree and available as plain text.
Volltext Hallesche FEELfree · As text (Markdown) Hallesche FEELfree