Health Insurance Benefits
Insurance coverage—when medically necessary—is provided for:
- Outpatient medical treatment. Reimbursement is based on the fee schedules within the framework described below.
- Inpatient medical treatment, including surgeries, within the scope of general hospital services, excluding optional services. Expenses for separately billable services provided by an affiliated physician are reimbursable in accordance with outpatient medical services within the framework described below.
- Medically necessary rehabilitation measures (follow-up treatment).
- Medications, bandages, and remedies prescribed by a physician.
- Medically prescribed remedies up to a maximum amount of €250 during the entire insurance period.
- Medically prescribed medical aids that become necessary as a result of an accident and serve the medical treatment of the accident’s consequences.
- Examination and treatment related to pregnancy and childbirth, provided the pregnancy occurred after the start of insurance coverage.
- Dental treatment exclusively for the relief of acute pain and necessary fillings, but not dental restorations, extensive dental work, or the treatment of underdeveloped or deeply fractured teeth. Reimbursement is based on the fee schedules within the framework described below.
- Simple repairs to existing dental prostheses are reimbursed at 50% up to an invoice amount of €1,000.
- Simple dental prosthetics resulting from an accident, up to €2,000.
- Alternative therapies, provided they are performed by licensed practicing physicians and the costs do not exceed those of a comparable conventional treatment.
- Medically necessary transportation for inpatient treatment.
- Medically necessary and physician-ordered repatriation to the home country if, based on the nature and severity of the illness, the duration of inpatient treatment would exceed 14 days.
- Repatriation costs for a deceased person to their home country or funeral costs in Germany up to €30,000.
- Treatment of mental illnesses (including inpatient treatment), with the exception of psychoanalysis, psychotherapy, and hypnosis. In the event of an acute mental or psychological illness, expenses of up to €500 for these services are also reimbursable on a one-time basis for the entire insurance period.
Preventive Examinations and Preventive Care
Expenses for preventive care, health checkups, pediatric examinations, or vaccinations—each within the scope of statutory programs—as well as dental preventive care are reimbursable only under the XL plan and only up to a total amount of €500 per insurance year.
Medical and Dental Billing Rates
Expenses for medical and dental treatment are reimbursable up to 2.3 times the rate specified in the currently valid official German Scale of Fees for Physicians (GOÄ) – for services under Section A, E, or O of the GOÄ, up to 1.8 times the rate; for services under Section M and Item 437 of the GOÄ, up to 1.15 times the rate – and up to 2.3 times the rate specified in the currently valid official German Fee Schedule for Dentists (GOZ).
Important Information Regarding Tuberculosis Among Foreign Guests!
Cases of tuberculosis have increased sharply in recent years, particularly in the former Eastern Bloc countries. In the interest of your family’s health, please ensure that your au pair undergoes a recent test (chest X-ray or Mendel-Mantoux intradermal test) immediately prior to arrival. This test, which should not be older than three months, protects you from the health risk of tuberculosis brought into the country.
In addition to the health risk, you also assume a high financial risk without such a test. This is because tuberculosis brought into the country – like all illnesses brought into the country – is excluded from insurance coverage.
Services Requiring Prior Agreement or Approval
In some cases, a treatment and cost plan is required in order to receive reimbursement of up to 100 percent of eligible treatment costs. In the following cases, we require a treatment and cost plan before treatment begins:
In outpatient care for:
- Allergy tests and prior to so-called radiological imaging diagnostics if these exceed conventional X-ray diagnostics (for example, prior to a CT scan, an MRI, or a scintigraphy).
In the dental sector for:
- Treatment of more than two teeth during the insurance period,
- Periodontal diseases,
- Treatments for which the expected invoice amount will exceed €250.
Without our written approval of the treatment and cost plan, reimbursement for the above-mentioned services is limited to 50 percent of the eligible costs.
Coverage Provided by Liability Insurance
With AU-PAIR24 au pair insurance, the au pair is covered by liability insurance in their capacity as a private individual and in connection with their specific au pair duties.
Personal injury caused by the au pair to you, your children, and other persons living in your household – as well as damage caused to third parties – is covered in all AU-PAIR24 products up to the respective maximum limit.
With AU-PAIR24, you benefit from special insurance coverage. If your au pair causes damage to a rented apartment, such damage is covered up to €100,000. Damage to the host family’s immovable property is also covered – with a deductible of €250 per claim.
What makes AU-PAIR24’s liability insurance unique: It includes the au pair’s personal liability insurance and professional liability insurance for au pair activities. It also provides coverage of up to two million euros.
The AU-PAIR24 L, XL, and Z product variants also provide coverage for key-related risks: If your au pair loses your private apartment keys, the resulting costs are covered up to €500.
Liability insurance coverage applies only if the insured person does not have sufficient alternative insurance coverage (subsidiary coverage).
Damage caused by the use of a motor vehicle is not covered.
Coverage Provided by Deportation Cost Insurance
In the event of the au pair’s deportation ordered by the authorities, deportation cost insurance covers the resulting costs up to €4,000 if claims are made against the host family.
Deportation cost insurance also provides coverage after the insurance period has ended if, contrary to all expectations, the au pair has not left the Federal Republic of Germany.