The following benefits are reimbursable:
1. Medically necessary expenditures for
a) outpatient medical treatment (does not apply for treatment by an alternative practitioner), including X-ray diagnostics;
b) Medicinal, therapeutic and dressing materials based on medical prescription (except massages, baths and medical packs). The expenses for remedies are refundable up to 250 € during the insurance period. The expenses for remedies are refundable up to 250 € during the insurance period. The term “medicine” does not include nutriments and strengthening supplements, cosmetic products and the like, even if they are prescribed by the treating physician and include medicinal substances; certain medicine-like nutriments that are imperative in order to avoid serious health damage (e. g. in case of enzyme deficiency diseases, Crohn’s disease and cystic fibrosis), are, however, considered as medicine.
c) dental treatment for pain relief and simple fillings (amalgam fillings) as well as repair of existing dentures;
d) inpatient treatment including operations and ancillary costs of operations in hospitals which are under constant medical supervision and use methods scientifically recognized in Germany or the country of stay;
e) transport to the nearest appropriate hospital for the purpose of inpatient treatment;
f) rental costs for medical aids prescribed by a physician that are required as a result of an accident and the medical treatment of the accident consequences serve, up to 500 € per claim (except visual aids and hearing aids).
No claim for compensation can be made, as far as the policyholder or his/her insured person can claim compensation from an own or third-party insurance contract that was concluded prior to or after the conclusion of the present contract.
This applies in particular with regard to more general insurance products like health insurance or breakdown coverage. It also applies if such insurance includes a subsidiarity clause. With regard to such types of insurance, the present insurance policy is regarded as a more specific insurance according to this contract. If the other insurer denies his obligation to perform in writing, there shall, however, be an advance payment within this contract. The policyholder or his/her insured person shall do everything in his/her power to help that claims against other insurers can be pursued.
Medical treatment in Germany
The following benefits are reimbursable:
a) Expenses for outpatient medical and dental treatment up to 2.3 times the rate of either the Physician Fee Schedule (GOÄ) or Dentist Fee Schedule (GOZ) valid in Germany; or up to 1.8 times the rate in case of benefits pursuant to paragraphs A, E or O of the GOÄ; or up to 1.15 times the rate in case of benefits pursuant to paragraph M and number 437 of the GOÄ.
b) In case of inpatient treatment in a hospital: expenses for the general care level without optional services and for separately billable treatments by an attending physician equivalent to outpatient medical treatment within the framework established under item a).
2. Additional costs
a) for medically necessary or prescribed return transport of an ill insured person from abroad to his/her permanent residence in his/her home country, as far as medical care is not guaranteed abroad and return transport is necessary within the course of reimbursable medical treatment. Unless there are medical reasons to do otherwise, the insured shall choose the most cost-effective means of transport. Travel expenses saved by return transport shall be set off against the benefits.
b) up to 30,000 € for the costs incurred by the transfer of an insured person to his or her home country or the burial at the place of death in the event of the death of an insured person.
The following applies to all benefits: scope of benefits and requirements of insurance coverage result from the General Insurance Conditions and the respective special conditions.
