Pronova BKK Your health insurance Information in English

As a member of a statutory health insurance fund like Pronova BKK you pay a monthly contribution to the health insurance provider. Up to a certain maximum, the contribution depends on your monthly income. Your employer shares by paying half of the contribution.

Regardless of the contribution paid, gender, age or health status, all members receive medically necessary health care benefits on an equal basis. This principle of solidarity is fundamental to the concept of statutory health insurance in Germany.

If you become ill or have an accident and need treatment from a doctor or in hospital, your health insurance covers the costs.

For some benefits, members of public health insurance have to share in the costs with the so-called co-payments. Children and adults are exempted from all co-payments, apart from transportation expenses.

The health insurance covers prescribed medication.

If you are on sick leave, your employer will continue paying your salary for a period of 6 weeks. You will then receive sickness benefit for a maximum of 18 months from your health insurance.

Public health insurance is compulsory for all employees, whose annual salary is below a certain limit, the so-called “Jahresarbeitsentgeltgrenze”. In principle apprentices / trainees, job seekers, students, pensioners are also subject to compulsory membership with a statutory health insurance.

Self-employed and employees whose annual gross income exceeds the "Jahresarbeitsentgeltgrenze", can become voluntary members of a statutory health insurance, if certain requirements are fulfilled.

Family members

Family members without or rather a low income are covered cost-free.

Children are generally covered up to the age of 18 years or 23 years if they are unemployed or 25 years if they are still pupils or students. Children with disabilities are covered without age limit, if they are unable to earn a living because of their disability.

Students

As a general rule, students from abroad who are enrolled in Germany for studies must be insured in Germany. This does not apply to students from EU countries who are already insured in their home country.

These students can benefit from their European health insurance card. The billing takes place in the home country. The contribution to student health insurance is 142,10 € for people over the age of 23 who have no children. For students under 23 or over 23 if they have at least one child, the monthly contribution is 136,97 €.

In order to be able to carry out the health insurance of the students, we need an application and the current enrolment certificate.

Statutory health insurance pays for health care that is “sufficient, appropriate and economic”. If you are offered benefits that do not meet these requirements, you have to pay for them. These include, for example, single rooms or treatment by senior consultants in hospital.

The most important health care benefits covered by statutory health insurance include:

• Treatment by doctors or dentists (free of choice if they’ve got a contract with public health insurance, which most of them have
• Hospital treatment (free choice to the nearest hospitals) and rehabilitation
• Sickness benefits (also for members who need to care for sick children)
• Prescribed medicines
• Prescribed remedies, such as physiotherapy, ergo therapy
• Prescribed therapeutic appliances such as hearing aids, compression stockings, wheelchairs
• Precautionary examinations for children and adults, skin cancer screening
• Dental check-ups and dental treatment like fillings, dentures
• Orthodontic treatment for children
• Psychotherapy
• Recommended vaccinations
• Support from a doctor and a midwife during pregnancy and delivery
• Domiciliary nursing care or palliative support

There is a legal co-payment for some benefits:

• Prescribed medicines: 10 %, minimum € 5, maximum € 10
• Hospital treatment: € 10 per day, maximum € 280 per year
• Prescribed remedies: 10 %
• Prescribed therapeutic appliances: 10 %, € 5 minimum, € 10

In order not to place anybody under financial stress, co-payments are limited to 2 percent of your annual gross income and in case of chronic illness to 1 percent.

Children and adolescents up to the age of 18 years are exempt from most co-payments. If you have paid the annual maximum co-payment, you will be exempt from further co-payments until the end of the calendar year. We recommend collecting the receipts, or using a receipt booklet.

Another form of co-payment could be charged, if you decide to get benefits that exceed the medically necessary providing. For example: If you decide to take special walking boots instead of normal orthopedic shoes, you need to pay the delta cost.

Your personal Pronova BKK card allows you to choose from all approved physicians, dentists and hospitals.

Please always take this card with you, if medical treatment is necessary. Family members receive their own card. For people who are 15 years and older the health insurance card is only valid with a photograph.

You can upload your photograph here.

You are covered in Germany and the countries Germany has a health insurance agreement with. These are the countries of the EU/EWR (Norway, Liechtenstein, Iceland) as well as Switzerland, Bosnia, Macedonia, Montenegro, Serbia, Turkey and Tunisia.

For getting benefits in the EU-/EWR-countries, Switzerland, Macedonia, Montenegro and Serbia, we will provide you with the European Health Insurance Card. It is on the back side of your Pronova BKK card.

If you travel to one of the other countries, please contact us to get a certain certificate, which you must show to a local health insurance to get a referral slip for doctor or hospital.

The coverage in the other countries depends on laws. To get the same or similar benefits as in Germany we always suggest to apply for private travel health insurance. This can be obtained for low money, but be of great use.

If you travel outside Europe, a private travel health insurance is necessary to avoid the risk of paying expensive bills without participation of Pronova BKK. You can find out more about a private travel health insurance here.

If medical treatment is required, you can choose freely amongst licensed doctors or dentists. If you get ill, please always see a doctor first. Hospitals should only be visited in case of emergency. If you are looking for a doctor or a hospital please contact us. By showing your health insurance card, the costs will be directly settled with Pronova BKK automatically.

Please be aware that private bills cannot be payed. In all cases “except emergencies”, it is recommended calling the doctor and make an appointment.

Public health insurance cover the costs of your dental treatment that for example include check-ups twice a year, removing of teeth plaque once a year, fillings and necessary periodontitis treatment. You have the free choice of dentists getting the treatment with your health insurance card.

Participation in dentures like crowns and bridges with a fixed sum. If you can proof regularly check-ups within the last five or ten years, the participation will be higher.

Prescribed medicines are covered. The colour of the prescription has to be pink, otherwise it is only a recommendation. You will get medicines only in pharmacies. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.

When hospital treatment is necessary, you will get a referral slip from your doctor. You can choose an approved hospital. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.

We cover the costs of prescribed remedies such as physiotherapy, ergo therapy. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.

If your doctor diagnoses chronic lumbar spine pain or chronic pain in one knee joint (gonarthritis), the costs of up to 10 treatments within six weeks are covered, if given by an approved doctor. You will get the treatment with your health insurance card.

Therapeutic appliances like hearing aids, compression stockings, orthopedic shoes, wheelchairs and prosthetics are covered if prescribed. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.

Our free preventive and early diagnosis measures caringly accompany you and your family through life: Starting with the check-ups during pregnancy and followed by the examinations for babies and children. Women aged 20 and older and men aged 45 and older are entitled to a free cancer check-up every year. Skin cancer check-ups are covered starting at the age of 35 years, every two years.

If orthodontic treatment is medically necessary because malformation of teeth frequently cause substantial functional disorders in the teeth and jaw area it is covered for children up to the age of 18 years for treatment levels 3, 4 and 5. During the treatment, you participate with 20 % of the costs.

However, at the end of a successful treatment (must be confirmed by the dentist or orthodontist) you get a reimbursement, so that 100 % of the treatment is covered.

The costs of psychotherapeutic treatment are covered with recognised methods such as analytical or in-depth psychotherapy and behavioural therapy (in individual or group therapy), if you consult an approved therapist who has a contract with the public health insurance system.

Coverage of all recommended vaccinations for example against diphtheria, whooping cough, polio, measles, mumps, tuberculosis, tetanus, tick-borne encephalitis (in endangered areas).

During pregnancy you are entitled to certain check-ups, premature birth prevention programs, medical care, midwife assistance, inpatient births, birthing houses and more.

In certain circumstances, for example if you need taking insulin but are not able regarding to your health status, your doctor prescribe domiciliary nursing care. That means you can get support from an examined person who comes to your home to do it.

If a disease is so severe that it will lead to death, it is also possible to get support from special examined units comes to your home supporting you.

The insurance of employees usually includes the entitlement for a sickness allowance when on sick leave and if they do not receive a salary. Whilst receiving the sickness allowance they are exempt from paying the health insurance premiums.

If you are an employed person and unable to work, because you have to look after your sick child, you will receive an allowance.

Outpatient or inpatient convalescence and rehabilitation measures, outpatient spa treatments, child and youth convalescence and treatments for mothers / fathers and child are, as a matter of course, included.

If you like to participate in health classes preventing diseases, for example a yoga class, Pronova BKK participate in the costs with 80 % (maximum € 150 for 2 classes every year).

We take care of our chronically sick members with special programs. These programs are called Disease Management Programs (DMP). You can register for it, if for example you suffer from diabetes, asthma, COPD (chronically obstructive pulmonary disease). Treatment and care is improved even more by closer cooperation between patient, doctor and hospital.

Do you take active preventive health care? Do you regularly go for dental check-ups, take advantage of the recommended preventive examinations and vaccinations? Perhaps you are also regularly active in sports? Then you should definitely take part in our bonus! Because if you actively take care of your health, your Pronova BKK will reward you with an attractive bonus. It doesn't matter whether you focus more on preventive medical care or are enthusiastic about sport. In the end, you benefit twice - for your health and your wallet.

The Preventive Care Bonus

The best thing about it: you get money from the very first activity! And the more the better:

• For the first fulfilled preventive measure: € 10.00 per year
• For the second fulfilled preventive measure: + € 20.00 per year
• fFor the third fulfilled preventive measure: + € 30.00 per year
• For each further preventive measure: + € 10.00 per year

The Active Bonus

Independently of the prevention bonus, we will reward you with an active bonus of € 40.00 per year if you are regularly active in sports, for example in a fitness studio or sports club. Participation in a certified health course to promote exercise or relaxation, healthy nutrition or addiction prevention also counts as an active measure.

And if you are participating in a Pronova BKK bonus programme for the first time, we will give you a one-time bonus of € 50.00 for your active new start to a healthy life!

How to get your bonus

You can get a booklet, which will be confirmed by your doctor / dentist. Alternatively you can use the digital one in our online office. You can also use our free app on Google Play or in the AppStore.

The bonus can be claimed latest until 31st March of the following year.

We do not only cover all recommended vaccinations for Germany but also the recommended vaccinations for traveling abroad in your holidays including malaria prophylaxis. We pay 100 % of the costs of the vaccine and the medical treatment (maximum € 15).

Not many public health insurances cover osteopathy, but it is covered by Pronova BKK. You will get a reimbursement of € 40 per treatment for a maximum of 4 treatments per year. For getting the reimbursement you need a recommendation of a doctor and an examined osteopath (member of professional association of osteopaths or trained osteopath) has to perform the treatment.

• Usually we only reimburse cost for medicines or supplements that require a prescription. During pregnancy we reimburse costs for medicines and supplements with the ingredients iron, iodide, vitamin D3, magnesium and folic acid, which are very important to pregnant women. You need a private prescription and will get a reimbursement of € 25.
• We participate with € 75 of the costs of several examinations and tests you normally have to pay for, like toxoplasmosis test or B streptococci test.
• Up to € 250 for the 24 hours on call midwife.
• Pronova BKK covers 50 % (maximum € 100) of the costs of your partner’s birth preparation class, if he / she is also insured with Pronova BKK.

Additional check-ups for children: The prevention examinations “so-called U1 to U9 and J1” are always covered. However, Pronova BKK also covers the examinations U10 and J2, which you usually have to pay yourself.

Rooming-in: When a child gets hospitalized, one of the parents can stay overnight at the hospital with the child.

Do you like to have a sports medical examination? Every 2 years we participate in the costs of a basic check-up with 50 % (maximum € 150). Requirements: The doctor is approved and a specialist (Sportmediziner) and you need a confirmation of the doctor that the examination is suited and necessary to prevent cardiac or orthopaedic diseases or to avoid the worsening of such diseases.

With TeleClinic's online video consultation, you can talk to doctors from different specialisms anywhere and at any time in just a few minutes. You can even get your prescription or sick note conveniently via the app.

We have a partner for additional private health insurances. If you would like to include private travel health insurance – which we always recommend if you travel abroad – or more benefits for dentures, like to include glasses or alternative practitioners, a one-bedroom in hospital with treatment by the chief doctor our partner Pronova Privat will offer you a single room additional insurance.

Pronova Privat - Our partner for additional private health insurance or send an e-mail to service@pronovaprivat.de.