The Only Document That Counts
Brochures promise, comparison portals score, advisers summarise — but when an invoice lands, only the contract documents decide. German PKV contracts stack three layers: the general conditions (Allgemeine Versicherungsbedingungen, AVB, largely following the industry model MB/KK), the tariff conditions (Tarifbedingungen) that modify them, and the benefit tables of your specific tariff. Specific beats general throughout — the tariff conditions are where insurers differentiate, and where you should read hardest.
Reading strategy: you do not need every page. Ten clauses decide 95% of real-life reimbursement outcomes — check them line by line and skim the rest.
The Ten Clauses That Matter
| # | Clause | What good looks like |
|---|---|---|
| 1 | GOÄ/GOZ factors | Reimbursement to the maximum rates (3.5), not capped at 2.3 |
| 2 | Hospital benefits | Free hospital choice, Chefarzt and 1/2-bed room if wanted; check Privatklinik wording |
| 3 | Dental table | Treatment ~100%, dentures ≥ 80%, fair Zahnstaffel |
| 4 | Medication | Full reimbursement; note any generics clause |
| 5 | Aids (Hilfsmittel) | Open catalogue ("insbesondere…" = examples) beats closed lists |
| 6 | Psychotherapy | Meaningful session numbers without restrictive preconditions |
| 7 | Rehab/AHB | Follow-up rehabilitation covered; beware full exclusions |
| 8 | Heilmittel | Physio, speech and occupational therapy at realistic rates |
| 9 | Abroad | Duration of worldwide cover; "medically reasonable" repatriation |
| 10 | Refund/deductible mechanics | Guaranteed vs discretionary refunds; what counts toward the deductible |
Wording That Separates Good From Mediocre
- "Insbesondere" (in particular) before a list = open catalogue, future-proof. A list without it = closed, 1990s technology forever
- "Medizinisch notwendig" vs "medizinisch sinnvoll": the second, rarer formulation is more generous — especially in transport and repatriation clauses
- "Wir erstatten" vs "erstattungsfähig sind bis zu": watch every "bis zu" (up to) — caps live there
- Silence: what a tariff does not mention it does not owe; missing rehab or psychotherapy lines are answers, not oversights
Practical Reading Workflow
Request the full conditions before signing — reputable insurers and brokers hand them over without fuss. Search digitally for the keywords above (Zahn, Psychotherapie, Hilfsmittel, Kur, Ausland, Selbstbeteiligung). Ask the adviser to show you in the document where each promised benefit stands; a good broker does this unprompted, and the exercise takes thirty minutes for a contract meant to last fifty years. Keep the version you signed — conditions valid at signing govern your contract even as the insurer updates later generations.
The Bottom Line
AVB reading is not lawyer work; it is a checklist and an hour of honesty between you and a PDF. Ten clauses, a handful of signal phrases, everything verified in the document rather than the brochure — that hour is the best-paid one in your entire insurance life.
Frequently Asked Questions
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