Birth in private health insurance: hospital benefits, midwife and optional services

The choice of the type of birth remains with the insured woman. A hospital birth is the standard and is fully reimbursed at €1,500 to €3,000. A birth center and a home birth are also reimbursed in most plans. Here, a short check with the insurer in advance is worthwhile.

A cesarean section is reimbursed according to medical necessity. An emergency cesarean section is always fully covered, even without a prior optional services agreement. An elective cesarean section without a medical indication, by contrast, can be refused.

Optional services such as chief physician treatment and accommodation in a single or two-bed room are only reimbursed if the plan expressly includes them. In entry-level plans they are excluded, in comfort plans they are standard. The extra charge for a normal delivery is typically €1,000 to €2,500.

A family room for the accompanying person is included in some comfort plans as an additional optional service, often with an extra charge of €50 to €150 per day. We recommend agreeing the planned optional services in writing before admission.

Newborns are not automatically covered by the parents' contract. They must get a contract of their own within two months of birth. Within this deadline, acceptance without health questions is possible, governed by the Kindernachversicherung under § 198 VVG. The child's premium depends on the plan.

If the two-month deadline is missed, full health questions are due. Pre-existing conditions or developmental abnormalities can then lead to exclusions or higher premiums. Alternatively, the child can be covered free of charge in the statutory health insurance of the other parent, provided this parent is insured there and the requirements for free family insurance are met.

After the birth, private health insurance reimburses the postnatal care by the midwife. Twelve to sixteen home visits are usual, billed under the fee schedule for midwives. Antenatal classes count as prevention and are reimbursed in many plans through the prevention module, sometimes limited to certain types of course.

An attending midwife is present at the birth in the hospital and works alongside the medical team. For people with private health insurance, this form of care can be used without restriction and is reimbursed in full. Check in advance whether your plan covers midwife services without a time limit.

From over 5,000 applications with health questions, we know the most common surprise: a chief physician surcharge for the hospital birth, although the plan does not include optional services. Upgrading the plan during the pregnancy is usually no longer possible, because it requires health questions.

We recommend that couples planning a family check their plan for the optional services they want before the pregnancy begins. The birth is also a good occasion to review the cover for the whole family.

The standard hospital service is typically €1,500 to €3,000. With chief physician treatment and a private room, comfort plans add €1,000 to €2,500.

In most plans, yes. The midwife bills under her fee schedule, a doctor under the official fee schedule for doctors. Clarify the reimbursement with the insurer in advance.

If it is medically necessary, in full. An elective cesarean section without an indication can be refused or can leave you with a share to pay yourself.

After the two-month deadline, full health questions are required. Pre-existing conditions can then lead to exclusions, higher premiums or even rejection.