From Lifestyle Wish to Legal Claim
Laser correction of short-sightedness — LASIK, Femto-LASIK, ReLEx SMILE — costs roughly €2,000–€3,000 per eye in Germany and is almost never paid by statutory insurance. Private insurance is a different story, and it has grown friendlier to patients over the years, largely thanks to the courts.
The landmark position: Germany's Federal Court of Justice ruled in 2017 (IV ZR 533/15) that short-sightedness is an illness in the sense of the insurance conditions — and that patients need not accept glasses or contact lenses as the permanently sufficient alternative. Laser surgery can therefore qualify as medically necessary treatment.
What Decides Your Case
| Factor | Effect |
|---|---|
| Tariff wording | Some tariffs explicitly include refractive surgery (often with caps, e.g. €1,000–€1,500 per eye); explicit inclusion is the cleanest case |
| Medical necessity | Documented visual defect and suitability per ophthalmological assessment; intolerance of contact lenses strengthens the case |
| Tariff exclusions | A minority of tariffs explicitly exclude refractive surgery — then only the visual-aids benefit remains |
| Method and pricing | Reimbursement follows GOÄ billing; excessive flat-rate clinic packages can be trimmed to GOÄ-conform amounts |
How to Apply Properly
- 1. Read your tariff: search the conditions for "refraktive Chirurgie", "LASIK" or "Sehhilfen" — inclusion, cap or exclusion changes everything
- 2. Collect medical documentation: current eyeglass prescription, ophthalmologist's findings, suitability assessment, any lens intolerance history
- 3. Request pre-approval: submit the clinic's GOÄ-based cost plan and ask for a written benefits confirmation before booking surgery
- 4. If declined: ask for the specific contractual basis; citing the 2017 BGH ruling in a reasoned objection changes outcomes surprisingly often, and insurers frequently settle on a partial reimbursement
Manage Expectations
Even a covered surgery interacts with the rest of your policy: the claim may cost you a year's premium refund, count towards your deductible, and some tariffs that pay for surgery then reasonably expect reduced visual-aid claims afterwards. And medically, laser surgery is elective — get independent ophthalmological advice on suitability, not only the laser centre's assessment.
The Bottom Line
If your tariff includes refractive surgery, PKV will pay within its cap; if it is silent, the BGH's illness doctrine gives a documented, well-framed application genuine prospects. Never book first and claim later — the written benefits confirmation is the whole game.
Frequently Asked Questions
Compare PKV Tariffs for Your Situation
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