A deductible is the amount you pay out of pocket for medical costs each year before your Private health insurance (PKV) plan begins to reimburse. Depending on the plan you hold, the deductible is either a fixed yearly amount or a percentage of each bill up to a yearly cap. A higher deductible generally means a lower monthly premium. Some treatments are exempt from the deductible, which means they are still covered and reimbursed in full without the deductible being deducted first — depending on the plan, this can apply to dental treatment, hospital stays, or preventative treatment. Always check the terms and conditions of your policy to see which treatments are exempt from the deductible.
What is a deductible in Private health insurance?
A deductible is the amount you pay out of pocket for medical expenses each year before your Private health insurance (PKV) coverage begins. Your policy uses one of two deductible types: a fixed amount you pay each year, or a percentage of each medical bill up to a yearly cap. Which type applies depends on the specific private (PKV) plan you hold.
How does the deductible amount affect my monthly premium?
A higher deductible on Private health insurance (PKV) generally results in a lower monthly premium. For that reason, a higher deductible is often suitable for people who visit the doctor infrequently, and for freelancers who want to keep their monthly costs lower.
How does a fixed deductible work?
With a fixed deductible on Private health insurance (PKV), you pay your medical costs yourself up to a set amount each year. Once your payments reach that amount, we pay for eligible treatments as set out in your policy. For example, on a plan with a €1,200 fixed deductible, you pay the first €1,200 of medical bills in a year before coverage begins.
How does a percentage deductible work?
With a percentage deductible on Private health insurance (PKV), you pay a set percentage of each medical bill out of pocket, up to a yearly cap. Once your out-of-pocket payments reach that cap within the policy year, we cover eligible medical expenses in full according to your policy. For example, on a plan with a 10% deductible capped at €500 per year, a bill of €300 means you pay €30 and we pay €270, and a bill of €1,000 means you pay €100 and we pay €900. You keep paying 10% of each bill until your own payments add up to €500 in that year, after which you pay nothing further toward eligible treatments for the rest of the year.
Does a deductible apply to all treatments?
No, a deductible is not applied to every type of treatment, and which treatments are exempt depends on the specific Private health insurance (PKV) plan you hold. Examples of how this differs between plans:
On some plans, no deductible is applied to dental treatment or to hospital stays, so we cover eligible costs for those treatments from the first euro.
On other plans, no deductible is applied to preventative treatment such as routine check-ups and screenings, while a deductible still applies to other treatments.
Because the exemptions are set at plan level, always check the terms and conditions of your own policy to confirm which types of treatment are excluded from your deductible.
You can contact our support team for more assistance or additional resources.