Explanation on how the Beihilfe scheme works

13 posts in this topic

Posted

Hello,

I am a Beamtin in Saxony and have a private Health Insurance under the Beihilfe scheme. So far, I have had a couple of visits to doctors for medical checkups. I'm then being sent the bill and I make an Ueberweisung to the doctor/medical specialist. Once I have that, I send the Ueberweisung receipt and the original of the bill to my insurance which gives me back 50% of the value. However, this didn't make sense to me, since according to my insurance plan, it seems as if I would have 100% return for most of the medical expenses, so I couldn't understand why I would only receive 50% back. I found only one more topic on this issue, which seems to clarify the situation a bit more, namely that the other half is paid by the employer/state. Just to make sure that I fully understand however, here are some questions:

- Should I need to be admitted at a hospital, do I get 100% back according to this: "100 %. Erstattung des jeweils angemessenen Honorars nach der GOÄ bis zu deren Höchstsätzen bei belegärztlicher Behandlung." and then "100 % für allgemeine Krankenhausleistungen (Mehrbettzimmer)"? There are also other things mentioned, but this looks as the most important.

- If my understanding about the 50% from the Insurance and 50% from Beihilfe holds, do I need to send my receipts to my employer (I work at the University) or is there a central Beihilfe organisation they should be sent to?

- Is there a time limitation during which one can do that? I have some receipts from a few months back. Is it too late for those? If so, can I make some claim the next time I do my Steuererklaerung?

Many thanks in advance.

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Posted

I'm in a different federal state, so I can only help with the basic ideas. All my answers are based on the assumption that you are a Beamtin of Saxony, not Germany.

First of all, you should have been offered an insurance scheme that covers only half of the bills/the part that isn't covered by your federal state if you told the company that you're a Beamtin. The fact that they actually pay 50% tells me that this is the case. However, you should ask one of your colleagues or an expert to go through the contact to make sure that everything is correct.

To get the 50% from your federal state, you send a copy of your receipts to the Beihilfestelle: Landesamt für Steuern und Finanzen:

These are your Beihlfe guys. Usually the insurance company wants the originals, Beihilfe gets a copy of the same.

This says that the minimum amount per application form is 200€ and it says that you can make claims for 2 years (either counting from when the expenses actually occurred or from the date on the bill), so a few months back shouldn't be a problem. I usually collect my receipts and send a whole bunch of them to Beihilfe, sometimes almost a year later.

Hope that helps a little.

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Posted

That was indeed very helpful! I'll be checking with my colleagues too, as you suggest, but it clarifies things a lot (esp. the two last points)! Many thanks!

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Posted

(Waves to Friederike, as a Beamten-Ehefrau, ex-Beamtin, formerly from SHA!)

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Posted

I would recommend that you have an expert check your insurance tariff for you to make sure you really have the correct set-up for public servants with Beihilfe. From your quotes in the text it sounds a bit as if you were set up with a "normal" tariff which would be plain wrong.

A good Beamte-Tariff should also contain a tariff-part that covers loopholes in the Beihilfe, i.e. certain areas where the state will not actually pay the 50% or 70% because certain treatments are not part of the Beihilfe-coverage.

And you should also have a Krankenhaustagegeld (per diem in case you have to stay in hospital). This is totally worthless in anyone elses normal private health insurance (though still often sold to unsuspecting Expats) but for Beamte it is important because you will be charged some costs per day from the hospital (analogue to public health insurance clients) for which the state does not pay.

So, it would make sense to have your existing insurance checked during the year in case you need to alter it or change entirely at the end of the year... that's what independent broker are there for. You'll find a number of them with good reputation advertising here on Toytown in the business directory.

Cheerio

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Posted

Glad to have been of help. Plus: Starshollow is definitely right although this type of part-cover should be bog-standard for insurance companies - have someone check your contracts. Mine are very confusing - and I'm German...

(Waves to Friederike, as a Beamten-Ehefrau, ex-Beamtin, formerly from SHA!)

Oh, how nice! Do you miss SHA?

(waves back!)

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Posted

@Friederike: sometimes. I still go occasionally; was there for the last Salzsiederfest and Weihnachtsmarkt. I have a friend there. (Actually, I have several friends there, all ex-pats)

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Posted

I just checked the Beihilfe rules for Baden-Württemburg and was surprised to read the following:

Sie können grundsätzlich auch zu Aufwendungen des Ehegatten oder Lebenspartners Beihilfe erhalten. Entscheidend für die Berücksichtigung der Aufwendungen sind die Einkünfte des Ehegatten oder Lebenspartners (maßgeblicher Gesamtbetrag der Einkünfte nach § 2 Abs. 3 Einkommensteuergesetz). Mit dem Haushaltsbegleitgesetz 2013/14 wurden zwei Grenzbeträge für Einkünfte geschaffen: 10.000 EUR und 18.000 EUR.

Der Gesamtbetrag der Einkünfte von 10.000 EUR gilt für

am 31.12.2012 vorhandene Ehegatten und eingetragene Lebenspartner, die gesetzlich versichert sind.

AM I reading this right? Can I still get Beihilfe, as long as I don't earn above €10000?

I always believed that if I were gesetzlich versichert (as I am), I can't get any Beihilfe at all. Or is this a new rule?

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Posted

That's how I read this, too, but let's wait for the expert. There's bound to be small print somewhere.

PS: Didn't go to the Weihnachtsmarkt this time - too busy :-( - although I liked lats year's a lot; much better than the boring stalls they used to have in Gelbinger Gasse

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Posted

I just checked. I got a letter from the Beihilfe in December... and I never read those letters, so I missed it.

Yes, there's been a change since 1.1.13; the Einkommensgrenze has been lowered to €10000.

Funny. I am so used to ignoring all these boring letters from them; even when they are headed Wichtige Mitteilung (like this one).

There's a lot more stuff which I haven't read. I guess I need to get into it!

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Posted

So, the law changed on 1.1.13. What I'm wondering now is if I misunderstood from the beginning. Was I wrong in my assumption that I couldn't get Beihilfe AT ALL once I was gesetzlich versichert?

Case in point: last September I had some dental work done. I was given the option between the cheaper standard fillings, and a higher quality of filling which I would have to pay myself; that is, the Barmer would pay the standard and I would top up for the rest. I eventually got a bill for €70, which I paid myself.

According to the new rules, I could get the 70% Beihilfe if this happened now. Was this also the case in September?

Well anyway. I'm going to submit the bill and see what happens.

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Posted

Glad to have been of help. Plus: Starshollow is definitely right although this type of part-cover should be bog-standard for insurance companies - have someone check your contracts. Mine are very confusing - and I'm German...

Oh, how nice! Do you miss SHA?

(waves back!)

@ Friederike: I fully agree with you that the full knowledge about how to set up a decent Beihilfe-Tarif should be bog-standard for everyone offering insurance advice in Germany. But... I am constantly mesmerized what simple facts people who offer professional insurance advice in Germany do either not know or rather carefully omit (because it might cost them commission if the give the full info and facts) - hence it makes sense to have your insurances checked by one of the independent broker who have generated some trustworthyness over time here on Toytown (and since they are several, there is a good selection available here).

Cheerio

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