A claim statement summarizes how your private health insurance claim was processed. It shows the total amount invoiced, the portion covered by your plan, how your deductible or cashback was applied, and the payout you receive. Hallesche issues the claim statement and sends it to you in the Hallesche4u app or by post.
What is a claim statement?
A claim statement summarizes how your private health insurance claim was processed. It shows the total amount invoiced, the portion covered by your plan, how your deductible or cashback was applied, and the payout you receive. It also breaks down coverage by service type and notes any limits or exclusions that applied.
Where do I find my claim statement?
Hallesche issues your claim statement once your claim is processed and sends it directly to you, either in the Hallesche4u app or by post to your home address, depending on what you've selected. Claim statements are not sent to us, so the app is the place to look for the most recent one.
What are the main sections of a claim statement?
A claim statement has three sections:
A summary of charges and payout
An overview of your deductible or cashback usage
A detailed breakdown of each recent claim
What does the summary of charges and payout show?
Page one provides a general overview, including:
The total amount invoiced for your recent medical bills.
The benefit amount covered by your insurance plan.
The amount credited toward your deductible or cashback.
The total payout amount made to you or the healthcare provider.
The recipient of the payout, usually yourself or the hospital for hospital bills.
Example
Example
Cristina submitted a claim for €380. The bonus covered €296 of it. No additional amount was paid out as the bonus fully covered the bills.
What does the deductible or cashback overview show?
Page two shows how much of your deductible has been used so far this year.
The total deductible or cashback used so far this year up to this claim.
The amount of deductible or cashback applied to the current medical bill.
The remaining deductible or cashback available for the rest of the year after processing the current bill.
Example
Example
Cristina is covered under the Standard plan with a €100 monthly cashback (€1200 per year). Earlier this year, €352.51 of the cashback was used to cover some medical bills. For the most recent medical bill, €296 of the cashback was used. € 551.79 of the cashback remains for additional medical expenses.
What does the detailed breakdown of invoices show?
This section continues on page two and provides a detailed breakdown of each submitted invoice, including:
The invoice amount for the medical service.
The amount covered by your insurance plan.
The type of medical service received.
Additional notes explaining reasons if a claim is partially or not covered, such as coverage limits.
Example
Example
Cristina has recently submitted two invoices: a bill for a GP treatment on May 15 is fully covered under her plan. However, a second bill for visual aids on May 18 was only partially covered. The reason is a €150 limit for visual aids under her plan.