General hospital services: what private health insurance covers in hospital

The Hospital Remuneration Act sets out what every patient receives at no extra charge. This includes medical care by the hospital staff within the normal duty roster, nursing care around the clock, accommodation in a shared room and the hospital meals. In addition, there are diagnostic and therapeutic measures that are medically necessary, such as operations, medicines, physiotherapy as part of the treatment and necessary laboratory tests.

Privately insured people are covered for these basic services through their comprehensive health insurance. The bill for general hospital services goes either directly to the insurer or first to the insured person, who then submits it. If you only use general services, you will rarely have problems with the billing, because the coding is standardized.

The difference between general services and optional hospital services is not about medical necessity. The specialist on duty also treats according to evidence-based guidelines, and the quality of medical care is comparable across German hospitals. The optional service of treatment by the chief physician mainly guarantees personal continuity of treatment by one specific doctor.

Plans with inpatient optional services typically include treatment by the chief physician and accommodation in a single or two-bed room. These services go beyond general hospital services and must be agreed in the plan. If you sign an optional services agreement when you are admitted to hospital and have these services in your plan, you pay no share yourself.

Timing is important: optional services such as treatment by the chief physician or a single room must be agreed in writing before admission. If you sign the document only after admission or not at all, you receive only general services, regardless of the scope of your plan.

If you have no plan with inpatient optional services, hospitals can still offer an optional services agreement. In this case, the patient pays the costs of treatment by the chief physician and the room upgrade personally. If you do not have such a plan, you should state clearly on admission that you will only use general hospital services.

For civil servants, the Beihilfe also covers general hospital services. Optional services are eligible for state allowance if they are included in the contract and meet the legal requirements for the allowance.

If you are planning a hospital stay, check in advance which optional services your plan covers. Surprises on the bill often arise where the insured person had the wrong expectations about the plan. Treatment by the chief physician and a single room are included in many high-quality plans, without you having to pay extra on admission.