Advising on medical aids in German private health insurance

The decision behind cover for medical aids

When you explain private health insurance benefits in Germany, give medical aids their own place in the conversation. A high reimbursement rate answers only part of your client’s question. The items covered, possible ceilings and the route to obtaining an aid matter too. Your client is also deciding how much choice and personal organisation they want later. Put two things alongside each other: the insured benefit and the steps that make it usable.

Start with a priority that can be understood without a medical history. Does the person want cover to encompass as many medically necessary aids as possible? Is freedom to choose a supplier particularly important? Or would they like a specific cost assessment before a major purchase? These wishes can coexist. Ask which difference would change their choice of policy. That gives you a practical comparison standard beyond the monthly premium.

Read the whole description of covered aids

The German private health insurance association’s service portal describes policies covering medically necessary aids in general and policies with an exhaustive list. Your first check is therefore the reach of the wording. Copy the relevant passage from the actual offer into your own comparison notes. Then look for additions and exceptions. A general heading may be narrowed by the paragraph beneath it. Together they establish what you can explain to your client.

With an exhaustive list, check whether the groups of aids discussed actually appear. If a group is missing, mark the question as unresolved and seek a specific assessment from the insurer. A similar item on the same list is insufficient grounds for your assurance. The client can then decide whether the verified selection is enough or whether to compare broader contractual wording for their long-term cover.

Broad wording still requires a look at the conditions. Check whether individual groups have separate rules and which versions of an aid are included. This second layer may matter more to the client than the label of an open catalogue. Explain the difference between a broadly described group and an entitlement to every desired feature. This connects the wish for long-term flexibility with the actual limits of the offer.

Read prescription and insured benefit together

The association’s service portal treats medical necessity, a prescription and reimbursement provided for in the policy as separate requirements. Keep responsibilities clear in your advice. The treating professional assesses medical need; you explain the insurance terms. The insurer assesses the specific cost reimbursement. A prescription is an important basis, but does not yet establish the amount reimbursable under the policy. This division helps clients direct the right question to the right person.

If someone already asks about a particular aid, distinguish general policy selection from an upcoming supply. For the latter, the specific quotation and applicable policy wording are crucial. Explain what still needs clarification before an order. You do not need to select the aid medically or collect extensive findings in general sales notes. The necessary specialist assessment belongs in the designated personal advice and claims process.

Understand percentages and ceilings separately

Always read a reimbursement percentage together with the amount to which it applies. Does the percentage refer to all eligible costs, or is there a monetary ceiling alongside it? Look for a separate rule for the relevant group of aids as well. Only then can the client assess their own contribution. A percentage in an overview is insufficient if the applicable clause is further restricted elsewhere.

Explain this through two questions for the actual documents: which amount is recognised as the calculation basis, and what share of it is reimbursed? If a ceiling applies, its operation must also be clear. Ask the insurer for an understandable explanation if the sequence is ambiguous. Inventing a calculation would create only apparent precision. A confirmed explanation shows which personal costs the client can assess for their actual offer.

Next, check the period to which a limit relates. A limit per purchase differs from one covering several supplies within a given interval. For visual aids, the service portal expressly describes policy-specific maximum amounts and intervals. Do not apply that statement indiscriminately to other groups. For each relevant item, ask when a further entitlement is recognised under the offered wording and which conditions apply.

Purchase, hire and insurer-arranged supply

The supply route deserves its own comparison. The service portal explains that policies may provide for hire or insurer-arranged supply for certain aids. Discuss whether the client can choose a route and how that choice affects reimbursement. A familiar medical supply shop may matter to them. Establish from the contract and, where needed, a specific assessment whether its quotation is reimbursable under the relevant conditions.

Hire can be practical for temporary needs, but requires a clear process. Ask about provision, return and changes in the period of use. Purchase raises other questions, such as the treatment of additional costs. Treat these as points to check in the documents and with the responsible suppliers. They do not amount to a blanket promise that a policy covers delivery, adjustment or maintenance. Each item needs its own reliable basis.

Consider accessories and subsequent expenses separately from the main item. Confirmed reimbursement for an aid does not automatically answer every question about consumables, repairs or replacement. Making these points visible before selection helps the client. Request the relevant rule where it affects the comparison. If something remains unresolved, identify that particular gap so the decision does not rely on benefits mentally added to the list.

Another check concerns other responsible benefit providers. The service portal names accident insurance and compulsory private long-term care insurance as possible providers with priority. If that appears relevant, first establish the appropriate claims route. A refusal by one body does not settle every question for another. The client needs to know where their specific request belongs and which answer has already been given.

When comparing several offers, use a cross-check: would the same described supply be assessed through the same route in each case? If one comparison assumes purchase and another hire, mark that difference explicitly. Otherwise, two reimbursement statements may appear comparable while referring to different benefits. A common basis enables the client to recognise the actual difference in choice, organisation and remaining personal contribution.

Prepare the right enquiry before obtaining an aid

Look for requirements for quotations and prior approval. The service portal notes that thresholds and consequences can differ by policy. Your comparison therefore needs the actual threshold and associated process in the offered wording. A figure from another policy is of little help. Explain whether the route is an optional opportunity to obtain information or a contractual requirement. Both support planning, but have different significance.

For a focused enquiry, clearly identify the aid, its version and the quoted cost items. The required prescription and other evidence go to the responsible body through the regular personal claims process. Frame the outstanding question so the answer supports a decision: which costs are recognised under which clause? Which item remains payable by the client? Which requirement is still outstanding? This turns a general request for confirmation into a verifiable basis.

Read the reply as carefully as the quotation. Does it refer to the entire quotation or only part? Does it state conditions, a different supplier route or limited cover? Match those details to the relevant items. The client can then see what is settled and which decision still depends on another reply. Keep general service information distinguishable from a cost assessment tied to a specific request.

Turn a client’s preference into alternatives

The following example is entirely fictional; it describes neither a real client nor a particular policy offer.

A prospective client says independent choice matters most to her for medical aids. The conversation reveals that she wants to use a familiar supplier and know her personal contribution before a major purchase. Separate those wishes. The first requires a statement about the supply route; the second needs a clear reimbursement basis and a route to a cost assessment. A high percentage alone does not answer both together.

Compare only offers that are actually available. Broader wording for aids may support long-term choice, while a prescribed supply route may affect her personal priority. She can weigh the flexibility she needs against the organisation she wishes to undertake. Recording both separately explains why an offer with an attractive individual feature may still fall short of her preferred solution. The assessment follows her stated needs.

If she changes her priority and wants more organised support, compare the verified services of that route. Ask exactly who takes on each task and where she must act herself. A general claim of support is insufficient for this decision. What matters is whether the described arrangement reduces her effort at the relevant point. Clear responsibility allows that assessment without inventing services.

Finish policy selection with a clear reason

Bring the comparison back to personal priorities. Which scope of aids is verified, which cost limit is clear and which supply route fits? Ask the client to describe the main differences themselves. If they remember only the percentage, return to the additional point that mattered to their decision. This shows whether your explanation addressed the actual choice. Advice ends with a reasoned instruction or a clearly identified outstanding enquiry.

Keep the policy wording, relevant replies and decision reasons together in your own advice records. A product page opened later may show a different version. Precise references preserve which basis belonged to the discussion. Also note whether a statement applied only to one offer. That boundary helps with later questions and prevents one cost assessment from becoming an assumed general benefit for subsequent purchases.

Reach new clients for your private health insurance advice

Register your brokerage for private health insurance enquiries. The welcome email takes you to webRichtung Customer. There you choose industry, area, delivery option and monthly limit and see the current price before ordering. You clarify personal needs for medical aids and the specific policy assessment in your own advice.

Sources

PKV service portal: medical aids, in German and PKV association: model conditions MB/KK 2009, June 2024, in German, particularly section 1(3) and section 4(1) and (3). Read on 18 October 2026. The model conditions provide orientation; the agreed policy wording determines individual cover.