Excess, coverage limits and reimbursement: insurance terms explained simply

Anyone coming to Germany to study, do a PhD, undertake a research project or take up a teaching post needs suitable health insurance. It’s not just about the monthly premium, but also about practical questions: Which costs are covered? Is there an excess? And how does reimbursement work?

Insurance terms in Germany are often unfamiliar, particularly for international academics. That is why we explain the most important terms in a simple and understandable way.

What does excess mean?

An excess means that you are responsible for paying a portion of certain treatment costs yourself. The remaining portion is reimbursed – provided the treatment is eligible for reimbursement – under the terms of the chosen policy.

Whether an excess applies and, if so, how much, depends on the specific plan. That is why it is worth checking the plan details before taking out a policy.

What are benefit limits?

Benefit limits determine the extent to which certain costs are covered. These can be maximum amounts for individual benefits, types of treatment or the entire insurance period. For example, IHC covers medically necessary treatment within the scope of the chosen plan and the agreed maximum limits. It is therefore important to ask: Which benefits are included in the plan? And are there any specific limits or conditions for certain areas? An overview of IHC plans is available here.

Typical questions include:

  • Are outpatient medical treatments covered?
  • What costs are covered for hospital stays?
  • Are there maximum limits for certain benefits?
  • Which treatments are considered medically necessary?

For planned treatments, we recommend briefly checking the scope of cover or contacting IHC Customer Services.

How does reimbursement work with IHC?

For outpatient treatment in Germany, an invoice is often issued first. This can then be submitted for review and reimbursement.

The process:

  • Receive medical treatment
  • Submit the invoice
  • Review in accordance with the policy
  • Reimbursement of the eligible amount

In the case of hospital stays, for example, IHC can often arrange for the hospital to cover the costs directly. This means that, in many cases, you do not have to pay large sums up front yourself.

What treatments are covered?

The scope of cover always depends on the chosen plan. Essentially, it covers medical care and medically necessary treatments during your stay in Germany or within the agreed area of cover.

Depending on the tariff, this may include, for example:

  • outpatient medical treatment
  • medically necessary diagnostics
  • prescribed medication
  • hospital treatment
  • emergency treatment
  • other benefits in accordance with the tariff conditions

For shorter stays of up to 92 days, IHC offers a suitable solution for international guests with ISHCP-STT. For longer study or research stays, the ISHCP tariff may be relevant.

What should international academics bear in mind?

Health insurance is often essential for international academics when applying for a visa, residence permit, enrolment or starting work at a research institution. It is therefore important to sort out your insurance cover well in advance.

The following applies particularly to planned treatment:

  • Check the scope of cover under your policy
  • Keep invoices and medical records
  • Contact the insurer in advance for major treatments
  • Ask for direct cost coverage in the event of hospitalisation
  • Read the policy terms and conditions carefully

Understand insurance terms and better estimate costs

Excess, benefit limits and reimbursement are important terms relating to health insurance in Germany. If you are familiar with them, you will be better able to assess which costs will be covered, when an invoice needs to be submitted and when it makes sense to seek clarification.

IHC supports international academics in finding the right insurance cover for their stay in Germany – in a clear, service-oriented manner and tailored to the needs of international visitors. Please feel free to contact us if you have any questions or would like advice.

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