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LKH für Angestellte: the policy wording in full
Krankentagegeld für Arbeitnehmer ab dem 43. bis 365. Tag, nur zusätzlich zu einer Krankheitskostenvollversicherung der LKH, mit Wiedereingliederungsgeld, Kinderkrankengeld, Kur und Entbindungspauschale.
German market: tariffs for people living in Germany.
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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 LKH für Angestellte.
Basics
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Insurable daily sickness benefit per calendar day (maximum) | not addressed | ||
| Benefit capped at net earned income (no overinsurance) | yes | „Das Krankentagegeld darf zusammen mit anderen Krankentage- bzw. Krankengeldern das …“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Income basis (reference period, self employed: profit as assessed for tax) | not addressed | ||
| Selectable deferment periods (benefit from day x of incapacity) | yes | „nach Tarif KTA43: ab dem 43. Tag, nach Tarif KTA92: ab dem 92. Tag, nach Tarif KTA183 …“ | Was ist versichert?, page 1 |
| Earliest benefit start (shortest deferment) | yes | „nach Tarif KTA43: ab dem 43. Tag“ | Was ist versichert?, page 1 |
| Benefit duration without time limit (as long as incapacity lasts) | not addressed | ||
| Eligible persons (employees, self employed, freelancers, members of statutory insurance) | yes | „Es handelt sich um eine Krankentagegeldversicherung für Arbeitnehmer zum Schutz vor …“ | Um welche Art von Versicherung handelt es sich?, page 1 |
| Tariff topping up statutory sickness pay (gap to net income) | no | „Sie können die KTA-Tarife nur zusätzlich zu einer bei der LKH bestehenden …“ | Um welche Art von Versicherung handelt es sich?, page 1 |
| Offsetting of continued pay and social benefits against the benefit | not addressed |
Scope of benefits
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Benefit for partial incapacity | yes | „Anteiliges Krankengeld bei Wiedereingliederung (Teil-Arbeitsunfähigkeit)“ | Was ist versichert?, page 1 |
| Benefit during gradual return to work | yes | „Das anteilige Krankentagegeld bei Wiedereingliederung wird bis zum Ende der …“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Benefit during inpatient treatment without or with shortened deferment | not addressed | ||
| Benefit during statutory maternity protection periods | yes, up to the sum insured | „Krankentagegeld während der gesetzlichen Mutterschutzfristen und am Entbindungstag“ | Was ist versichert?, page 1 |
| Benefit when a child falls ill (care) | yes, up to the sum insured | „Die Zahlung von Kinderkrankengeld ist auf 15 Arbeitstage (max. 30 Arbeitstage) pro …“ | Gibt es Deckungsbeschränkungen?, page 1 |
| Benefit for mental illness without special restriction | not addressed | ||
| Benefit during spa treatment, sanatorium stay or rehabilitation | yes | „Krankentagegeld bei Kur- und Sanatoriumsbehandlungen“ | Was ist versichert?, page 1 |
| Benefit for incapacity abroad (Europe, worldwide) | yes | „Bei einem vorübergehenden Aufenthalt im europäischen Ausland wird bei …“ | 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) | yes | „Für das Krankentagegeld während der Mutterschutzfristen und am Entbindungstag beträgt …“ | Wann beginnt und endet die Deckung?, page 2 |
| 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 | 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 | yes | „Die ärztlich festgestellte Arbeitsunfähigkeit ist der LKH unverzüglich anzuzeigen.“ | Welche Verpflichtungen habe ich?, page 2 |
| 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 | yes | „Hält sich die versicherte Person vorübergehend im Ausland auf, erhält sie für akut …“ | Wo bin ich versichert?, page 2 |
| Further sickness benefit cover only with the insurer's consent | yes | „Der Neuabschluss einer weiteren oder die Erhöhung einer anderweitig bestehenden …“ | Welche Verpflichtungen habe ich?, page 1 |
Exclusions
| Point | Rule | Wording (German) | Clause |
|---|---|---|---|
| Exclusion for intent | yes | „Leistungen für auf Vorsatz beruhende Krankheiten und Unfälle einschließlich deren Folgen.“ | 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 | „Zusätzliche Leistungs- und Risikoausschlüsse im Rahmen der Risiko- und …“ | Was ist nicht versichert?, 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 | yes, up to the sum insured | „Entbindungspauschale in Höhe des zehnfachen versicherten Tagessatzes“ | Was ist versichert?, page 1 |
| 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
- Landeskrankenhilfe V.V.a.G.
- Distribution
- brokers and direct
- Produktinformationsblatt KTA Edition: 12.24 (LKH 6-143) 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 LKH für Angestellte and available as plain text.
Volltext LKH für Angestellte Krankentagegeld · As text (Markdown) LKH für Angestellte