Glasses and visual aids in private health insurance: reimbursement, budgets, intervals

For glasses, most plans of private health insurance provide a fixed budget, typically €200 to €500 every two to three years. Contact lenses often have their own limit of €100 to €300 per year. This makes private health insurance much more generous than the statutory health insurance fund, which subsidizes visual aids for adults only in cases of severe visual impairment.

Guide

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Expert tips

How to make full use of your visual aid budget and which clause counts in everyday life.

Know the interval, use the budget

We recommend that you note the renewal interval of your own plan and use the budget for glasses consistently. A visual aid budget you do not use is a benefit you paid for and gave away.

Check the prescription change clause

Good plans reimburse new glasses before the interval ends if your prescription changes by at least half a diopter. This clause makes the difference in everyday life, not the nominal maximum amount.

Think of contact lenses separately

Contact lenses often have their own annual budget and do not replace the entitlement to glasses. If you use both, check whether the plan keeps the two budgets side by side or offsets them against each other.

Submit the complete bill

Lenses, frame and eye test belong on one bill. We recommend that you submit the optician's bill with the current prescription from your ophthalmologist or the refraction record. This speeds up reimbursement.

Contents

Comparison
What is paid
Clauses that matter
Our recommendation
Doctor and optician costs
After eye surgery
Designer frames
For children

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Visual aids compared: statutory and private

Criterion	Statutory	Private
Cost coverage	subsidy for lenses only for severe visual impairment or for children and young people	a fixed amount or a percentage depending on the plan, often in an interval of several years
Benefit amount	low fixed amounts, frame usually not included	several hundred euros per period, depending on the plan
Contact lenses	only in exceptional medical cases	included in the visual aid budget, depending on the plan
Billing	fixed amount through the health insurance card	submit the receipt, reimbursement under the plan

Glasses and visual aids in private health insurance in detail

What does private health insurance pay for visual aids?

Benefit	Typical plan rule
Glasses (lenses and frame)	€200 to €500 per entitlement, every two to three years
Contact lenses	€100 to €300 per year, often a separate budget
Early renewal	if your prescription changes by about half a diopter or more
Prescription sunglasses	only in comfort plans, usually within the budget for glasses

In insurance terms, glasses are a medical aid. They do not treat the refractive error, they compensate for it. This is why plans work with budgets and renewal periods here instead of the open reimbursement of a medical treatment. Within the budget, you are free to spend the money on high-quality lenses or on the frame. All amounts are guide values. The plan is binding.

Which clauses matter in everyday life?

The nominal maximum amount says little about the quality of the visual aid clause. The interval matters more. A plan with €300 every two years is more generous than one with €400 every three years. Then there is the diopter rule for early renewal. Without it, you wait for the next interval after your prescription changes or you pay yourself.

A third point concerns progressive lenses. They quickly cost twice as much as standard lenses, but the plan budget does not distinguish between lens types. If you depend on progressive lenses, plan for your own share or choose a higher visual aid budget at your next plan change. By comparison, the statutory health insurance fund pays for visual aids for adults only in cases of severe visual impairment, which means nothing at all in the everyday life of most people who wear glasses.

What do we recommend to people who wear glasses?

From our work with plans, we see that visual aid budgets are among the benefits given away most often, right after dental prevention. The entitlement renews quietly, and the policyholder does not notice. A simple calendar entry at the renewal interval solves the problem.

We also recommend that you assess the visual aid clause in context. If you are thinking about laser eye correction, you will hardly need the budget for glasses in future. If you depend on progressive lenses for good, give it a high weight. The clause is one building block of choosing a plan, not a decision criterion on its own.

Does private health insurance also reimburse the ophthalmologist and optician costs around your glasses?

The examination by an ophthalmologist, including refraction, is a normal outpatient service and sits outside the visual aid budget. Depending on the plan, the eye test at the optician is counted against the budget. The distinction is worth it. If you have your prescription measured by an ophthalmologist, you protect your budget for glasses.

What applies after eye surgery, for example for cataracts?

If your prescription changes after an operation, good plans apply the clause for early renewal. The operation itself is a medical treatment and is kept completely separate from the visual aid budget.

Are rimless or designer frames excluded?

No. Within the budget, you decide freely on lenses and frame. The insurer checks the amount, not your taste. Anything above the budget you pay yourself.

Does private health insurance cover visual aids for children more generously?

Many children's plans reimburse visual aids more often, because the prescription changes quickly while a child grows. Since the child has a separate contract, it is worth looking at its clause. It can be better or worse than the parents' clause.

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