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Approximately 90 percent of the population in Germany, approx 70 million citizens in total, are members of statutory health insurance funds (so-called: GKV), providing them with comprehensive and high quality medical care.
Around 650.000 insured persons throughout Germany put their trust in pronova BKK for matters of health. This is because of the personal commitment and health competence of our employees in around 60 nationwide customer services – which amounts to many years of professional experience!
If you visit us, call or write to us, you can always rely on committed and expert advice – as should be expected from a true ‘health partner’.
pronova BKK belongs to the largest health insurance companies in Germany and is a modern service provider, with roots dating back to 1815. As such we are one of the oldest and most constant health care insurance companies in Germany.
Excellent companies like BASF, Bayer, Boehringer Ingelheim, Braun-Gillette, Continental, Ford, Georgsmarienhütte, Hapag Lloyd, Johnson Controls, Lanxess, Michelin or Vaillant employ many of our customers.
The relationship between pronova BKK and these companies is based on a trusting partnership.
Facts about statutory health insurance
As a member of a statutory health insurance fund like pronova BKK you pay a monthly contribution to the health insurance provider. Up to a certain maximum, the contribution depends on your monthly income. Your employer shares by paying half of the contribution.
Regardless of the contribution paid, gender, age or health status, all members receive medically necessary health care benefits on an equal basis. This principle of solidarity is fundamental to the concept of statutory health insurance in Germany.
If you become ill or have an accident and need treatment from a doctor or in hospital, your health insurance covers the costs.
For some benefits, members of public health insurance have to share in the costs with the so-called co-payments. Children and adolescents are exempted from all co-payments, apart from transportation expenses.
The health insurance covers prescribed medication.
If you are on sick leave, your employer will continue paying your salary for a period of six weeks. You will then receive sickness benefit for a maximum of 18 months from your health insurance.
Public health insurance is compulsory for all employees, whose annual salary is below a certain limit, the so-called “Jahresarbeitsentgeltgrenze”. In principle apprentices/trainees, job seekers, students, pensioners are also subject to compulsory membership with a statutory health insurance.
Self-employed and employees whose annual gross income exceeds the "Jahresarbeitsentgeltgrenze", can become voluntary members of a statutory health insurance, if certain requirements are fulfilled.
Family members without or rather a low income are covered cost-free.
Children are generally covered up to the age of 18 years or 23 years if they are unemployed or 25 years if they are still pupils or students. Children with disabilities are covered without age limit, if they are unable to earn a living because of their disability.
As a general rule, students from abroad who are enrolled in Germany for studies must be insured in Germany. This does not apply to students from EU countries who are already insured in their home country.
These students can benefit from their European health insurance card. The billing takes place in the home country. The contribution for health insurance and long-term care insurance amounts to a total of 111,07 Euro per month, and for childless persons from the 23rd birthday 112,95 Euro.
In order to be able to carry out the health insurance of the students, we need an application and the current enrolment certificate.
Statutory health insurance pays for health care that is “sufficient, appropriate and economic”. If you are offered benefits that do not meet these requirements, you have to pay for them. These include, for example, single rooms or treatment by senior consultants in hospital.
The most important health care benefits covered by statutory health insurance include:
- Treatment by doctors or dentists (free of choice if they’ve got a contract with public health insurance, which most of them have
- Hospital treatment (free choice to the nearest hospitals) and rehabilitation
- Sickness benefits (also for members who need to care for sick children)
- Prescribed medicines
- Prescribed remedies, such as physiotherapy, ergo therapy
- Prescribed therapeutic appliances such as hearing aids, compression stockings, wheelchairs
- Precautionary examinations for children and adults, skin cancer screening
- Dental check-ups and dental treatment like fillings, dentures
- Orthodontic treatment for children
- Recommended vaccinations
- Support from a doctor and a midwife during pregnancy and delivery
- Domiciliary nursing care or palliative support
There is a legal co-payment for some benefits:
- Prescribed medicines: 10 percent, minimum 5 Euro, maximum 10 Euro
- Hospital treatment: 10 Euro per day, maximum 280 Euro per year
- Prescribed remedies: 10 percent
- Prescribed therapeutic appliances: 10 percent, 5 Euro minimum, 10 Euro maximum
In order not to place anybody under financial stress, co-payments are limited to two percent of your annual gross income and in case of chronic illness to one percent.
Children and adolescents up to the age of 18 years are exempt from most co-payments. If you have paid the annual maximum co-payment, you will be exempt from further co-payments until the end of the calendar year. We recommend collecting the receipts, or using a receipt booklet.
Another form of co-payment could be charged, if you decide to get benefits that exceed the medically necessary providing. For example: If you decide to take special walking boots instead of normal orthopedic shoes, you need to pay the delta cost.
Your personal pronova BKK card allows you to choose from all approved physicians, dentists and hospitals.
Please always take this card with you, if medical treatment is necessary. Family members receive their own card. For people who are 15 years and older the health insurance card is only valid with a photograph.
You can upload your photograph here.
You are covered in Germany and the countries Germany has a health insurance agreement with. These are the countries of the EU/EWR (Norway, Liechtenstein, Iceland) as well as Switzerland, Bosnia, Macedonia, Montenegro, Serbia, Turkey and Tunisia.
For getting benefits in the EU-/EWR-countries, Switzerland, Madeconia, Montenegro and Serbia, we will provide you with the European Health Insurance Card. It is on the back side of your pronova BKK card.
If you travel to one of the other countries, please contact us to get a certain certificate, which you must show to a local health insurance to get a referral slip for doctor or hospital.
The coverage in the other countries depends on laws. To get the same or similar benefits as in Germany we always suggest to apply for private travel health insurance. This can be obtained for low money, but be of great use.
If you travel outside Europe, a private travel health insurance is necessary to avoid the risk of paying expensive bills without participation of pronova BKK. If you like to find out more about a private travel health insurance please "click here”.
More detailed information about benefits
If medical treatment is required, you can choose freely amongst licensed doctors or dentists. If you get ill, please always see a doctor first. Hospitals should only be visited in case of emergency. If you are looking for a doctor or a hospital please contact us. By showing your health insurance card and the costs will be directly settled with pronova BKK automatically.
Please be aware that private bills cannot be payed. In all cases “except emergencies”, it is recommended calling the doctor and make an appointment.
Public health insurance cover the costs of your dental treatment that for example include check-ups twice a year, removing of teeth plaque once a year, fillings and necessary periodontitis treatment. You have the free choice of dentists getting the treatment with your health insurance card.
Participation in dentures like crowns and bridges with a fixed sum. If you can proof regularly check-ups within the last five or ten years, the participation will be higher.
Prescribed medicines are covered. The colour of the prescription has to be pink, otherwise it is only a recommendation. You will get medicines only in pharmacies. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.
When hospital treatment is necessary, you will get a referral slip from your doctor. You can choose an approved hospital. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.
We cover the costs of prescribed remedies such as physiotherapy, ergo therapy. Insured persons aged 18 years and older need to make a co-payment. For more details, please see “Co-payments”.
If your doctor diagnoses chronic lumbar spine pain or chronic pain in one knee joint (gonarthritis), the costs of up to 10 treatments within six weeks are covered, if given by an approved doctor. You will get the treatment with your health insurance card.
Therapeutic appliances like hearing aids, compression stockings, orthopedic shoes, wheelchairs and prosthetics are covered if prescribed. Insured persons aged 18 years and older need to make a co- payment. For more details, please see “Co-payments”.
Our free preventive and early diagnosis measures caringly accompany you and your family through life: Starting with the check-ups during pregnancy and followed by the examinations for babies and children. Women aged 20 and older and men aged 45 and older are entitled to a free cancer check-up every year. Skin cancer check-ups are covered starting at the age of 35 years, every two years.
If orthodontic treatment is medically necessary because malformation of teeth frequently cause substantial functional disorders in the teeth and jaw area it is covered for children up to the age of 18 years for treatment levels 3, 4 and 5. During the treatment, you participate with 20 % of the costs.
However, at the end of a successful treatment (must be confirmed by the dentist or orthodontist) you get a reimbursement, so that 100 percent of the treatment is covered.
The costs of psychotherapeutic treatment are covered with recognised methods such as analytical or in-depth psychotherapy and behavioural therapy (in individual or group therapy), if you consult an approved therapist who has a contract with the public health insurance system
Coverage of all recommended vaccinations for example against diphtheria, whooping cough, polio, measles, mumps, tuberculosis, tetanus, tick-borne encephalitis (in endangered areas)
During pregnancy you are entitled to certain check-ups, premature birth prevention programs, medical care, midwife assistance, inpatient births, birthing houses and more.
In certain circumstances, for example if you need taking insulin but are not able regarding to your health status, your doctor prescribe domiciliary nursing care. That means you can get support from an examined person who comes to your home to do it.
If a disease is so severe that it will lead to death, it is also possible to get support from special examined units comes to your home supporting you.
The insurance of employees usually includes the entitlement for a sickness allowance when on sick leave and if they do not receive a salary. Whilst receiving the sickness allowance they are exempt from paying the health insurance premiums.
If you are an employed person and unable to work, because you have to look after your sick child, you will receive an allowance.
Outpatient or inpatient convalescence and rehabilitation measures, outpatient spa treatments, child and youth convalescence and treatments for mothers/fathers and child are, as a matter of course, included.
Special benefits of pronova BKK
If you like to participate in health classes preventing diseases, for example a yoga class, pronova BKK participate in the costs with 80 percent (maximum 150 Euro for 2 classes every year).
We take care of our chronically sick members with special programs. These programs are called Disease Management Programs (DMP). You can register for it, if for example you suffer from diabetes, asthma, COPD (chronically obstructive pulmonary disease). Treatment and care is improved even more by closer cooperation between patient, doctor and hospital.
Are you active and take care for your health? Then join our so-called bonus program. Participating in only three health measures like check-up at the dentist, check-up to prevent cancer, complete vaccination status in a calendar year. This will be rewarded with 60 Euro. Even your children can join the bonus program, which means every family member can get 60 Euro per year.
You can get a booklet, which will be confirmed by your doctor/dentist. Alternatively you can use the digital one in our online office. You can also use the cost-free App „meine pronova BKK“ on Google Play or in the AppStore,
The bonus can be claimed latest until 31st March of the following year.
We do not only cover all recommended vaccinations for Germany but also the recommended vaccinations for traveling abroad in your holidays including malaria prophylaxis. We pay 100 percent of the costs of the vaccine and the medical treatment (maximum 15 Euro).
Not many public health insurances cover osteopathy, but it is covered by pronova BKK. You will get a reimbursement of 40 Euro per treatment for a maximum of four treatments per year. For getting the reimbursement you need a recommendation of a doctor and an examined osteopath (member of professional association of osteopaths or trained osteopath) has to perform the treatment.
- Usually we only reimburse cost for medicines or supplements that require a prescription. During pregnancy we reimburse costs for medicines and supplements with the ingredients iron, iodide, vitamin D3, magnesium and folic acid, which are very important to pregnant women. You need a private prescription and will get a reimbursement of 25 Euros.
- We participate with 75 Euros of the costs of several examinations and tests you normally have to pay for, like toxoplasmosis test or B streptococci test.
- Up to 250 Euros for the 24 hours on call midwife.
- pronova BKK covers 50 percent (maximum 100 Euros) of the costs of your partner’s birth preparation class, if he/she is also insured with pronova BKK.
Additional check-ups for children: The prevention examinations “so-called U1 to U 9 and J1” are always covered. However, pronova BKK also covers the examinations U10 and J2, which you usually have to pay yourself.
Rooming-in: When a child gets hospitalized, one of the parents can stay overnight at the hospital with the child.
Do you like to have a sports medical examination? Every two years we participate in the costs of a basic check-up with 50 percent (maximum 150 Euro). Requirements: The doctor is approved and a specialist (Sportmediziner) and you need a confirmation of the doctor that the examination is suited and necessary to prevent cardiac or orthopaedic diseases or to avoid the worsening of such diseases.
If you need competent medical advice you can reach our health service by phone around the clock cost-free. Please dial 0621 53391-4911.
If you like to have your doctor’s appointment digital you can find an app on our website for registering for teleclinic. This service is also cost-free. For further informations click here.
We have a partner for additional private health insurances. If you would like to include private travel health insurance – which we always recommend if you travel abroad – or more benefits for dentures, like to include glasses or alternative practitioners, a one-bedroom in hospital with treatment by the chief doctor our partner pronova private will offer you a single room additional insurance.
pronovaprivate - Our partner for additional private health insurance or send an e-mail to firstname.lastname@example.org.