Benefits - BKK Wirtschaft & Finanzen

Benefits
2015 Summary
Individual service
Secure benefits
A message from the Director
Dear Members and Prospective Members,
Are you thinking about changing health insurers? Or are you
already with us and are looking for more information on
the service available to you
from the BKK? The following
pages provide detailed information on the benefits offered
by BKK Wirtschaft & Finanzen
(BKK WF) and the options
open to you.
Not every health insurer is the same – on the contrary.
We are a medium-sized insurer offering a transparent
benefits portfolio and a wide range of supplementary
programmes to keep you healthy. A personal advisory
service, individual support and the search for alternative
solutions are an integral part of our work.
Who we are
BKK Wirtschaft & Finanzen (BKK WF) emerged in 2007
from the ­occupational health insurance fund of KPMG
AG, the leading audit, tax and advisory firm. Committed
employer and member representatives on the executive
board ­secure the ongoing strategic development of our
efficient and flexible structure. This ensures our members
receive maximum benefits and comprehensive advice,
rapidly and without the red tape. We don‘t deal in exclusions or waiting times: from the day they join, our new
members have full, unrestricted access to all benefits.
The BKK WF articles of association allow a wide range of
additional benefits. Our insurance advisors can use this
freedom in your best interests. We participate in the use
of recognised new but untested therapies [Außenseitermethoden] and always seek alternative solutions instead
of simply sending people away. Comprehensive and
above all transparent benefits are a key priority at BKK,
as is frank and open communication with members and
contractual partners on the strengths and weaknesses of
statutory health insurance. Unlike other health insurers
and despite our good results, we do not display test
seals of any kind – such awards are not always reliable.
We only make promises which we can and do keep and
prove. BKK WF is ideal for all those looking for a statutory
health insurer offering strong and transparent benefits.
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In 2015, BKK WF is combining incentives and useful supplementary benefits in an attractive package tailored to
all its members and all sections of society.
Service is our top priority. If you would like additional
information on a specific area or have individual needs or
queries, simply contact one of our specialist advisors. We
will provide rapid assistance with a minimum of red tape
– that is one of our key strengths.
Wishing you a healthy 2015,
Björn Hansen
Director of BKK Wirtschaft & Finanzen
The benefits / How to join
Key benefits at a glance
Are you looking for a health insurance provider that offers you more than the usual standard? When it comes to protecting your
health, is it important to you to have a partner that keeps you fully informed of your rights at all times? If so, BKK WF is the perfect
choice for you. We are a modern service provider where competent consultancy and convenient service go hand in hand. We combine a number of worthwhile additional benefits and financial attractiveness:
+ Greater benefits: For example: we cover the costs of
homeopathic and anthroposophic remedies, as additional
alternative therapies, from approved contractual partners.
Osteopathic treatment and herbal remedies can also qualify for cover. We pay for a wide range of additional vaccinations – even for foreign travel – and refund all costs up to
500 euros for fitness courses.
+ Attractive bonus programmes: Healthy living is even more
whorthwhile witz out bonus programs: as well as improving your quality of life, you can collect a fixed annual bonus
of 100 euros if you take part in three healthy activities – for
instance if you are member of a fitness studio oder sports
club. We also offer our own programmes for
children and refund the full costs of certain travel health
insurance policies for each participant. Participants in our
programmes for GPs or the chronically ill are rewarded with a
registration bonus of 40 or as much as 60 euros.
+ Medical Advice Hotline: Are you looking for a new GP or
specialist after moving house? Do you need an appointment
with a specialist in your area? Our partner INFOMED-Gesundheitswegweiser ensures you have around-theclock access to
doctors and nurses to respond in depth and at length to your
medical queries. INFOMED can be contacted 24 hours a day.
lf staff involved in this service are bound by medical confidentiality. The costs of the service and the costs of calls are
borne by BKK WF.
How to join
Despite its somewhat unusual name („Business & Finance“),
BKK WF is a health insurer open to all across Germany with just
a few exceptions*. Usually, notice of termination of your previous insurance is required before you can move insurers. We do
not need confirmation of cancellation from anyone starting an
apprenticeship, or (re-)entering employment subject to statutory
insurance, who is switching from private or family insurance. We
will, however, always contact you in good time if we need any
further details or documents to process your application.
Family insurance
Unlike a private insurer, we can insure spouses and civil partners
without additional contributions. The same applies for children
until they turn 23; or until they are 24 if they are still at school
or engaged in vocational training. „Children“ includes largely
dependant stepchildren and grandchildren, foster children
and the children of children covered by the family insurance.
Non-contributory insurance primarily excludes persons who are
exempt, insured individually or in full-time self-employment,
or whose total monthly income exceeds 405 euros (for those in
marginal part-time employment [geringfügige Beschäftigtung],
permitted total monthly income is 450 euros).
Recommend and benefit
As a thank-you for choosing us, and a little incentive to
recommend us to family, colleagues or friends, we give you
a bonus of 20 euros for every new BKK member who comes to
us through you. For more information, please see the back of
our magazine „revista“ or our website: www.bkk-wf.de.
* U nfortunately, BKK WF is not
open to people resident and
working in Sleswick-Holstein,
Thuringia, Saxony-Anhalt or
Mecklenburg-Western Pomerania.
** The same also applies if an
existing increased contribution
is raised further, or surplus
dividend payouts are reduced.
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BKK WF branch Kassel
BKK WF headquater Melsungen
GKV
Statutory Health Insurance (GKV)
The German health system still counts as one of the best in the world, but not as one of the simplest. It is often difficult to understand how it functions, not only for people who have just arrived in Germany or have not yet lived here long. Just the question of
whether you can take out health insurance, and how, is difficult to answer. Although we cannot respond to every potential query,
this guide is still a good orientation assistant.
Whoever lives and works in Germany is
usually covered by statutory insurance.
Ninety percent of the population are insured through one of the health insurance companies within statutory health
insurance (e.g. AOK, BKK, DAK or IKK).
You pay a specific amount towards the
insurance each month. The amount is
determined by the level of the monthly
income. In addition to that amount your
employer pays another part. If you become ill or have an accident and have
yourself treated by a doctor or in hospital, your health insurance will cover the
treatment costs, except for the statutory
additional payments. This means that
no insured person suffers financial hardship due to illness in Germany. Therefore the health insurance pays not only
for medical treatment but also for the
medicines the doctor prescribes for you.
If you cannot work due to illness, your
employer will also, as a rule, continue to
pay your wages for 6 weeks. After this
the health insurance will provide sick pay
for a certain amount of time. Thus, the
statutory health insurance is a dependable safeguard in case of illness. Particular cases can also be: accidents or treatment of diseases of employed persons.
If you cannot pursue your profession any
longer, due to illness, necessary measures will be covered if need be by other
organisations, e.g. by the pension or the
accident insurance. The responsibilities of
statutory health insurance are subject to
change, from time to time. Regulations,
e.g. about benefits, contributions, or referrals from one doctor to another can be
changed in the near future. The health
insurance that you are insured with will
update you on the changes. The general
principle in statutory health insurance is
solidarity. The insurance premiums are
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commensurate with the income, and do
not depend on whether one has a family, is female or male, is old already or
perhaps is frequently ill. This means that
a person with a higher income will pay
more into the insurance than a person
with a lower income. In this system, the
young support the old, single people support families, and healthy payers support
sick ones. Yet, everybody has a right to
the same statutory benefits.
Insured persons
There is a difference between being insured by statutory insurance and being
privately insured. Usually, employees
whose annual income does not exceed
a certain amount (the amount changes annually, – the current amount can
be found under „compulsory insurance”
on the supplementary sheet), as well
as trainees, unemployed people, students, pensioners, artists and publicists
are members of the statutory insurance
scheme. The members of their families
can be insured with them free of charge,
if they have little or no income. There is
an age limit for children, depending also
on whether they are still participating
in vocational training or higher education. Handicapped children are covered
through their parents without any age
limit, if their disability prevents them
from supporting themselves. Self-employed individuals and employees with
a gross income above a certain amount
can take out statutory or private health
insurance voluntarily. You may choose
your health insurance company yourself.
At the doctor’s
Regardless of whether you have private or statutory insurance, in Germany
you may choose your doctor yourself.
Statutory insurance members may only
choose between the doctors who are
registered and under contract to the statutory insurance scheme, which almost
all doctors are, in practice. One differentiates between family doctors and
specialized doctors. Family doctors are
general practitioners, paediatricians and
some of the practitioners specialized in
internal medicine. You should always
go to the same family doctor because
he/she knows you and your state of
health best. If necessary, he will refer
you to the correct specialist. Specialists
are doctors specialised in certain areas,
for example gynaecologists or ear, nose
and throat doctors. You can go directly
to a specialist when you are sick, but you
will have to pay the additional practice
fee. If the referral of the family doctor
to the specialist is handed in later you
will receive a refund of the practice fee.
Health insurances pay rewards to their
members for always going to their family
doctor first. Prior to deciding on a doctor,
it is wise to consider what is important to
you. Maybe you would rather be treated
by a woman doctor than a doctor who is
a man. Maybe the location of the doctor’s surgery is important for you because
you rely on public transport to get there.
It can be worth it to compare the surgery
hours of different doctors, too. You can
inform yourself as well about whether
the surgery is always very crowded, and
whether there are always long waiting
periods. A good doctor will listen to you
properly and explain to you in understandable terms what he is doing and
why he recommends which treatment.
He links his work to that of other doctors
and thus refers you to a specialist or a
hospital if needed. If you are not satisfied
with your doctor or you do not trust him,
GKV
you can change to another doctor. You
should not do this too often, though,
because every doctor has to get to know
you all over again, and you him or her.
Apart from this, changing doctors frequently may often also lead to unnecessary duplication of diagnostic procedures,
for example X-rays, which may be a risk
to your health.
Preparing for appointment
Before going to see the doctor, you
should start preparing yourself for the
appointment, for instance by accurate
self-observation and writing down your
complaints. Make a list of your current
medications, too, and whether you recently received treatment elsewhere.
You can also write down questions you
want to ask the doctor. If you do not
speak German well enough, you should
take somebody with you for interpreting.
The health insurance does not have to
cover the cost for interpreting during a
visit to your doctor. There are no obstacles to you choosing a member of your
family, or a friend who understands Ger-
man better to accompany you to the doctor. In many towns, there are lists available naming doctors who speak other
languages or who have foreign language-speaking staff. For your visit to the
doctor‘s it is best to make an appointment in advance by telephone. This will
help you to reduce waiting periods. If you
need an appointment urgently because
you are acutely ill you should say so on
the phone. You can of course go to see
the doctor during surgery hours without
an appointment, but you must expect
longer waiting times. If you are seriously
ill or very weak and therefore cannot go
yourself to see the family doctor, he can
also come to your home. Making use of
this possibility of a visit at home should
be reserved for situations when you are
really unable to go to see the doctor.
In hospital
The doctor attending you will determine
whether you need to be admitted to hospital for treatment of an illness, or for an
operation. With statutory health insurance you can only be treated in accred-
ited hospitals. For example, all University
hospitals are also accredited. Treatment
in a private clinic is impossible for statutory health insurance members. Your
doctor will give you a note of referral for
hospital treatment. On this note you will
find listed the two closest hospitals best
suited for your treatment. If you choose
a different hospital for treatment, you
might have to pay for the extra cost. In
this case, speak to your doctor and health
insurance, and feel free to explain about
special religious aspects.
You will be referred by your family doctor
or specialist to the hospital. He will write
you an admission note which you have to
take to the hospital with you. For some
operations you do not need to stay in hospital for days or weeks at a time. These
operations can be performed in a hospital
or specialist clinic as out-patient treatment. This means that you can go home
on the same day after the operation is
performed. A longer stay in the hospital is
referred to as „in-patient treatment”.
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Comprehensive cover
BKK WF benefits
Our benefits portfolio is as diverse as our members. For those in their first job or enjoying their well-earned retirement; for singles
and for families, we offer just the benefits you need – and of course make full use of flexibility under our articles of association in
the best interests of our customers.
For all (eventualities) & not just for singles
Just as in your professional life, getting priorities right is also essential in health insurance. We welcome those with mandatory
insurance, voluntary insurance and the self-employed – BKK offers excellent standard benefits for people in all walks of life.
Medical treatment
Both the older health insurance cards and
the new electronic cards give you a free
choice of around 150.000 licensed doctors
and psychotherapists operating within the
statutory health insurance system.
Integrated care
Our members have access to the best
possible treatment options for a range
of illnesses, thanks to numerous integrated care contracts. Integrated care brings
together outpatient, inpatient and rehabilitative care for our members, and this
closer coordination means more effective
treatment. Practices, hospitals, pharmacies, physiotherapists, rehabilitation professionals and psychologists all have the
same, clearly defined therapeutic goal.
BKK WF has a range of integrated care
contracts; a list is available in our special
contract database at www.bkk-wf.de. If
you fall ill and your doctor suggests the
option of – voluntary – participation in
integrated care, simply contact us: we
will be happy to help.
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Medical Advice
Have you recently relocated and are
Wherever you happen to be and when-
looking for a a new General Practitioner
ever you need an answer or support, you
or medical specialist? Do you need a
can reach medically trained staff on the
comprehensive consultation about an
following number from wherever you
illness – including for children– or a the-
are in Germany. The costs of this service
rapy? So you need an appointment with
and the telephone call are covered by
a specialist in your area? Our professio-
BKK WF.
nal partner „INFOMED-GESUNDHEITSWEGWEISER“ is available to you day and
freecall: 0800 38 65 43 5
night with consultations from doctors
E-Mail: kdn.bkkwundf@md-medicus.net
and nurses, who will be able to answer
your questions in detail and without
Please Note: INFOMED is an independent
time pressure.
service provider and adheres to strict data protection rules as well as rules cover-
THE „INFOMED GESUNDHEITSWEGWEIS-
ing medical confidentiality. The content
ER“ is a ‘round the clock’ information
of the conversation and will of course
service for all your health questions.The
not be passed on to the BKK. Please have
INFOMED specialists naturally speak Eng-
your membership card ready when you
lish as well as several other languages.
call INFOMED.
Comprehensive cover
Drugs
BKK WF will cover the costs of generic
drugs prescribed by doctors operating
within the statutory health insurance
system, provided these drug qualify
for reimbursement. Patients only pay
a contribution to the prescription based
on the price of the drug: 10 percent of
the pharmacy retail price per drug and
at least 5 euros but no more than 10.
Children and young people up to the
age of 18 are exempt from prescription
charges.
that their drugs are no longer sourced
from all providers on the ­market, but instead come from specific partner manufacturers. BKK WF‘s partners are reliable,
established companies with long experience in the pharmaceutical sector. The
drugs provided always contain exactly
the same active agents as your previous
prescriptions and are of equally high
quality. There may be differences in
­colour, form and packaging, but there
is absolutely no difference in effectiveness or safety.
Contracts with specific pharmaceutical
companies agreeing reduced rates for
their drugs offer potential savings for
health insurers. Under these contracts,
we commit to preferential drug purchasing for our members from certain
manufacturers, and in return receive a
discount. For our members, this means
Reference prices
Cover for drugs which are not discounted is limited to defined statutory sums.
These „reference prices“ are the maximum amounts up to which drug prices may be reimbursed. Health insurers
therefore do not automatically pay the
full price; they cover a maximum of the
statutory reference price. The reference
prices are defined for groups of comparable drugs and are updated at regular
intervals. Charges for the patient therefore constantly vary.
If a doctor prescribes a drug which is
more expensive than the reference
price, the patient is liable for the
­difference in addition to the statutory
prescription charge.
Generics
Generic drugs are products which
have the same active ingredient as
branded medicines, and are launched
under a new name by other com­
panies once the original manufacturer‘s patent has expired. Generic
drugs are exempt from prescription
charges if their price is at least 30
percent below the reference price.
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Comprehensive cover
Therapy and aids
Therapy is also part of the range of benefits for our members. Therapy includes
for example massage, physiotherapy
and speech therapy. For members who
have turned 18, the prescription charge
is 10 percent of the costs plus 10 euros
per prescription. Aids include hearing
aids, wheelchairs and prostheses. BKK
cover for aids is based on reference
prices or contract prices. The patient
­contribution here, also due for members
who have turned 18, is 10 percent of the
retail price and at least 5 euros, but not
more than 10 euros.
Tip: Supplementary aids
· C hildren up to the age of ten are
­entitled to two dermatitis suits each
year where this is indicated.
· All members are entitled to anti-allergy encasings once a year where this
is indicated.
· BKK WF contributes towards the costs
of a continuous passive motion devices
for short-term knee and shoulder
therapy.
· I n certain circumstances, BKK WF
will cover the costs of a mandibular
advancement splint. Simply contact
us for details on whether or not you
qualify.
Sick pay benefits [Krankengeld]
Sick benefits are paid once a member‘s
sick pay [Entgeltfortzahlung] entitlement
period has expired. They are paid for
as long as he is unfit for work due to
the same condition for a maximum of
78 weeks within a three-year period.
Sick pay benefits are equal to 70 percent
of the member‘s gross salary and a maximum of the social security assessment
threshold, but no more than 90 percent
of the net salary.
The following contributions are deducted from sick pay benefits: pension, unemployment benefit and nursing care
contributions. However, the period du-
8
ring which sick pay benefits are paid is
then counted as a qualifying contribution
­p eriod for your pension. We pay your
health insurance contributions.
BKK WF will cover the costs of psychotherapy provided the chosen therapist is
authorised to work with statutory health
insurers.
Hospital treatment
Our partner hospitals in the statutory
health insurance system guarantee you
the latest treatment methods, covering
even the most expensive procedures.
Heart surgery and kidney stone removal
are among the procedures offered. We
bear the full costs of medical treatment
and other procedures, the drugs, and
early rehabilitation or care. The patient
contribution for members aged 18 and
over is 10 euros per day for a maximum
of 28 days per calendar year.
Transport and travel costs
BKK covers transport and travel costs
for in-patient care such as hospital
treatment and for emergency transport
to hospital if an ambulance is needed
and in-patient treatment can thus be
­avoided. We are only able to cover journeys for outpatient treatment in exceptional cases. In this case, too, the patient
contribution is ten percent of costs and at
least 5 euros, but no more than 10 euros
per journey.
Tip: Rooming-in
Sick children benefit from having someone familiar at their side ­during hospital
treatment. That is why BKK WF will often cover the costs of an accompanying
adult, in line with recommendations
from the German association of children‘s hospitals and children‘s wards
[­Gesellschaft der Kinderkrankenhäuser
und Kinderabteilungen in Deutschland
e. V., GKinD]. Costs are covered in the
following cases:
· for new-borns and infants
· for toddlers and pre-school children
· for schoolchildren under the age of nine
We will also cover the costs for ­older
children in a number of cases, for
­example if the child has severe separation anxiety. Simply contact us for further details of how the system works.
Psychotherapy
Psychotherapy is the treatment of mental
problems with recognised psychotherapeutic methods. A course of psychotherapy uses recognised procedures and aims
to cure the patient‘s condition, ameliorate his condition or prevent his condition
from becoming chronic. In many cases,
Assistance in the home
BKK WF pays for home help if members
are hospitalised, undergoing preventive
or rehabilitative treatment or have a serious, acute illness and are therefore unable to run their household. The patient
contribution for members aged 18 and
over is 10 percent of the costs and a
minimum of 5 euros, but no more than
10 euros per day of assistance.
Tip: are you single?
Unlike many other health insurers, in
the case of serious, acute illness BKK
WF does not restrict benefits to those
with a dependant child under the age
of twelve living in the same household.
Nursing care at home
Instead of in-patient treatment, care
by trained medical staff can also be
­p rovided in the home in members‘
­familiar surroundings. BKK WF will generally cover the costs for this for as long
as it is medically necessary. This also
applies if care is required to ensure the
success of medical treatment. For members aged 18 or over, the patient contribution is 10 percent of costs per day for a
maxi-mum of 28 days per calendar year,
plus 10 euro per prescription.
Families & children
Families & children
We all want our children to be healthy. BKK WF offers a comprehensive range of benefits for children which covers each stage
from pre pregnancy plans to exclusive child screenings.
GP Programme
GPs have an extremely important role
in the healthcare system. When someone falls ill, the GP is usually the first
point of contact: GPs have often known
their patients for years, and are therefore familiar with the details of both
­patients‘ medical history and their social
and family background. GPs already act
as the guide between and to specialists,
­h ospitals and other providers such as
physiotherapists. This function is even
more important in GP-focused patient
care (GP model).
Provided they have turned 18, members of BKK WF in an ­increasing number
of federal states now have the chance
to sign up with our GP model at their
local practice. Participants undertake
to go first to their GP when they fall ill
and to specialists only when transferred
by their GP, and this for a ­period of at
least one year. Members who opt for
the GP programme receive a bonus of
10 euros for each quarter in which they
participate. The bonus up to a total of
40 euros is paid out in the first quarter of
the following year.
Pregnancy
BKK WF provides young families with advice, financial support and naturally also
medical care before, during and after the
birth of their child. We make sure that
mother and ­baby lack nothing. Pregnant
mothers have access to a wide range of
preventive care both during this period
and ­after the birth. Our members also
have the option of taking part in our preventive care programmes „Hallo Baby”,
„BabyCare” and „PlanBab”.
Tip: OTC drugs for pregnant women
BKK WF will refund the costs of overthe-counter drugs available only from
pharmacies up to a total of 300 euros
per pregnancy, provided these drugs
are taken as an additional preventative
healthcare measure during pregnancy.
The drugs must be eligible for statutory
health insurance cover and a ­private
prescription from a gynecologist is
­required.
The 300 euros budget can be used
­alternatively for checkups not generally
paid for by the public health system,
a birth preparation course for the husband (as long as he is also insured with
the BKK WF) or midwife on-call services
between the 30th and 42nd week of
pregnancy.
Maternity
We offer a wide range of services for
pregnancy and birth, from screening
for mother and child, midwife services,
medical care and drugs and remedies,
to the costs of birth in hospitals in the
statutory system, and care and help at
home. Members in employment even
receive maternity benefits during statutory ­maternity leave (six weeks ­before
and eight weeks after the birth, or
twelve weeks after the birth if the child
is premature or the mother gives birth to
more than one child). The maximum is
13 euros per calendar day; your employer pays the difference to net salary as a
contribution to maternity pay (exempt
from tax and social security).
Tip: Bonus for newborns
Members receive a one-off bonus
of 100 euros when they show their
BKK-insured Child has attended all
check-ups from “U1” to “U4” and relevant immunisations. Bonus applications
must be submitted by the time the
child turns seven months.
Mother/father and child programmes
We offer parents special packages for
mother/father and child. We cover
100 percent of costs, excepting the statutory patient contribution, at clinics in
the statutory health insurance system
if the programme is medically
­indicated. Simply contact us for
advice and further information.
Sickness benefits when your
child is ill
Child sickness benefits can be
paid if a BKK member in employment has to look after or care for
their sick child (aged twelve or
under; no age limit if the child
is handicapped). The member
is eligible for benefits provided
the child has statutory health insurance,
and cannot be looked after by another
person living in the same household. We
can pay for up to ten working days each
calendar year for each child, and up to a
total of 25 working days for more than
one child. Single parents are entitled to
double: 20 working days for one child
and no more than a total of 50 working
days for more than one chid.
Child check-ups („U“)
To ensure the best possible health and
development for children and young
adults, there are a range of check-ups
for children from birth to the age of 14 –
the „U“ check-ups. Children insured with
BKK WF across Germany have access to
supplemen­tary regional services from
participating doctors. With participation
in the „Ihren Zähnen zuliebe“ („For the
sake of your teeth“) programme, children aged six to seventeen receive a
special supplementary benefit: dental
sealant treatment for their premolars
free of charge – a service usually to be
financed privately (more information can
be found on page 13).
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In your prime
In your prime
A new phase in your life, a new attitude: time to enjoy the things for which you have worked so hard. You have earned it. You
enjoy travelling, are active, mobile, confident and relaxed; ready for new experiences, new commitments, new roles, with or
without a spouse or partner. You watch your grandchildren and godchildren grow up, and are there to offer moral and active
support. And you enjoy plenty of leisure time with your partner, family and friends. Small wonder that so many over-50s find
these years the best time of their life – especially as BKK WF has a whole range of services to keep you fit and healthy.
Treatment programmes for the chronically ill (DMP or BKK MedPlus)
The chronically ill often need lifelong
medical treatment, and that on a highly
individual basis. Some patients are able
to lead a completely normal life and require hardly any assistance, whilst others
are wholly dependent on the help of
multiple doctors, therapists and medical
­facilities. What is essential in all cases is
ensuring the best possible coordination
of all providers involved. Through the
BKK MedPlus treatment or Disease Management ­Programme (DMP), BKK WF
provides valuable ­assistance for many
chronically ill members. Programmes are
currently in place for type 1 diabetes,
type 2 diabetes, breast cancer, coronary
heart disease, asthma and chronic obstructive pulmonary disease (COPD). BKK
MedPlus supports your treatment in and
over the long term to help improve your
health and quality of life. Participation in
the programmes is, of course, voluntary.
Members who decide to join the DMP
programme receive a bonus of 60 euros.
Tip:
Please simply contact us if you would
like a detailed brochure. Registration
for the programmes is organised directly by the participating GPs.
an intensive programme once a year up
to a total of 160 euros.
Medical Checks
Members of the BKK WF are allowed to
receive up to 25 Euro per year for special
checkups from a special budget. The following can be paid for privately and then
reimbursed by the BKK WF in the amount
of maximum 25 Euro.
· Early warning checkups for glaucoma
· Skin cancer screenings for persons under
35 years of age and living in Hessen,
Sachsen, Sachsen-Anhalt and Berlin*
· M ammography for members under
50 years of age
· Mammographic sonography
· M edical exams for persons under
35 years of age
·b
one density measurements (after age
55, every 2 years)
A precondition is a well-founded suspicion based on the existing risk factors
as well as the presentation of invoices
which are to be submitted before March
31 of the following year. We would be
happy to answer any questions relating
to the claims process on the telephone
number 0800 566 1800
* In the other states of Germany we are able
to offer these additional benefits using a direct invoice arrangement with many doctors.
Health trips
In cooperation with its partners, BKK WF
offers a wide range of intensive programmes at selected health resorts both
in Germany and abroad. All types of preventive courses from Nordic walking and
back fitness to relaxation and nutrition
are also covered by our health trip partners. Instead of courses at your place of
residence, BKK WF will cover the cost of
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Long-term nursing care insurance
Every BKK WF member also naturally has
nursing care insurance [Pflegepflichtversicherung]. As with the family insurance,
children and spouses are co-insured for
free. Those who are permanently – and
at least for a projected 6 months – unable
to deal with everyday tasks and chores
(personal hygiene, eating, moving) as
a result of a physical, mental or psychological illness or disability need support
from care professionals for the activities
of daily living (ADL). This is where the
BKK WF care fund steps in with home
and/or institutional care services.
The care fund can assist with the following day-to-day tasks depending on
the severity of the physical, mental or
psychological impairment:
· Personal hygiene – washing, showering, bathing, dental hygiene, haircare,
shaving;
· Food – preparation for easy eating and/
or assistance with eating;
· M obility – getting up and going to
bed, dressing and undressing, walking,
standing, climbing stairs or leaving and
returning to the patient‘s house;
· D omestic help – shopping, cooking,
housecleaning, washing up, changing
and washing linen and clothing, ensuring correct heating.
Sole exception: there is no entitlement
to care fund benefits if domestic help is
all that is required.
Important: care fund benefits are only
available to ­patients who have paid into
the care fund for at least two years out
of the ten years prior to their benefits
appli­cation. For those with family insurance, one parent must have met this
condition.
Do you have questions about the wide
range of nursing care insurance benefits
on offer? Simply contact us with your
individual queries.
Targeted prevention
Targeted prevention
BKK WF is not just there when you need treatment or care. We also offer a wide range of preventive services to help you keep
as healthy as possible, and detect any health issues at an early stage to maximise your chances of a full and successful recovery.
Cancer screening
We offer annual cancer screening for
women aged 19 and over and men over
the age of 44. If you are 19 or over, you
should see your gynaecologist once a
year for cancer screening – even if you
feel fine. (breast and skin screening for
the over-30s; over-50s are also screened
for cancer of the colon). Men aged 44
and over are screened for cancer of the
prostate, external genitalia and skin;
men aged 49 and over are also screened
for cancer of the colon.
Check-up 35
This check-up focuses on cardiovascular
disease, kidney disease, skin cancer, and
metabolic disorders. It should be taken
every two years by all those over the
age of 35. The check-up is designed to
detect diseases as early as possible.
Staying healthy
BKK WF does not just offer primary prevention services through and in support
of alternative methods (see also Alternative therapies, page 12) as we seek
to maintain and improve the health of
our members. We also offer courses and
seminars on exercise, diet, fighting addiction, and on relaxation. These include
back and aqua jogging courses. You will
find a wide range of courses on our website in the BKK course database. If you
are unsure whether we recognise the
course you wish to take, simply contact
one of our advisors ­before starting. We
cover 100 percent of the costs of qualified
health and fitness ­courses twice a year up
to a total cost of 500 euros. If you take
part in a health trip as part of one of our
intensive programmes, this is equal to
two courses at your place of residence.
The same courses are not funded for two
years in a row.
Immunisations
BKK WF will generally cover the costs of
all essential, recommended vaccinations
for children, e.g. diphtheria, tetanus,
whooping cough (pertussis), haemophilus influenza type b (Hib), infantile paralysis (polio), hepatitis B, measles,
mumps and rubella.
BKK WF also covers a wide range of other
vaccinations including necessary immunisations for travel abroad (see also page
14). As a supplementary service, we refund the costs of vaccinations without
deducting the pharmacy and manufacturer discounts common at many other
insurers. Invoices for vaccination services
for up to 12 euros are paid in full. Please
note: the costs of vaccinations required
for business trips abroad must still be
borne by your employer.
Bonus programme
Healthy living is even more worthwhile
with our bonus programme: as well as
improving your quality of life, you can
collect a bonus of 100 euros per calendar year. Our 2015 programs allow all
adult participants to receive 100 euros if
they take part in at least three healthy
activities – for instance joining a sports
club or attending a fitness studio and
can prove these. There is a list of 14 activities. All members and insured family
members who successfully take part in
the bonus program will also ­receive a
reimbursement for private travel health
insurance. The maximum reimbursement
is equivalent to the premiums offered by
our cooperation partner Barmenia Krankenversicherung a.G. in their travel health
insurance tariff BKKR (in 2015 between
4,50 euros for children and 25,20 euros
for persons over 70 years of age). We
offer special bonus programs for children
and young people under 18.
Medical sport examination
Members of the BKK WF are allowed
to receive a consultation and checkups
from a sports doctor if their own ­doctor
has certified that such examinations
would help prevent or determine any
cardiac or orthopedic issues leading to
illness at an early stage or help avoid
further deterioration.
Further examinations such as a stress
ECG, a lung function test and a lactate
allergy test are also possible if the member’s own doctor issues a certificate stating that these are necessary.
The BKK WF will reimburse 80% of the
invoice every 2 years up to a maximum
amount of 60 euros for the basic examination or 120 euros including the further
examinations.
Tip:
You will find more information about
the programme in our detailed bonus
programme brochure.
11
Alternative therapies
Added benefits: alternative therapies
For many years, BKK WF has combined conventional medicine with established alternative medicine. Our members have access
to the full cover of a statutory health insurer with a special commitment to alternative medicine, and a wide range of supplementary benefits.
Acupuncture
Members of BKK WF naturally also have
access to alternative therapies such as
acupuncture, provided this is for the
treatment of
· chronic pain in the lumbar column or
· chronic knee pain due to gonarthrosis
For either of these two diagnoses, doctors
with acupuncture qualifications can charge
the acupuncture directly to the patient‘s
health insurance card. Another course of
acupuncture can be given twelve months
later at the earliest.
Homeopathy
Members of BKK WF have access to
the following supplementary medical
services from doctors registered with
the statutory health insurance network
who are also certified homeopaths:
· Initial anamnesis (first in-depth consultation with the doctor to establish an
overall mental and physical picture)
· Subsequent anamnesis (to check the
progress of treatment and recovery)
· Choice of medicine (selection of suit­
able homeopathic remedy on the basis
of the analyses)
· Homeopathic analysis and advice (response to question during treatment)
The above services are invoiced like other
medical services using the patient‘s health
insurance card.
Anthroposophic medicine
Anthroposophic medicine draws on philosophical findings which go back to Rudolf
Steiner and Ita Wegman. In diagnosis and
treatment, it looks not just at measurable
medical results for the patient, but also at
his general state of health and mind and
his specific circumstances.
Among the special features of anthroposophic medicine is a wider range of
therapy, with special physical therapy
methods and creative arts therapy.
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BKK Contibution to these phamacics above
is awarded following submission of the
original invoice, and may be up to a total
of 130 euros.
2. Osteopathic treatment from a provider
with membership of a professional osteopath association or with the necessary
osteopath training and qualifications to
join such a professional association. The
treatment must be prescribed by a doctor.
BKK contribution to Osteopathic treatments above is awarded following submission of the original invoice, and may
be up to a total of 360 euros.
Our members have access to the following
anthroposophic treatment from doctors
and therapists [Heilmittelerbringer] in the
statutory health insurance system:
· c onsultation and treatment with
­anthroposophic medicine
·p
rovision of anthroposophic remedies
Osteopathy & alternative herbal remedies (alternative medicine budget)
BKK WF contributes to the following health
services for its members:
1. Over-the-counter homeopathic, herbal and anthroposophic remedies available only from pharmacies if your doctor
has prescribed them. The drug must
be obtained from a pharmacy, or from
a mail-order business licensed under
German law, and must be eligible for
statutory health insurance cover.
Tai-chi, qigong, yoga, Pilates,
autogenic training
BKK WF offers „primary prevention“ services to improve the health of its members. Primary prevention covers courses
and seminars run by trained physiotherapists, sports science professionals and
other qualified providers, including a
range of courses from the field of alternative medicine such as tai-chi, qigong,
yoga, pilates and autogenic training.
We cover the costs of up to two qualifying
health or fitness courses each year up to
an annual total of 500 euros (see also
„Targeted prevention“ on page 11 for
further details of this additional service).
Supplementary insurance – for those
who want more
Would you like to use other alternative
therapies from an alternative practitioner?
Our private health insurance partners offer
an excellent portfolio of services and good
terms. Simply phone us for more information or contact your insurance broker.
Healthy teeth
Healthy teeth
To make sure you‘re still biting into your favourite snacks tomorrow, it is essential to take good care of your teeth today – and
everyone likes a beaming smile.
Dental treatment
With BKK WF, you can use the dentist of
your choice from amongst all practitioners
within the statutory health insurance system. Simply show your health insurance
card when you register.
For children, we offer three dental checkups to prevent tooth, mouth and jaw
diseases. The first is for children of two,
and subsequent check-ups at intervals of
twelve months until the child turns six.
Dental health education group events are
also provided at nurseries and schools.
Children aged 5 to 17 should visit a dentist
for a check-up every six months; for children aged five and over, this should include
the application of dental sealant for molars.
Adults over 17 should visit the dentist once
a year. Once a child has turned eleven,
the dentist can record the check-up in the
child‘s „bonus book“.
Dental prostheses
Should you need dental prostheses, for
­example crowns, bridges, partial or complete denture, we will contribute to the costs
incurred on the basis of so-called „fixed,
results-based contributions“ (befund­
bezogene Festzuschüsse). If you require a
dental prosthesis, your dentist will draw up
a treatment and cost estimate plan for you.
The insurer contribution to the expected
costs detailed in this plan will be higher if
you have been to a dentist‘s for a regular
dental check-up at least once a year for the
preceding five or indeed ten years. Always
remember, therefore, to have your annual
check-up recorded in your bonus book. Bonus books are available free of charge from
all dentists. For a leading dental prosthesis
comparison portal, supported by BKK WF,
visit www.2te-ZahnarztMeinung.de.
Orthodontic treatment
For children under the age of 17, we cover
the costs of treatment in the event of serious functional impairment such as jaw or
tooth misalignment. We may also provide
cover in certain, exceptional, cases for
those who start treatment after they have
turned 17.
How members benefit: the patient contribution of 20 percent or 10 percent (as of
the second child in treatment at the same
time) initially due for the orthodontist is
­refunded by us in full following the successful completion of treatment.
„For the sake of your teeth“ – special conditions from partner dentists
High quality prostheses, tooth-coloured
fillings and professional dental cleaning: our partnership with dentists in the
„Ihren Zähnen zuliebe“ („For the sake of
your teeth“) network gives our members
­access to excellent dental services with
exclusively German-made premium materials at fixed, discount prices. Participating dentists provide the following services
to our members at fixed prices, unlike in
the normal statutory dental care system:
· Composite filling for 40 euros
You pay a maximum of 40 euros (plus
material at 10 euros max.) per filling for
high quality composite filling.
· Fully faced crown for a maximum of
250 euros plus material
No more gold or silver when you smile:
you will always be given tooth-coloured
crowns with full facing.
· Bridge or implant?
Even for implants, which are a purely private (insurance) service, we have negoti-
ated a price of 500 euros maximum plus
material costs for our members. Now, you
need no longer sacrifice healthy teeth for
a bridge.
· Supplementary service for children of
participating members: free dental sealant treatment for premolars
Sealing the molars is covered by standard
statutory health insurance. As an additional service, dentists in the network will
also seal your children‘s premolars free
of charge.
· Dental bleaching for 250 euros
Tooth whitening is available for 250 ­euros.
· Professional tooth cleaning
Professional dental cleaning is the basis
for beautiful and healthy teeth. This treatment removes deposits (tartar, discoloration, plaque) from and between your
teeth. The dentist will then lightly polish
your teeth and apply fluoride to strengthen them and help prevent tooth decay.
BKK WF covers the costs of professional
dental cleaning once a year by one of
the dental practices in the „Ihren Zähnen
zuliebe“ network. You will find a database
of all participating dentists:
www.ihren-zaehnen-zuliebe.de
Your other option is to have a professional tooth cleaning done by any dentist of your choice and then submit the
paid invoice to the BKK WF for a reimbursement of up to 50 euros to be paid
to your private bank account. The 50 euro
budget can be used for other reasons
for instance towards the cost of a more
expensive filling or an anesthetic in case
a wisdom tooth needs to be pulled. If an
insured child is having orthodontic work
carried out the BKK WF will also reimburse
50 euros for a professional tooth cleaning.
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Flexibility
Abroad
Travel vaccinations
BKK WF is the perfect travelling companion. To make sure you bring back only
souvenirs and no diseases, we refund
the costs of a wide range of travel vaccinations.
pharmacy and manufacturer discounts
common at many other health insurers.
We refund doctors‘ invoices for vaccinating in full up to 12 euros. Vaccination
costs for business trips abroad are, however, to be borne by the employer.
· Cholera
· TBE
· Yellow fever
· Hepatitis A
· Hepatitis B
· Japanese encephalitis
· Meningococcus
· Poliomyelitis
· Rabies
· Typhus
· Antimalarials
Essential despite EHIC: private travel
health insurance
Travel within Europe and you will, in many
countries, have cover from your ­European
health insurance card (EHIC). This is printed on the back of your German health insurance card and is your foreign health insurance ID in countries which have signed
up to identical social security agreements
for all health insurers.
Our additional service: we refund the
costs of vaccines without deducting the
cover services for which statutory health
insurers are not authorised to pay – for
example transport back to Germany
where medically necessary. In countries
outside Europe, you will almost always
need private travel health insurance, as
BKK WF cannot cover costs there.
Tip:
For successful participants in our bonus
programme (page 11), we will refund
costs of private travel health insurances. You will find further information on
our bonus programme in the detailed
bonus brochure.
Good private travel health insurance is,
nevertheless, always advisable even
within Europe: private insurance will
Customised flexibility: optional rates & supplementary insurance
Members of BKK WF have access to the best possible patient care and excellent service. With innovative optional rates and supplementary insurance, you can choose to extend your insurance cover to meet your own, personal needs.
BKK optional rates and bonuses
Stay healthy, and this can also bring financial benefits. Member on the BKK
rate „Prämienzahlung“ („bonus payments“) receive a financial bonus if they
have not used their health insurance for
a year. To qualify for the bonus, you and
your adult co-insurees must not have
used health insurance services – with the
exception of certain preventive services
– for one whole year. Bonuses are staggered. In principle, the longer you have
gone without health insurance benefits,
the higher the bonus. If you fall ill and
14
use our services, you will not receive a
bonus for that year; however, you will
still have access to all other benefits.
Supplementary insurance
We are a statutory health insurer and our
scope of action therefore has limits. That
is where private supplementary insurance
comes in. What is special for our members: low contributions are just one of
the benefits we have negotiated with our
private partners. Another is that you will
not be faced with the long waiting times
usual in private health insurance. Rates
and cover can be taken out individually or
in combination – you decide what supplementary cover you would like, what risks
it is to cover, and how much you are willing to pay for your supplementary health
insurance.
Tip:
Simply phone us or contact your insurance broker who recomended us for
­detailed information if you are interested
in our optional rates or supplementary
insurance.
Service
In case of emergency: 112
The Emergency Number for the whole of Germany is 112. An emergency is any illness or injury that is so bad that it requires immediate medical treatment. This can be high fever, a broken leg, haemorrhaging (bleeding), difficulty in breathing, poisoning, or
a sudden loss of consciousness. In situations which you consider life threatening you should call an ambulance immediately. Then
the patient will be transported as fast as possible to hospital, and can be treated in the ambulance already, if necessary. Other
injuries, for example broken bones or head injuries are not to be taken lightly either. In these cases, the patient must also be taken
to hospital immediately.
It would be best to tape the number on a piece of paper to your telephone, because you can easily forget the number in panic. You
should try to stay as calm as possible while on the phone. You are of no use to anybody if you become hectic. Explain calmly and
clearly where the patient is, what has happened and what his condition is. Listen carefully yourself and answer any questions as
well as you can. If you or your child are simply sick, you can go to your family doctor or to a paediatrician. If you are too ill, you can
ask your doctor to visit you at home. If you cannot reach your doctor during weekends or on Wednesday afternoons, check the local
newspaper for doctors on emergency duty and call them. Often there is a centralized phone number, or even a real emergency
surgery. If the situation is so acute that you cannot afford to search for the right doctor, take the sick or injured person to the emergency room (“Notfall-Ambulanz”) of the nearest hospital, where he or she will be treated as soon as possible.
15
Editor
BKK WIRTSCHAFT & FINANZEN
Bahnhofstr. 19
34212 Melsungen
Branch Kassel
Frankfurter Straße 174
34134 Kassel
Phone: +49 5661 7374 - 0
Fax: +49 5661 7374 - 129
Email:
info@bkk-wf.de
Web page: www.bkk-wf.de
Notice: This brochure has been issued by BKK to meet its statutory obligation to inform members about their rights
and obligations in the social security system. Statute and the articles of association are the binding legal documents
for all matters under social security law. Druckstücknummer BKKWF_2015-003
Imprint