Alternative practitioners in private health insurance: reimbursement, plan modules, practice

In private health insurance, the reimbursement of alternative practitioner benefits is a separate plan area. Comfort plans include the module as standard, entry-level plans often not at all or with low limits. A single session typically costs €50 to €150. Statutory health insurance, by contrast, has no entitlement to alternative practitioner benefits, so there the treatment remains a private matter. Two limits that work together are common. A percentage reimbursement of the bill, often seventy to one hundred percent, and an annual maximum of €1,000 to €3,000.

It is important to look at what the budget covers. In many plans, treatment by alternative practitioners, osteopathy, acupuncture and other naturopathic treatments share the same annual maximum. A plan with a separate budget for each method is more generous than the bare percentage suggests. All amounts are guide values. Your own plan is binding.

Alternative practitioners do not bill under the official fee schedule for doctors. They follow the fee schedule for alternative practitioners instead. The GebüH is not an official state fee schedule but a directory from 1985 that has never been adjusted to price developments. In practice, alternative practitioners therefore regularly agree fees above the GebüH rates.

For policyholders, this leads to the most common surprise when they submit a bill. The plan reimburses up to the GebüH rate, the agreed fee is higher, and the patient pays the difference. We recommend that you ask about the fee before treatment, compare it with the plan clause and get a written confirmation of cover for longer courses of treatment.

Naturopathic treatment is not only provided by alternative practitioners. Doctors with additional qualifications such as naturopathy or acupuncture bill the same methods under the official fee schedule for doctors. These bills go through the normal outpatient part of the plan, without the module for alternative practitioner benefits and usually without its annual limits.

This has a practical consequence. If your plan has no module for alternative practitioner benefits but naturopathic treatment matters to you, you can choose doctors on purpose. Here too, the treatment must be medically necessary. No plan area reimburses pure wellness treatments.

In our advice work we see two recurring situations. In the first, policyholders want to add the module later but fail because of the health questions that are then due, or they pay surcharges. In the second, policyholders pay for years for a module they never use. Both can be avoided if you make a conscious decision when you join.

We recommend that you choose the module for alternative practitioner benefits only if you will realistically use naturopathic treatment, but then with a high annual amount and a clear GebüH clause. We take no position on how well individual methods work. The scientific assessment of many methods is disputed, and only the plan decides on reimbursement. Medical questions belong in a conversation with your doctor or practitioner.

No. Alternative practitioners may diagnose and treat on their own, and there is no referral. For reimbursement, the only thing that counts is that the plan covers the treatment and that it qualifies as medical treatment.

As a rule, no. Most plans reimburse psychotherapy only with licensed medical or psychological psychotherapists. Sessions with an alternative practitioner for psychotherapy usually fall neither under the module for alternative practitioner benefits nor under the psychotherapy part of the plan.

You pay for further treatment in the same calendar year yourself, and the budget starts again in the following year. For courses of treatment you can plan, it pays to spread the appointments over the turn of the year or to agree a treatment plan with your practitioner in advance.

Yes. Switching to a plan without alternative practitioner benefits is a reduction in benefits and is possible under § 204 VVG without new health questions. The opposite way, adding the module later, counts as additional benefits and triggers the health questions.