Specific purchase of benefits in a foreign country
What to consider when planning to purchase benefits in a foreign country.
TK also pays for certain costs of benefits when received in a foreign country. This applies to the following EU-countries:
Belgium, Bulgaria, Denmark, Estonia, Finland, France, Greece, Great Britain and Northern Ireland, Ireland, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Mazedonia, the Netherlands, Norway, Austria, Poland, Portugal, Romania, Sweden, Serbia, Slovakia, Slovenia, Spain, Czech Republic, Hungary and Cyprus (Greek part) and Switzerland.
Please note that the following conditions have to be fulfilled
The benefits utilized abroad have to be statutory benefits also in Germany.
TK would have also paid for the benefits in case it would have been provided in Germany.
All the demands that have to be met to receive the benefits in Germany have to be fulfilled before the treatment abroad starts, including when indicated
filing of applications (e.g. for a dental replacement)
appraisal of the Medical Review Board of the statutory health insurance
For a reimbursement of specific treatments in a hospital abroad a special prior agreement of TK is required.
Which costs does TK reimburse?
To receive a reimbursement it is important that you supply detailed bills/medical prescriptions. These should provide information about the person treated, the treatment itself and the costs. TK reimburses the costs that would have resulted from that treatment in Germany, limited to the amount of the bill, minus:
the additional contribution/co-payments stipulated by German law,
a rebate for administrative charges and the missing profitability check (12 percent, minimum 6 Euro, maximum 55 Euro).
In case of dental prosthesis the amount of the reimbursement is restricted to a limited allowance for control supplies.
What to consider beforehand
A reimbursement cannot be paid for benefits specifically utilized abroad that are not allowed in Germany (e.g. in Germany not acknowledged methods of treatment, not approved pharmaceuticals etc.).
In case you are insured in Germany, live abroad and claim benefits in another country or Germany respectively, the claim might be excluded by law.
Important to know
In case you travel to a foreign country for treatment and pay the costs yourself beforehand, then you are the direct contractual partner of the foreign care provider. TK rebates the costs but cannot influence the quality or price of the benefits you receive.
erstellt am 12.10.09
Quelle: TK
