Health Care Budget

The health care budget is the amount that employees can use each year for health care services within a given plan. It is the key metric of supplementary health insurance—and, at the same time, the one where the differences between plans are greatest.

What Is Covered by the Budget

Typically, the following can be billed:

• Preventive medical examinations beyond the scope of statutory health insurance
• Alternative Medicine Services and Natural Healing Methods
• Resources
• Medications and medical supplies, to the extent provided for in the collective bargaining agreement
• Additional outpatient services, depending on the plan

Whether vision aids and dentures are covered by the budget or reimbursed separately as a separate benefit depends on the plan—and this is the most important factor to consider when comparing plans. With a plan that reimburses dental and vision care separately, the entire budget is available for everything else. With another plan, the budget is used up after one pair of glasses and one dental treatment.

What Limits the Budget

In addition to the total amount, there are often other factors that can push the real value significantly below the nominal value:

• Sublimits for individual expense categories that apply even if the total budget has not been fully utilized
• Reimbursement rates below 100 percent—such as 75 or 90 percent for vision aids and dental prosthetics
• Dental benefit schedules that cap the reimbursable amount during the first years of the policy
• Waiting periods, unless excluded by the collective bargaining agreement
• Advance payment by the statutory health insurance provider, if required by the plan

When comparing two plans with the same budget, this factor determines which one actually offers more.

Carry forward to the next year

Whether an unused budget expires or can be carried over in full or in part to the next year varies by insurer.

For more extensive procedures, a carryover can make the difference between a treatment being beneficial and ineffective: Dental prostheses regularly exceed an annual budget of 300 or 600 euros by a significant margin. Without the option to carry over funds, the only alternative is to spread the treatment over two calendar years—which isn’t always medically advisable.

Budget and Utilization Rate

A large budget alone does not produce results. What matters is how many employees actually take advantage of it—and that depends less on the budget size than on two other factors: whether the workforce even knows what they’re entitled to, and how easy it is to submit a request.

A well-communicated 600-euro budget with a functional submission app regularly has a greater impact than an unknown 1,200-euro budget that relies on paper-based processes. Therefore, those who want to increase the impact of the bKV are often better off investing in communication than in the next higher budget level.

Tax Classification

The budget is not the benchmark for the 50-euro exemption limit—what matters is the monthly contribution, which is significantly lower. Even those who do not submit anything receive the same monetary benefit as someone who fully utilizes their budget: it is the contribution that is evaluated, not the actual use of the benefit.

Conclusion

The health care budget is the most visible part of the supplementary health insurance (bKV) and the easiest to explain. However, its true value lies in the details—what is excluded, what is additionally reimbursed, what limits apply, and whether funds can be carried over.