General Terms and Conditions of Insurance for Healthcare Costs and Daily Hospital Benefits - Version of January 2022

Sep 28, 2026

Uploaded by ahduag

General Terms and Conditions of Insurance for Healthcare Costs and Daily Hospital Benefits, including German standard conditions (MB/KK 2009), tariff conditions (TB/KK), and the version dated January 2022. The text defines the subject, scope, and application of coverage, explains what constitutes an insurance event, and sets out where coverage applies, including medical treatment in Europe and possible extensions under specified conditions. It also describes key obligations and effects of breaches, premium payment rules, start and end of coverage, and contractual termination grounds.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Contents

§ 1 Subject, scope and scope of application of insurance coverage

§ 2 Start of insurance coverage

§ 3 Waiting periods

§ 4 Scope of the duty to render benefits

§ 5 Restriction of the duty to render benefits

§ 6 Disbursement of the insurance benefits

§ 7 End of insurance coverage

§ 8 Payment of premiums

§ 8a Calculation of premiums

§ 8b Premium adjustments

§ 9 Obligations

§ 10 Consequences of breaches of obligations

§ 11 Obligations and consequences of breaches in claims against third parties

§ 12 Set-off

§ 13 Termination by the policyholder

§ 14 Termination by the insurer

§ 15 Miscellaneous grounds for termination

§ 16 Declarations of intent and notices

§ 17 Place of jurisdiction

§ 18 Modifications of these General Terms and Conditions of Insurance

§ 19 Switch to the standard tariff

§ 20 Switch to the basic tariff

Annex – Legislative texts

General Terms and Conditions of Insurance for Healthcare Costs and Daily Hospital Benefits Part I 2009 German standard conditions (MB/KK 2009) Part II Tariff Conditions (TB/KK) Version of January 2022 Contents § 1 Subject, scope and scope of application of insurance coverage............................................. 2 § 2 Start of insurance coverage.............................. 3 § 3 Waiting periods ................................................... 4 § 4 Scope of the duty to render benefits .............5 § 5 Restriction of the duty to render benefits ....7 § 6 Disbursement of the insurance benefits .......9 § 7 End of insurance coverage................................9 § 8 Payment of premiums......................................10 § 8a Calculation of premiums .................................11 § 8b Premium adjustments......................................12 § 9 Obligations .........................................................12 § 10 Consequences of breaches of obligations...13 § 11 Obligations and consequences of breaches of obligations in the case of claims against third parties....................................................... 13 § 12 Set-off................................................................. 13 § 13 Termination by the policyholder .................. 13 § 14 Termination by the insurer ............................ 15 § 15 Miscellaneous grounds for termination ...... 16 § 16 Declarations of intent and notices ............... 17 § 17 Place of jurisdiction ......................................... 17 § 18 Modifications of these General Terms and Conditions of Insurance .................................. 17 § 19 Switch to the standard tariff ......................... 17 § 20 Switch to the basic tariff ................................ 18 Annex – Legislative texts ........................................... 19 These General Terms and Conditions of Insurance consist of: Part I (German standard conditions 2009 of the Association of Private Health Insurance [MB/KK 2009]), Part II (Tariff conditions [TB/KK 2013]) and Part III (Rates). The Tariff Conditions shall supplement the German standard conditions and moreover contain variations in favor of the insured persons. The insurance coverage § 1 Subject, scope and scope of application of insurance coverage I (1) The insurer offers insurance coverage for illnesses, accidents and other events mentioned in this Agreement. As agreed, the insurer shall perform additional services directly related thereto. In an insurance event, the insurer shall render: a) in the case of healthcare cost insurance the reimbursement of expenses for medical treatment and other agreed benefits; b) in the case of daily hospital benefit insurance a daily hospital allowance for in-patient medical treatment. (2) An "insurance event" shall mean the medically necessary treatment of an insured person due the consequences of an illness or accident. The insurance event shall commence with the medical treatment and cease when no further need for treatment exists in accordance with the medical findings. If the medical treatment has to be expanded to any consequence of an illness or accident that does not relate in a causal fashion to the treated consequence to date, a new insurance event shall arise in this regard. The following shall also be considered as an insurance event: a) examinations and medically necessary treatment due to pregnancy and delivery; b) out-patient checkups for early detection of illnesses in accordance with programs introduced by law (deliberate preventative checkups); c) death, insofar as benefits are agreed in this case. (3) The scope of the insurance coverage shall result from the insurance certificate, later written agreements, these General Terms and Conditions of Insurance (German standard conditions with the tariff annexes and Tariff Conditions) and the provisions of law. The insurance

FAQs

What does the insurance cover under these terms?

The insurer provides coverage for illnesses, accidents, and other events stated in the agreement. For healthcare cost insurance it reimburses agreed medical treatment expenses, and for daily hospital benefit insurance it pays a daily allowance for inpatient medical treatment.

When does an insurance event start and end?

An insurance event begins with medically necessary treatment of the insured person due to illness or accident consequences. It ends when no further need for treatment exists based on medical findings.

Where is insurance coverage applicable, and can it extend outside Europe?

Coverage applies to medical treatment in Europe. By agreement it may be extended to non-European countries, and during the first months of temporary stays outside Europe, coverage exists even without a separate agreement under the conditions described.

Sep 28, 2026

Uploaded by ahduag