Insurance broker / Private health insurance in Germany (PKV) / Policy wording archive
Gothaer MediVita Medivita 250: the policy wording in full
Grundschutz mit 100 % ambulant und stationär im Mehrbettzimmer, ohne Heilpraktiker, Zahnleistungen und Wahlleistungen, 250 Euro Selbstbeteiligung und garantierter Beitragsrückerstattung von zwei Monatsbeiträgen (nur Produktinformationsblatt ausgewertet).
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Everything about this policy
What the policy covers: 68 points, each with its clause
Basics
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Eligible persons (employees above the income threshold, self-employed, freelancers, civil servants, students) | not addressed | ||
| Benefit model: reimbursement, direct billing or benefits in kind via a provider network | not addressed | ||
| Free choice among all registered doctors | not addressed | ||
| Gatekeeper principle (GP or telemedicine first, otherwise reduced reimbursement) | not addressed | ||
| Reimbursement beyond the maximum rate of the fee schedule (GOÄ, GOZ) | not addressed | ||
| Annual deductible per insured person | EUR 250 | „Selbstbeteiligung: 250 Euro (125 Euro für unter 21-Jährige) im Tarif MediVita 250“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Co-insurance per service or treatment case (percentage or fixed amount) | not addressed | ||
| Reduced or no deductible for children | yes | „Selbstbeteiligung: 250 Euro (125 Euro für unter 21-Jährige) im Tarif MediVita 250“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Adjustment to the civil service subsidy rate (top up when the subsidy changes or ends, without new health check) | not addressed |
Outpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Reimbursement rate for outpatient medical treatment | yes | „Ambulante Behandlung: 100 %“ | Was ist versichert?, page 1 |
| Medication and dressings (including non prescription) | yes, up to the sum insured | „Arznei- und Verbandmittel: 100 %; der Erstattungssatz vermindert sich bei regelmäßig einzunehmenden Arznei- und zu verwendenden Verbandmittel auf 80 %, wenn die vom Versicherer benannte Bezugsquelle nicht in Anspruch genommen wurde.“ | Was ist versichert?, page 1 |
| Alternative practitioners and naturopathy | no | „Heilpraktiker“ | Was ist nicht versichert?, page 1 |
| Therapeutic remedies (physiotherapy, occupational and speech therapy) with rate and price list | yes, up to the sum insured | „Heilmittel: 100 % gemäß tariflichem Heilmittelverzeichnis“ | Was ist versichert?, page 1 |
| Therapies only up to the prices of a tariff price list | yes | „Heilmittel: 100 % gemäß tariflichem Heilmittelverzeichnis“ | Was ist versichert?, page 1 |
| Medical aids with an open catalogue (not an exhaustive list) | yes | „Hilfsmittel: 100 %; der Erstattungssatz vermindert sich auf 80 %, wenn die vom Versicherer benannte Bezugsquelle nicht in Anspruch genommen wurde.“ | Was ist versichert?, page 1 |
| Medical aids with a closed catalogue (only those listed) | not addressed | ||
| Glasses and contact lenses (amount and period) | yes, up to EUR 100 | „Sehhilfen: 100 %; bis 100 Euro pro Jahr“ | Was ist versichert?, page 1 |
| Hearing aids | not addressed | ||
| Outpatient psychotherapy (reimbursement rate) | yes, up to the sum insured | „Psychotherapie: 80 %, bis zu 20 Sitzungen pro Jahr“ | Was ist versichert?, page 1 |
| Psychotherapy limited to a number of sessions per year or in total | yes | „Psychotherapie: 80 %, bis zu 20 Sitzungen pro Jahr“ | Was ist versichert?, page 1 |
| Check ups and vaccinations without deductible | not addressed | ||
| Home nursing and specialised outpatient palliative care | not addressed | ||
| Patient transport (ambulance, journeys to outpatient treatment) | not addressed | ||
| Telemedicine and video consultations | not addressed |
Inpatient benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Accommodation in a two bed room | no | „Unterkunft Zweibettzimmer“ | Was ist nicht versichert?, page 1 |
| Accommodation in a single room | no | „Unterkunft Einbettzimmer“ | Was ist nicht versichert?, page 1 |
| Private treatment by the chief or chosen physician | no | „Privatärztliche Behandlung (Chefarzt)“ | Was ist nicht versichert?, page 1 |
| Treatment in private hospitals without public contract | not addressed | ||
| Inpatient psychotherapy and psychiatry (number of days, approval) | yes, up to the sum insured | „Krankenhausbehandlung: 100 %; für psychotherapeutische Behandlung für 6 Wochen, danach 70 % bei nachgewiesener medizinischer Notwendigkeit“ | Was ist versichert?, page 1 |
| Follow up rehabilitation after hospital | not addressed | ||
| Spa and sanatorium treatment | not addressed | ||
| Accommodation of an accompanying person (rooming in for children) | not addressed | ||
| Substitute daily allowance when private options are not used | not addressed |
Dental
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Dental treatment (fillings, root canal, periodontal) with rate | no | „Zahnärztliche Leistungen“ | Was ist nicht versichert?, page 1 |
| Dentures (crowns, bridges, prostheses) with rate | no | „Zahnärztliche Leistungen“ | Was ist nicht versichert?, page 1 |
| Implants without a limit on number | no | „Zahnärztliche Leistungen“ | Was ist nicht versichert?, page 1 |
| Orthodontics (children, adults after accident or illness) | no | „Zahnärztliche Leistungen“ | Was ist nicht versichert?, page 1 |
| Caps on dentures in the first policy years (dental scale) | not addressed | ||
| Dental lab work only up to a price and benefit list | not addressed |
Sick pay and abroad
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Daily sickness allowance in the plan or as an add on (self-employed and employees) | not addressed | ||
| Start of sick pay (waiting day) | not addressed | ||
| Cover during temporary stays abroad (duration, worldwide or Europe) | yes | „bieten wir Ihnen Versicherungsschutz in Europa. Während der ersten sechs Monate eines vorübergehenden Auslandsaufenthaltes auch im außereuropäischen Ausland.“ | Wo bin ich versichert?, page 1 |
| Continuation when moving to another EU or EEA country | not addressed | ||
| Medically advisable repatriation from abroad | not addressed |
Underwriting and waiting periods
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General waiting period | yes | „Es können Wartezeiten gelten, nach deren Ablauf Sie erst Leistungen erhalten.“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Special waiting periods (childbirth, psychotherapy, dentures, orthodontics) | not addressed | ||
| Waiver of waiting periods (prior insurance, medical exam, accident) | not addressed | ||
| Health questions: look back period (years outpatient, inpatient, psychotherapy) | yes | „Vor Vertragsschluss wird ggf. eine Gesundheitsprüfung durchgeführt.“ | Welche Verpflichtungen habe ich?, page 1 |
| Exclusion of or surcharge for pre existing conditions | yes | „Eine Gesundheitsprüfung kann zu individuellen Leistungsausschlüssen führen, auf die wir Sie gesondert hinweisen.“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Newborn cover without health check or waiting period | not addressed | ||
| Maximum entry age | not addressed |
Contract and premium
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Profit related premium refund when no claims are made | yes, up to the sum insured | „zusätzlich erfolgsabhängige (nicht garantierte) Beitragsrückerstattung“ | Was ist versichert?, page 1 |
| Guaranteed (contractually promised) premium refund | yes, up to the sum insured | „garantierte Beitragsrückerstattung für leistungsfreie Versicherungsjahre in Höhe von 2 Monatsbeiträgen“ | Was ist versichert?, page 1 |
| Option to upgrade without health check | yes | „Optionsrecht: Option auf höherwertigen Versicherungsschutz“ | Was ist versichert?, page 1 |
| Right to lower the deductible without health check | not addressed | ||
| Ageing reserves and portability on switching | not addressed | ||
| Premium relief in old age (add on or built in) | not addressed | ||
| Dormant cover or suspension (abroad, parental leave, return to statutory insurance) | not addressed | ||
| Insurer waives ordinary right to terminate | not addressed | ||
| Premium adjustment rules (trigger factor, caps, limitation funds) | not addressed |
Austria and Spain
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Replacement of statutory health insurance (opting out for professionals) | not addressed | ||
| Only available through a chamber or employer group contract | not addressed | ||
| Provider network (cuadro médico) with scope and regional coverage | not addressed | ||
| Co-payment per visit or service (copago) | not addressed | ||
| Annual cap on co-payments | not addressed | ||
| Single hospital room with companion bed | not addressed | ||
| Second medical opinion, including international | not addressed | ||
| Waiting period for childbirth | 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
- Gothaer Krankenversicherung Aktiengesellschaft
- Distribution
- brokers and direct
- Produktinformationsblatt Krankheitskostenvollversicherung Tarif MediVita Edition: ohne Angabe im Text Copy hosted by an intermediary, not by the insurer
Full text of the wording
Converted from the insurer's PDF, page numbers in square brackets. Tables may have shifted; if in doubt, the original applies. As text (Markdown)