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ALTE OLDENBURGER KTO für Selbstständige und Arbeitnehmer: the policy wording in full
Krankentagegeld für Selbstständige und Arbeitnehmer mit langen Karenzzeiten ab dem 43. Tag, Leistung ohne zeitliche Höchstgrenze und Anpassung bei Gehaltserhöhung.
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Everything about this policy
What the policy covers: 62 points, each with its clause
Quotes are shortened.
The full German wording of each point is on the German page for ALTE OLDENBURGER KTO für
Selbstständige und Arbeitnehmer.
Basics
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Insurable daily sickness benefit per calendar day (maximum) | yes | „Das Krankentagegeld beträgt mindestens 5,– EUR und kann mehrfach versichert werden“ | Teil III A, page 2 |
| Benefit capped at net earned income (no overinsurance) | yes | „Das Krankentagegeld beträgt mindestens 5,– EUR und kann mehrfach versichert werden …“ | Teil III A, page 2 |
| Income basis (reference period, self employed: profit as assessed for tax) | not addressed | ||
| Selectable deferment periods (benefit from day x of incapacity) | yes | „KTO 6 nach Ablauf von 42 KTO 13 nach Ablauf von 91 KTO 26 nach Ablauf von 182 …“ | Teil III A, page 1 |
| Earliest benefit start (shortest deferment) | yes | „KTO 6 nach Ablauf von 42“ | Teil III A, page 1 |
| Benefit duration without time limit (as long as incapacity lasts) | yes | „Das tarifliche Krankentagegeld wird ohne zeitliche Höchstgrenze bis zum Ende …“ | Teil III A, page 2 |
| Eligible persons (employees, self employed, freelancers, members of statutory insurance) | yes | „Krankentagegeldversicherung für Selbstständige und Arbeitnehmer“ | Teil III Titel, page 1 |
| Tariff topping up statutory sickness pay (gap to net income) | not addressed | ||
| Offsetting of continued pay and social benefits against the benefit | yes | „Entsprechend der Dauer der Entgeltfortzahlung durch den Arbeitgeber ist die …“ | Teil III B, page 2 |
Scope of benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Benefit for partial incapacity | not addressed | ||
| Benefit during gradual return to work | not addressed | ||
| Benefit during inpatient treatment without or with shortened deferment | not addressed | ||
| Benefit during statutory maternity protection periods | not addressed | ||
| Benefit when a child falls ill (care) | not addressed | ||
| Benefit for mental illness without special restriction | not addressed | ||
| Benefit during spa treatment, sanatorium stay or rehabilitation | not addressed | ||
| Benefit for incapacity abroad (Europe, worldwide) | not addressed | ||
| Benefit for incapacity due to organ or tissue donation | not addressed | ||
| Benefit for pregnancy complications outside protection periods | yes | „Es besteht ein Leistungsanspruch für Zeiten außerhalb des Beschäftigungsverbotes nach …“ | Teil III C, page 2 |
| Retroactive payment from the start despite late notice (no reduction) | not addressed |
Waiting periods
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| General waiting period | not addressed | ||
| Special waiting periods (childbirth, psychotherapy, dental treatment) | not addressed | ||
| No waiting period after an accident | not addressed | ||
| Credit for prior insurance periods against waiting periods | not addressed | ||
| No new deferment for recurring incapacity from the same cause | not addressed |
End of benefit and contract
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Benefit ends on occupational disability | not addressed | ||
| Definition of occupational disability (degree, prognosis period) | not addressed | ||
| Continued payment after occupational disability (months) | not addressed | ||
| Ends on receipt of old age or reduced earning capacity pension | not addressed | ||
| Age at which cover ends | not addressed | ||
| Continuation or dormant cover during unemployment | not addressed | ||
| Continuation or dormant cover during parental leave | not addressed | ||
| Insurer may reduce the benefit when income falls | yes | „Erlangt der Versicherer davon Kenntnis, dass das versicherte Krankentagegeld höher ist …“ | Teil III, page 2 |
| Insurer waives ordinary right of termination | not addressed | ||
| Ends when residence or workplace moves abroad | not addressed |
Adjustments and options
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Increase on higher income without health check | yes | „Für die Anpassung entfallen erneute Wartezeiten und eine erneute Risikoprüfung; bei …“ | Teil III D, page 2 |
| Shorter deferment without health check | not addressed | ||
| Conversion between employed and self employed without new health check | not addressed | ||
| Automatic indexation of the benefit | yes | „Der Versicherer bietet den Versicherungsnehmern mindestens alle 3 Jahre Gelegenheit, in …“ | Teil III D, page 2 |
| Dormant cover for a reduced premium | not addressed | ||
| Premium waiver while receiving benefit | not addressed | ||
| Right to convert into disability income insurance | not addressed |
Obligations
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Deadline to report incapacity | not addressed | ||
| Interval for proof of incapacity (medical certificate) | not addressed | ||
| Examination by a doctor appointed by the insurer | not addressed | ||
| Duty to report a fall in income | not addressed | ||
| Benefit only while staying at home or in the country during incapacity | not addressed | ||
| Further sickness benefit cover only with the insurer's consent | not addressed |
Exclusions
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Exclusion for intent | not addressed | ||
| Exclusion for addiction (alcohol, drugs) and withdrawal treatment | not addressed | ||
| Exclusion for acts of war | not addressed | ||
| Exclusion for accidents under alcohol or drugs | not addressed | ||
| Exclusion for medically unnecessary procedures (e.g. cosmetic surgery) | not addressed | ||
| Exclusion of pre existing conditions | not addressed | ||
| Exclusion of certain sports or competitions | not addressed | ||
| Exclusion or restriction for back conditions | not addressed |
Spain specifics
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Benefit by diagnosis table (baremo) instead of actual days | not addressed | ||
| Maximum benefit duration per claim (days) | not addressed | ||
| Additional daily benefit for hospital stay | not addressed | ||
| Benefit only if incapacity is recognised by social security or the professional mutual | not addressed | ||
| Fixed benefit for childbirth or maternity | not addressed | ||
| Additional lump sum for death or permanent disability | 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
- ALTE OLDENBURGER Krankenversicherung AG, ALTE OLDENBURGER Krankenversicherung von 1927 Versicherungsverein auf Gegenseitigkeit
- Distribution
- available through brokers
- Krankentagegeldversicherung für Selbstständige und Arbeitnehmer KTO (AVB Teil III, Tarifstufen KTO 6, 13, 26) Edition: Stand 08/2010 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 ALTE OLDENBURGER KTO für Selbstständige und Arbeitnehmer and
available as plain text.
Volltext ALTE OLDENBURGER KTO für Selbstständige und Arbeitnehmer Krankentagegeld · As text (Markdown) ALTE OLDENBURGER KTO für Selbstständige und Arbeitnehmer