Gothaer's Supplementary Health Insurance: Plans, Benefits, and Costs

Gothaer’s group health insurance has a modular structure and distinguishes between modular plans and budget plans. While modular plans cover individual benefit categories—such as outpatient care, dental care, or preventive care—separately, a budget plan like MediGroupAG FlexSelect combines these benefits into a single, freely usable annual budget. Employers can choose from several plan tiers with varying budget amounts and adjust the tier annually—either across the board or for individual employees. For very large companies, MediGroupAG FlexSelect XL offers a specialized version designed for organizations with 500 or more employees.

Within the budget-based plans, employees can freely allocate their annual budget to outpatient services, such as medications, medical aids, vision aids, or treatments by alternative practitioners. For over-the-counter medications, a separate maximum amount—which counts toward the total budget—applies, meaning these services place an additional burden on the remaining budget. If the budget is exhausted during the year, the insurer’s obligation to provide benefits is suspended for the remainder of the insurance year and does not become fully available again until January 1; the date of treatment or purchase is always decisive for allocation. In the modular plans of the dental coverage line, statutory advance payments are also taken into account, whereas the budget plans do not require such advance payments from statutory health insurance (GKV).

For inpatient care, the daily hospital allowance provides financial compensation of 10 euros per calendar day for up to 28 days per year for hospital stays and childbirth. For dental care, the budget plan covers professional teeth cleaning, while dental prosthetics are covered under separate dental plans, which feature tiered reimbursement rates and maximum limits during the first few years of coverage—reimbursement amounts are higher if regular preventive checkups are documented in the bonus booklet. In addition, digital health services such as video consultations with doctors, a specialist appointment service, a medical hotline, and digital health applications (DiGA) are available free of charge to all insured individuals.

From an organizational standpoint, Gothaer requires a minimum company size of five employees. When setting up a group insurance policy, a medical examination may be waived for the first six months, provided that at least 50 employees are insured and they have not been unable to work for more than 20 days in the preceding twelve months. This waiver may also be extended to co-insured family members under the same conditions, although certain serious diagnoses remain excluded from coverage. A separate advance payment from the statutory health insurance (GKV) is not required for enrollment.

Family members—spouses or domestic partners, as well as children up to age 21 (or up to age 27 if still in school)—may be optionally included in the insurance coverage, which is typically employee-funded. If an employee leaves the company, it is possible to continue the insurance coverage privately without a new medical examination; however, this is only available under the modular plans and not under the budget plan itself. Anyone planning to make the switch should therefore explore their options well in advance of leaving the company.

With its tiered pricing model, the waiver of medical underwriting for groups of 50 or more insured individuals, and a special solution for large companies with 500 or more employees, Gothaer’s offering is designed for both smaller businesses with five or more employees and very large groups. External evaluations confirm the quality of the offering: Morgen & Morgen awards a “Very Good” rating (4/5, 2025), Ascore rates it “Excellent” (2024), and the IVFP rates it “Excellent” (2024).

• Preventive screenings: covered differently depending on the plan
• Alternative practitioners: regulations vary depending on the insurance plan
• Alternative Medicine: Regulations Vary Depending on the Plan
• Medications and medical supplies: covered differently depending on the plan
• Remedy: Yes
• Resources: Yes
• Vaccinations: included depending on the plan
• Vision aids: Regulations vary depending on the plan
• Professional teeth cleaning: included
• Daily Hospitalization Benefit: Yes, €10 per day (up to 28 days)
• Digital Health Services: Video consultations with doctors · Specialist appointment service · Medical hotline · Digital health applications (DiGA)
• Budget carryover: No, expires at the end of the year
• Upon leaving the company: Continued insurance coverage is available only under modular plans
• Services for Family Members: Care Assistance Only

The monthly premium is primarily based on the selected plan tier or budget level, as well as on whether the plan is employer- or employee-funded and whether a premium waiver—for example, in the event of incapacity to work—is included. Higher budget levels result in a higher monthly premium, but also in a larger annual reimbursement limit, which employees can flexibly allocate to the types of benefits they desire.

As a general rule, all covered benefits used are counted toward the annual budget; for over-the-counter medications, there is also a separate maximum amount that is likewise counted toward the total budget. Counseling and assistance services are excluded from this and do not reduce the budget. If the budget is fully exhausted within an insurance year, the insurer is no longer obligated to provide benefits for the remaining months until the end of the year.

Any unused budget expires at the end of the year and is not carried over to the following year; as of January 1, the insured person once again has access to the full annual budget for the agreed-upon rate tier. Even if coverage begins during the year, the full annual budget applies to the MediGroupAG FlexSelect budget plan. Employers may change the rate tier—either for the entire workforce or for individual employees—at the start of each insurance year, provided that the change is requested in a timely manner.

• Morgen & Morgen: Very Good (4/5) · 2025 — Rating
• Ascore: Award-Winning · 2024 — Rating
• IVFP: Excellent · 2024 — Rating