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Gothaer Tarif TG: the policy wording in full
Krankentagegeld nach Teil III mit acht Tarifstufen vom 8. bis zum 366. Tag, frei wählbar in Schritten zu 1 Euro, Stufen bis zum 43. Tag nur für Selbstständige.
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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 Gothaer Tarif TG.
Basics
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Insurable daily sickness benefit per calendar day (maximum) | yes, up to the sum insured | „Das Krankentagegeld kann in einer Höhe von 1 EUR oder einem Vielfachen hiervon …“ | Teil III A. Nr. 3, page 1 |
| Benefit capped at net earned income (no overinsurance) | not addressed | ||
| Income basis (reference period, self employed: profit as assessed for tax) | not addressed | ||
| Selectable deferment periods (benefit from day x of incapacity) | yes | „Als Leistungsbeginn kann vereinbart werden in Tarifstufe TG1 der 8. Tag der …“ | Teil III A. Nr. 2, page 1 |
| Earliest benefit start (shortest deferment) | yes | „Tarifstufe TG1 der 8. Tag der Arbeitsunfähigkeit“ | Teil III A. Nr. 2, page 1 |
| Benefit duration without time limit (as long as incapacity lasts) | yes | „Für die Dauer einer Arbeitsunfähigkeit (§ 1 Abs. 3 AVB) wird ab vereinbartem …“ | Teil III A. Nr. 1, page 1 |
| Eligible persons (employees, self employed, freelancers, members of statutory insurance) | yes | „Nach den Tarifen TG6, TG13, TG26 und TG52 können nur Personen versichert werden, die …“ | Teil III B. Nr. 3, 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 | „ab vereinbartem Leistungsbeginn, frühestens nach Fortfall der Gehaltszahlung, ein …“ | Teil III A. Nr. 1, page 1 |
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 | yes, up to the sum insured | „Für die Dauer der Nichtbeschäftigung im Rahmen des gesetzlichen Beschäftigungsverbotes …“ | Teil III A. Nr. 4, page 1 |
| 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) | yes | „Sofern der Tarif keine anderslautenden Regelungen vorsieht, bieten wir Ihnen …“ | Wo bin ich versichert?, page 1 |
| Benefit for incapacity due to organ or tissue donation | not addressed | ||
| Benefit for pregnancy complications outside protection periods | not addressed | ||
| 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 | yes | „Wird ein versicherter Arbeitnehmer nach Eintritt des Versicherungsfalles arbeitslos …“ | Teil III C., page 1 |
| Continuation or dormant cover during parental leave | not addressed | ||
| Insurer may reduce the benefit when income falls | not addressed | ||
| 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 | not addressed | ||
| Shorter deferment without health check | not addressed | ||
| Conversion between employed and self employed without new health check | not addressed | ||
| Automatic indexation of the benefit | not addressed | ||
| 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 | yes | „Krankheiten und Unfälle, die vorsätzlich verursacht wurden sind nicht versichert.“ | Was ist nicht versichert?, page 1 |
| 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 | yes | „Eine Gesundheitsprüfung kann zu individuellen Leistungsausschlüssen führen“ | Gibt es Deckungsbeschränkungen?, page 1 |
| 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
- Gothaer Krankenversicherung Aktiengesellschaft
- Distribution
- brokers and direct
- Krankentagegeld-Tarif TG, Teil III der AVB (212522) Edition: 01.06.2017 Original from the insurer (PDF, German)
- Informationsblatt zu Versicherungsprodukten Tarif TG Edition: 01.2018 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 Gothaer Tarif TG and available as plain text.
Volltext Gothaer Tarif TG Krankentagegeld · As text (Markdown) Gothaer Tarif TG