Two Words, Two Worlds
German insurance vocabulary loves near-identical terms for different things, and Heilmittel and Hilfsmittel are a classic trap. They sit next to each other on tariff summaries, sound almost the same, and are constantly muddled — but they cover distinct categories, often under separate rules and separate annual limits. Knowing which is which tells you where to look when a claim is only partly paid.
The simple split: a Heilmittel is a prescribed therapy delivered by a person — physiotherapy, occupational therapy, speech therapy, medical massage. A Hilfsmittel is a device or aid — hearing aids, orthopaedic insoles, wheelchairs, prostheses, compression stockings.
How PKV Treats Heilmittel
Therapies are usually reimbursed when medically prescribed, but tariffs often apply a Heilmittel price list or percentage, and sometimes an annual cap or a rule that reimbursement follows “customary” rates. Good comprehensive tariffs pay these generously; leaner tariffs may reimburse a set schedule that leaves a gap on premium therapists. If you rely on regular physiotherapy, this line of the tariff matters more to you than most.
How PKV Treats Hilfsmittel
Devices are where tariffs vary most, because a modern hearing aid or prosthesis can be expensive. Watch for three patterns: a closed list (only named aids are covered), percentage co-payments on certain categories, and caps — for example a maximum contribution to hearing aids or glasses over a period. A tariff can look comprehensive and still leave a four-figure gap on a high-end aid if it has a low Hilfsmittel ceiling.
Reading Your Tariff for Both
- Find the two separate clauses: Heilmittel and Hilfsmittel are usually governed by different tariff paragraphs — read both, not just the headline “100% outpatient”
- Open vs closed lists: an open catalogue (anything medically necessary) beats a closed named list for future-proofing
- Caps and cycles: note any euro caps and how often they reset — critical for hearing aids, which are replaced periodically
- Prescription first: both generally need a doctor’s prescription to be reimbursable — keep it with the invoice
The Bottom Line
Heilmittel are therapies; Hilfsmittel are devices — and your PKV almost always covers them under different rules. When you compare tariffs, read both clauses separately, watch for closed lists and euro caps on the device side, and check the reimbursement schedule on the therapy side. That is where an otherwise strong tariff quietly shows its limits.
Frequently Asked Questions
Compare PKV Tariffs for Your Situation
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