The fixed allowance: how health insurance calculates

The fixed allowance is the core of the system and the most frequent source of misunderstandings. Health insurance does not pay a percentage of what your restoration costs. It pays a fixed amount based on the findings.

How it comes about

Every finding has a standard care attached to it. The insurer covers 60 per cent of the costs laid down for it. With five years of an unbroken bonus booklet it is 70 per cent, after ten years 75.

What that means in practice

If you choose the standard care, a manageable own share remains. If you choose something more elaborate, the allowance stays the same – you carry the whole difference. That is why the question is not „how much does the insurer pay“ but „how far do I go beyond the standard care“.

The allowance is valid for two years

An approved treatment and cost plan is valid for six months. If you start treatment later, it has to be applied for again – and the amounts may have changed in the meantime.