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Health insurance

GKV, Expat Tariff or Full PKV? A Practical Benefits Comparison for Germany

Martin B. Groedl
A couple reviewing health insurance documents together at a laptop.

Germany’s statutory health insurance (GKV), temporary private cover and full private health insurance (PKV) follow different rules. This comparison sets out selected benefits for one example of each; it is not a ranking or a substitute for checking your eligibility and the full policy wording.

In brief: the Hallesche example is Hi.Medical L P500 with Hi.Dental L, a temporary option for eligible residents. The Allianz example is full private cover with Best 100 and Zahn 90. GKV is the statutory baseline, with some additional benefits varying by health fund.

A couple reviewing health insurance documents together at a laptop.
AI-generated image for illustrative purposes.

Compare the benefits side by side

Open a category to see the selected benefits and limits. Benefit details are from NEOdirect’s English comparison summary dated 27 September 2026. Individual eligibility, medical necessity, policy wording and statutory rules still apply.

Benefit Statutory insurance (GKV)Statutory baseline · fund not specified HallescheHi.Medical L P500 + Hi.Dental L AllianzBest 100 + Zahn 90
Itemized monthly premium exampleAdviser quote dated 11 June 2026 for cover from 1 July 2026; applicant age 35, employed. The 27 September benefits summary has no premium data. Income, family status and GKV fund are not stated. Amounts and employer shares below are reproduced as quoted, not current rates.
GKV health cover: €1.004,98/month
PV long-term care: €209,25/month
€1.214,23 /month total
Employer share as quoted: €592,17
Employee outlay as quoted: €622,06
Hi.Medical L P500: €236,78/month
Hi.Dental L: €43,23/month
PVN long-term care: €69,11/month
KT.43/140 (€140/day from day 43): €45,08/month
€394,20 /month total
Employer share as quoted: €197,11
Employee outlay as quoted: €197,09
GSB70: €518,66/month
GSUB90: €57,58/month
GSUB100: €29,72/month
GSZ90: €123,45/month
PVN long-term care: €70,28/month
KTA07W/140 (€140/day from day 43): €62,44/month
Statutory surcharge: €72,95/month
€935,08 /month total
Employer share as quoted: €467,54
Employee outlay as quoted: €467,54

Cover being compared
Statutory health insurance. Core benefits are set by law; additional benefits vary by health fund.
Hi.Medical L P500 is temporary comprehensive private cover. Hi.Dental L is a separate dental tariff available alongside it.
Best 100 combines GSB70, GSUB90 and GSUB100; all three medical modules are required. The dental option is MeinGesundheitsschutz Zahn 90 (GSZ90).
Eligibility and term
Compulsory, voluntary or family membership depends on statutory eligibility.
For eligible temporary residents; the product term is up to five years. Confirm individual eligibility and the exact end date.
Comprehensive private cover. The reviewed product information gives no fixed maximum term; eligibility is assessed individually.
Medical deductible and remaining costs
No universal annual deductible. Statutory co-payments generally have a 2% household-income limit, or 1% for qualifying chronic illness; private extras are separate.
10% of eligible medical reimbursement, capped at €500 per calendar year; hospital treatment is excluded. Dental has its own annual cap, and fee limits can leave further costs.
€0 medical deductible with both upgrade modules. Service-specific limits and dental co-insurance still apply.
Dependants and family cover
Eligible spouses and children may qualify for contribution-free family insurance, subject to the statutory conditions.
Each person needs their own cover and premium.
Each person is insured separately; family benefits do not replace separate cover for a child.
Ageing reserves
Members do not build individual private-health-insurance ageing reserves.
Hi.Medical L is temporary cover and does not build the ageing reserves used by full PKV.
Full PKV includes collective ageing reserves. They are not personal savings and do not guarantee that premiums will never rise.

Doctor and specialist fees
Contracted medical care is covered under statutory rules. Private fee agreements are not automatically covered.
100% of eligible fees up to the statutory maximum rates in the German physician fee schedule (GOÄ).
100%; fees above GOÄ maxima may be covered when costs remain reasonable.
Outpatient treatment
Eligible contracted care; treatment and provider rules apply.
100% of eligible costs, subject to tariff exclusions and the €500 annual medical deductible.
100% of eligible costs under the selected medical modules and their conditions.
Alternative practitioners and psychotherapy
Approved psychotherapists, methods and approval rules apply. There is no general Heilpraktiker entitlement; fund-specific extras may exist.
Psychotherapy: 100% for up to 25 sessions per calendar year without prior confirmation. Heilpraktiker care: 100% up to €500 per year, including medicines.
Eligible psychotherapy is covered at 100%. Heilpraktiker care is 100% up to €2,000 per year including medicines, subject to GebüH fee limits.

General hospital treatment
Medically necessary treatment in eligible hospitals; adults usually pay €10 per day, up to 28 days per year.
100% within the tariff’s hospital-cost rules.
100% within the tariff’s hospital-cost rules.
Room and private doctor
Standard accommodation and hospital medical care; no general private-room or named-consultant entitlement.
Single or twin room; private doctor fees up to GOÄ maxima.
Single or twin room; private doctor fees may exceed GOÄ maxima under the tariff.
Private hospital charges
No general entitlement to treatment in a non-contracted private clinic.
Public-hospital general-service benchmark, with an emergency exception.
Up to 250% of the specified public benchmark, with an emergency exception; separate medical fees are covered under the tariff.
Rehabilitation and spa treatment
Eligible rehabilitation is assessed under statutory rules; another payer may be responsible. Co-payments can apply.
Follow-up care is covered only under defined tariff conditions. Spa treatment needs prior written consent; accommodation and meals are not covered.
Rehabilitation up to 150% of the statutory benchmark, normally once per 36 months, with exceptions. Prescribed spa treatment: up to €3,000 per 36 months.
Home nursing and palliative care
Prescribed, eligible services; household support and duration depend on the indication. Specialist palliative and hospice care follow statutory requirements.
Home nursing at customary rates; basic domestic support is normally limited to four weeks, with consent needed for longer periods. Palliative and hospice benefits follow tariff and rate limits.
Home nursing at 100% under statutory-based provider and rate conditions; eligible palliative and hospice care follows tariff conditions.
Parent accompanying a child
Medically necessary accompanying persons may be covered within general hospital services.
Accommodation and meals for one parent when the child is under 16.
Covered when medically necessary; necessity is presumed when the child is under 12.

Annual and initial limits
No single tariff-wide annual euro allowance; each statutory service has its own rules.
€1,500 total per calendar year across all Hi.Dental L benefits.
Cumulative cap: €1,000 in year one, €2,000 over years one and two, and €3,000 over years one to three; then no initial cap. Accident exceptions apply.
Routine treatment and cleaning
Eligible standard treatment is covered; private upgrades can cost extra. Professional cleaning subsidies vary by fund.
Routine treatment: 100% within the €1,500 annual cap. Cleaning and prophylaxis: €100 per year, included in that cap.
Routine treatment: 100%, subject to initial limits. Cleaning: 100%; a designated prevention programme can protect refunds and the initial allowance.
Crowns, bridges, inlays and implants
Dentures receive 60% of the standard-care reference cost, or 70%/75% with qualifying bonus history. Implants are generally excluded except for narrowly defined severe cases.
100% within the €1,500 annual cap; associated bone-building for implants is included.
Crowns, bridges and inlays: 90%, subject to initial limits. Implants: 90%, including associated surgery, subject to tariff conditions.
Orthodontics
Qualifying childhood cases and limited adult surgical exceptions; the patient share may be refunded after eligible treatment is completed.
100% within the annual cap when treatment starts before age 18, or when treatment follows an accident during cover.
90% until age 21, with accident or defined severe-condition exceptions; initial limits apply.
Fees and treatment-cost plans
Contracted statutory billing applies. A treatment and cost plan is required for the statutory denture subsidy process.
GOZ fees up to 3.5×, GOÄ maxima and reasonable laboratory/material costs. A plan is not compulsory but is strongly advised before costly treatment.
Fees above GOZ/GOÄ maxima may be covered when reasonable. A treatment and cost plan is recommended for major dental work.

Glasses and contact lenses
Children and qualifying adults may receive eligible lenses under statutory rules and price limits. Frames are generally excluded.
€250 every two years; earlier replacement if vision changes by at least 0.5 dioptres.
Up to €1,000 within 36 months, including eligible care products.
Laser vision correction
Elective correction is not generally covered; medical indications require individual assessment.
€750 per eye once per contract, after 12 months.
100% where medically necessary.
Medical aids, hearing aids and shoes
Necessary eligible aids use approved supply arrangements and statutory co-payments. Optional upgrades or ordinary footwear costs may remain.
Eligible medical aids: 100%, subject to definitions, exclusions, caps and the deductible. Request insurer supply for items above €350 or recurring needs; otherwise reimbursement falls to 75%. Hearing aids: €1,500 per ear once per contract; hearing implants: €4,000 per ear. Orthopaedic shoes/insoles: €250 per calendar year.
Eligible aids: 100%, subject to definitions and limits. Hearing aids: €3,000 per ear; bone-anchored aids: €6,000 per ear. No general procurement reduction is shown in the reviewed Best documents.
Prescription and non-prescription medicines
Eligible prescriptions are covered under statutory rules; adult co-payment is usually 10%, at least €5 and at most €10, not exceeding the cost. Non-prescription medicines are generally excluded, with exceptions.
100% for eligible prescribed medicines, subject to tariff exclusions. No separate non-prescription allowance is established; a prescription is required.
100% for eligible prescribed medicines; up to €100 per calendar year for non-prescription medicines.
Preventive examinations and vaccinations
Statutory programmes follow defined eligibility and intervals. Travel-vaccination benefits vary by fund, subject to statutory exceptions.
100% for statutory preventive programmes without their age limits. STIKO-recommended vaccinations; travel vaccinations and employer-paid occupational vaccinations are excluded.
100% for preventive examinations including those beyond statutory programmes, and for travel vaccinations. Employer obligations take priority.

Daily sickness benefit in the price example
The quoted GKV route includes statutory Krankengeld, subject to statutory eligibility and calculation rules; it is not a private daily-benefit tariff.
The separate quote includes KT.43/140: €140 per day from day 43.
The separate quote includes KTA07W/140: €140 per day from day 43.
Fertility treatment and maternity care
Fertility treatment is usually 50% of approved eligible costs, subject to marriage, age and medical rules; fund extras may apply. Statutory pregnancy, delivery and midwife benefits are provided under the relevant rules.
Fertility treatment: €2,500 once after 24 months and written consent; age, organic-cause and couple rules apply. Maternity and midwife care: 100% within fee and facility limits.
Fertility treatment: 100% for defined attempts under medical criteria and age limits. Pregnancy and delivery benefits include a €3,000 home-birth allowance.
Sick-child benefit and household assistance
Child sickness benefit depends on insured status, income loss and statutory entitlement. Household assistance depends on the illness, treatment and household circumstances.
No separate parental income allowance is established in Hi.Medical L. Domestic support is limited to qualifying home-nursing situations.
Sick-child benefit: €100 per day, up to 15 days per child per year, subject to both parents being insured, income loss, age and care rules. Household assistance: up to €100 per day for 30 days, or 180 days in specified severe-illness/child cases.
Premium waiver for parents
Contributions during parental leave depend on compulsory, voluntary or family-insured status.
No comparable six-month premium waiver is established in the reviewed documents.
Up to six months where qualifying parental-benefit/leave and prior-insurance conditions are met.
Compulsory long-term care insurance
Social long-term care insurance accompanies statutory health insurance. Benefits depend on assessed care grade and setting; personal costs can remain.
Private compulsory long-term care insurance (PVN) must be included as a separate policy and meet statutory equivalence requirements; it is not a full-cost nursing-home guarantee.
Private compulsory long-term care insurance (PVN) must be included separately and meet statutory equivalence requirements; benefits do not guarantee full nursing-home costs.

Medical return transport to Germany
Medical repatriation is not part of standard statutory travel protection.
Covered subject to medical and transport conditions and applicable deductions.
Included subject to tariff requirements.

How to read the figures: the €1.214,23, €394,20 and €935,08 monthly premiums come from a separate June 2026 adviser quote, not the September benefit summary. The private totals include PVN and the quoted private sickness-benefit cover; the GKV total includes statutory health and long-term care contributions. The Hallesche medical percentages are before the P500 deductible. Dental and service-specific annual limits can leave additional costs.

The table is a selected-benefit summary, not a complete list of exclusions or a promise that every invoice will be reimbursed. The German policy conditions and each person’s eligibility determine cover. GKV extras can vary by health fund.

Sources and scope

The benefit comparison is an independent English summary of selected terms dated 27 September 2026. The German policy conditions and individual contract prevail. Ageing-reserve information and the dated monthly quote are from separate sources and are identified above.

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