Most of the treatments and healthcare services covered by public health insurers are a part of the standard catalog, and are compulsory for all of the public insurers. These standard benefits include:
- treatment by family doctors, specialists and psychotherapists in practices, hospitals and – under certain circumstances – in rehabilitation facilities
- screening tests and medical check-ups for preventive purposes
- dental check-ups, dental treatment, gum treatment, and orthodontic treatment
- health care related to pregnancy and birth
- medication that has been prescribed by a doctor (with a few exceptions)
- necessary vaccinations (not travel vaccinations)
- certain kinds of therapy known as "Heilmittel" (like physical therapy or speech therapy) and certain medical aids known as "Hilfsmittel" (like prosthetic devices or hearing aids) – as long as they are medically necessary and have been prescribed by a doctor. The Hilfsmittel aids have to be listed in the official catalog of approved aids known as the Hilfsmittelverzeichnis.
- certain digital health applications (DiGAs)
- the costs of medically necessary transportation (for example, to get to a hospital or a dialysis appointment)
For many of these standard benefits, you have to pay a certain amount yourself, known as a co-payment (Zuzahlung in German). This amount is fixed by law. It ranges from 5 to 10 euros for prescribed medications, depending on their price. But there's a limit to the co-payments you are expected to make each year: you only have to pay up to 2% of the gross annual income of all the family members living together in your household. This limit (known as the Belastungsgrenze in German) is 1% for people who have a severe chronic illness. Once it has been reached, you no longer have to pay any co-payment costs that year. In general, no co-payments are needed for medications that are prescribed for children and teenagers under the age of 18.
When it comes to dental prosthetics, public health insurers pay a fixed amount. Before any dental work involving prosthetics is started, your dentist makes a treatment and cost plan which must be submitted to your insurer. The insurer then decides what costs it will cover, giving you a better idea of how much you will need to pay yourself.
What's more, if you usually work but are prevented from working for longer than 6 weeks in one go due to illness, your public health insurer will pay sickness benefit (Krankengeld, which is 70% of your gross salary). In the first 6 weeks of illness, your employer will continue to pay your usual salary. The sickness benefit is paid for a maximum of 18 months. If you're still unable to work after that, other forms of financial support may be possible.
With the exception of the additional fees mentioned above, all the costs of benefits listed in the standard catalog are paid by the insurer directly to the care provider – this means that you aren't involved in the payment. All you have to do is take your electronic health insurance card along to the doctor's practice or hospital.
If you have special requests not included in the standard benefit catalog – such as a private room in hospital, treatment by a senior consultant or certain dental treatments – you have to pay for them yourself. Private health insurance companies offer separate policies for some of these. Different private insurers may have different reimbursement rules for some treatments and healthcare services, so it's worth asking about that beforehand.