Insurance broker / Company health insurance in Germany (bKV) / Policy wording archive
Hallesche Zusatzbedingungen für -Tarife: the policy wording in full
Zusatzbedingungen für Gruppenverträge der Hallesche: regeln versicherte Personen, Mitversicherung von Angehörigen, Annahme jeder ordnungsgemäßen Anmeldung, Weiterversicherung und Beitragsanpassung; die Leistungen stehen im jeweiligen Tarif (Fassung Januar 2027).
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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 Zusatzbedingungen für -Tarife.
Group contract and enrolment
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Minimum number of insured employees for the group contract | yes | „endet der Gruppenversicherungsvertrag wegen Unterschreitens der im …“ | § 5 (3), page 2 |
| Employer funded version (the company pays the premium) | yes | „Mitarbeiter/-innen, die in der arbeitgeberfinanzierten Krankenzusatzversicherung …“ | § 1 (3) a), page 1 |
| Employee funded version on group terms | yes | „Mitarbeiter/-innen, die in der arbeitnehmerfinanzierten betrieblichen …“ | § 1 (3) b), page 1 |
| Spouses, partners and children can be insured | yes | „Mitversicherte Personen sind die Ehegatten, Lebenspartner gemäß § 1 …“ | § 1 (4), page 1 |
| Enrolment without health questions | yes | „Der Versicherer verpflichtet sich, keine ordnungsgemäße Anmeldung zum …“ | § 2 (2), page 1 |
| Ongoing treatment and pre-existing conditions covered | yes | „Für Versicherungsfälle, die vor Beginn des Versicherungsverhältnisses eingetreten“ | § 2 (4), page 2 |
| 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 | yes | „nach den gültigen gleichartigen Tarifen des Versicherers in unmittelbarem Anschluss …“ | § 5 (2), page 3 |
| Continuation without new health questions or waiting period | yes | „außerhalb der ZbKV-und ZbKVA-Tarife wird rückwirkend zum Beginn des …“ | § 5 (5) b), page 4 |
| 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 | not addressed | ||
| Selectable budget levels | not addressed | ||
| Budget usable freely across all benefit areas of the catalogue | not addressed | ||
| Sub-limits inside the budget (e.g. glasses at most half) | not addressed | ||
| Pro rata budget when cover starts during the year | not addressed | ||
| 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 | not addressed | ||
| Laser eye surgery (LASIK and similar) | not addressed | ||
| Check-ups beyond the statutory programme, without age limits | not addressed | ||
| Vaccinations including travel vaccines | not addressed | ||
| Non-medical practitioners and naturopathy | not addressed | ||
| Osteopathy | not addressed | ||
| Remedies such as physiotherapy, occupational and speech therapy | not addressed | ||
| Medicines and dressings including co-payments | not addressed | ||
| Medical aids such as insoles and braces | not addressed | ||
| Hearing aids | not addressed | ||
| 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 | not addressed | ||
| Dental treatment (fillings, root canal, periodontal) | not addressed | ||
| Dentures (crowns, bridges, prostheses) | not addressed | ||
| Implants | not addressed | ||
| 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) | yes | „Ergibt die Gegenüberstellung eine Veränderung von mehr als 10% der in den technischen …“ | § 7 (1), page 4 |
| 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 | not addressed | ||
| 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.
Please report errors, we correct them the same day.
Policy wordings and provider
- Legal entity
- Hallesche Krankenversicherung auf Gegenseitigkeit
- Distribution
- brokers and direct
- Zusatzbedingungen ZbKV/ZbKVA (MG 99) Edition: Fassung Januar 2027 (MG 99, 06.2026) 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 Zusatzbedingungen für -Tarife and available as plain text.
Volltext Hallesche Zusatzbedingungen für -Tarife · As text (Markdown) Hallesche Zusatzbedingungen für -Tarife