Partial reimbursements on an expat health insurance claim usually come down to two things: a flat €25 copay deducted from each insured event, and the severity factor (Steigerungsfaktor) your doctor assigns to a procedure. Reimbursement is capped at 2.3 times the base rate set by the Fee Schedule for Dentists and Doctors (GOZ and GOÄ), so a higher severity factor does not increase your payout beyond that cap. Because doctors set the severity factor case by case, reimbursement can differ even for similar treatments. When the factor exceeds set thresholds, the doctor must give you a written explanation and obtain your signature.
Why did I only receive a partial reimbursement for my expat health insurance claim?
Partial reimbursements on an expat health insurance claim usually come from 2 things:
We deduct a flat €25 copay from each insured event, which lowers the amount reimbursed.
The severity factor (Steigerungsfaktor) the doctor assigns to a procedure caps reimbursement at 2.3 times the base rate set by the Fee Schedule for Dentists and Doctors (GOZ and GOÄ).
Because doctors set the severity factor case by case, reimbursement can differ even for similar treatments.
What is the €25 copay fee on my expat health insurance claim?
The €25 copay is a flat fee we deduct from each insured event covered by an expat health insurance claim. This fee reduces the total reimbursement you receive for that event.
What is the severity factor (Steigerungsfaktor) and how does it affect my reimbursement?
The severity factor is a number the treating doctor assigns to a procedure based on its difficulty and complexity. It starts at 1.00 for the simplest treatments and increases for more demanding ones. Reimbursement is capped at 2.3 times the base rate set by the Fee Schedule for Dentists and Doctors (GOZ and GOÄ), no matter how high the severity factor is set. Using a base rate of €10 as an example, reimbursement works out as follows:
Severity factor | Treatment costs | Reimbursed |
1.00 | €10 | €10 |
2.00 | €20 | €20 |
2.30 | €23 | €23 (maximum reimbursement) |
3.50 | €35 | €23 |
5.00 | €50 | €23 |
Why do reimbursement amounts differ for similar treatments?
The treating doctor selects the severity factor for each specific case, so reimbursement can differ even for similar treatments. Higher severity factors are not commonly applied.
When does my doctor need to provide a written explanation about the severity factor?
When the severity factor for a treatment exceeds a set threshold, the doctor must give you a written statement explaining the reason and obtain your signature before proceeding. This applies to:
Medical treatments with a severity factor above 3.50.
Medical technical items with a severity factor above 2.50.
Laboratory work with a severity factor above 1.30.
Where can I find more information about the fee schedule and expat health insurance?
We have additional resources that explain the Fee Schedule for Dentists and Doctors (GOZ and GOÄ), along with information about expat health insurance plans and enrollment.