In public health insurance, insured persons receive an electronic health card. It makes it easier for service providers to bill the health insurance company. In private health insurance (PKV), healthcare providers bill their patients directly. Do you also need a chip card? All questions about the card for privately insured persons are answered below.
Insurance card: What's the difference between private and public health insurance?
Public health insurance: The Electronic Health Card
In 2015, the German government introduced the Electronic Health Card (elektronische Gesundheitskarte, or eGK for short) for everyone with public (statutory) health insurance.
It features information about you to confirm your identity and information that allows doctors to treat you and bill for your treatment appropriately. Each card includes:
- The insured person’s name, insurance provider (Krankenkasse) and insurance ID number
- A photo of the insured person
- The Electronic Health Card logo and the logo of the insured person’s insurance provider
- An encrypted microchip containing details of the insured person’s insurance status and key health information, such as allergies and current medication
Two cards in one: eGK and EHIC
The reverse of the eGK is used for the European Health Insurance Card, more commonly known as an EHIC (German: Europäische Krankenversicherungskarte). This allows people insured in the German public insurance system to enjoy free healthcare coverage in EU member states plus Iceland, Liechtenstein, Norway and Switzerland.
In many countries, the EHIC is a separate card, but the modern German system combines two cards in one.
Private health insurance: PKV cards
People with private health insurance in Germany usually receive a card directly from their insurance provider. Each card usually carries the name of the insurance company – so, for example, if you were insured with a fictional insurance provider called AB123, you would receive an AB123 card.
Not all private insurance providers issue insurance cards. Unlike in the public insurance system, cards are not mandatory in the private system. However, because they contain information about you and your insurance cover, they are certainly useful and help to simplify payments to hospitals, doctors and pharmacies.
Do privately insured persons have a health card and an insurance number?
Private health insurance is available to people who, for example:
- are self-employed
- civil servants or persons entitled to benefits
- have an income as an employee above the compulsory income limit (69.300 €)
- students
When signing a contract with a private health insurance company, they receive an insurance number, the format of which depends on the insurance company. In many cases and as a special service, they also receive an insurance card.
Do all insured persons in private health insurance need a card?
The so-called card for privately insured persons is not mandatory. However, most insurance companies issue this card to their customers to save them time at the doctor's office or hospital.
ottonova's customers also receive a corporate-look card in our comprehensive private health insurance tariffs - regardless of whether they are employed, self-employed, students or civil servants.
There are also insurance companies that do not issue a card or where tariffs such as the basic tariff are excluded from this service.
What information is stored on the card for privately insured persons?
Various information about the policyholder and the insurance company is stored on the card. This typically includes:
- Personal data: Name, address, date of birth
- Insurance information: policy number, hospital benefits eligible for reimbursement
- Validity period of the card
What do I have to take with me to the doctor as a private patient?
At the doctor's office, patients with private health insurance become contractual partners for those treating them. In order for doctors to know that they can bill privately and to whom they may bill, they need some information from private patients about themselves and their insurance.
People who are insured with private health insurance can dictate this important information to the receptionist - or use their private health insurance card. All the relevant data is stored there. It makes it easier to read in this data, reduces errors in the billing process and saves time when visiting the doctor.
How does billing work in private health insurance?
In private health insurance, there is the so-called reimbursement principle: patients with private health insurance are self-payers and bill the dentist, orthopedist or family doctor directly. The bill is then submitted to the private insurance company with which they are insured.
The bill is then checked by the insurer and the money is subsequently reimbursed. Which services are reimbursed in private health insurance depends on the individually selected tariff.
In the area of outpatient care, private patients receive an invoice after each visit to the doctor. The costs incurred depend, on the one hand, on the services provided. On the other hand, the invoice amount for individual treatment items is based on the fee schedules that apply to doctors and dentists.
Normally, the standard maximum rate is used for billing. In the case of complex examinations, a certain factor is applied that increases the invoice amount. For this reason, it is difficult to make general statements about the costs of treatment for private health insurance patients.
The following list shows examples of what providers can charge for outpatient services at the standard maximum rate:
- Regular doctor's visit: 35 €
- Vaccination: 10 €
- Changing bandages: 10 €
- Small blood test: 8 €
- Discussion of blood values: 11 €
- Cancer screening for women: 43 €
- Cancer screening men: 38 €
- Spinal MRI: 563 €
With some private health insurance providers, invoice reimbursement can take up to a month; with ottonova, reimbursement is much faster.
