Alcohol clause: what the term means

The clause releases the insurer from paying benefits if an illness or an accident is the result of alcohol consumption. If, for example, an accident happens while your consciousness is impaired by alcohol, benefits can be limited. Whether there is an addiction problem or a one-off occasion such as a party makes no difference for the clause. The only thing that matters is the link to alcohol. Statutory health insurance has no such clause.

It is found in the general insurance conditions under the item on limits of the duty to pay benefits, traditionally in § 5. Besides a possible alcohol clause, this section lists other reasons that can limit benefits. A targeted look at this section gives you clarity. It is important to distinguish the types of benefit: after an accident caused by alcohol, private health insurance usually pays for the treatment, but an agreed Krankentagegeld can be lost.

Competition has led many insurers to drop the clause. In modern plans it is the exception, but it can still appear in older sets of conditions. We recommend having the insurance conditions checked before you sign. This way you can spot an alcohol clause and choose a plan without this restriction.