Optional tariffs
Optional tariffs - when they actually pay off.
Deductible, premium refund, GP-only models: they can look attractive, but they're not for everyone.
What are optional tariffs?
Optional tariffs (Wahltarife) are alternative tariff variants that health funds offer their members in addition to the standard tariff. Codified in § 53 SGB V, they enable better contribution efficiency for insured with specific behaviour or life situations. The range is wide: from deductible to premium refund, GP-only model, cost-reimbursement and special natural-medicine tariffs. Each fund offers its own selection that varies considerably - one fund may have 8 optional tariffs, another only 2 or 3.
Important to understand: optional tariffs are not supplemental insurance but modifications of the existing GKV contract. They change neither benefit scope nor insurance status - you stay in GKV with the full benefits catalogue. What changes is the way contributions are calculated or benefits are processed. Some tariffs return money (premium refund), others lower the monthly premium (deductible), and still others change benefit handling (cost-reimbursement tariff).
Signing up for an optional tariff is done in writing or online with your own health fund - no extra check is required as with supplemental insurance. However, optional tariffs typically bind for at least 12 months, some (deductible) even 3 years. During this lock-in you can change neither the tariff nor the fund, which can become a trap with rate increases. An honest self-assessment before signing is therefore essential.
GP-only tariff: steering and discount
You agree to coordinate every specialist visit through your GP first - emergencies, eye, gynaecological and paediatric care are excluded. In return you get €60-120 a year in cashback or a contribution discount. In practice, little changes for most people since they already see the GP first, and continuity of care actually improves. Less suitable if you frequently need to consult specialists directly or move regularly between cities.
The GP tariff is based on GP-centred care (HZV) under § 73b SGB V - a care model where the GP serves as coordinator. Benefits are demonstrable: better coordination among specialists, fewer duplicate examinations, improved medication management for chronic conditions. AOK-Bundesverband studies show HZV-insured have 8-12 % fewer hospitalisations and rate quality of life with chronic conditions higher. The financial bonus is therefore only part of the advantage.
Which GPs participate in HZV varies regionally - comprehensive in cities, often limited in rural areas. When choosing a tariff, first check whether your current GP or a desired doctor participates. With a move you must enrol with a new HZV GP - otherwise you lose the bonus or must cancel the tariff. The tariff is therefore better suited to settled insured with a fixed GP relationship, less so to mobile professionals.
Deductible tariff: when it pays off
You commit to paying the first €300-900 of treatment costs each year out of pocket and receive a €120-500 cashback in return. Preventive check-ups, pregnancy, and children's treatment are usually excluded from the deductible - so the real cost only hits if you get sick. Run the numbers honestly: with more than two doctor visits a year that result in a prescription or referral, the math quickly turns negative. The tariff fits young, healthy singles without chronic conditions - and only for the main insured, not for co-insured family members.
Concrete examples: Tariff A offers a €500 deductible and €250 annual bonus. If you claim nothing in benefits, you get €250 - a saving. If you have €200 in sickness costs, you pay them yourself and get an additional €50 bonus (€250 minus €200 personal share). If costs reach €600, you pay the €500 deductible yourself and lose the bonus - additional costs are covered by GKV from the 501st euro. Calculate your typical annual benefit usage to find the break-even point.
An important limitation: the deductible doesn't apply to all benefits. Preventive care, vaccinations, hospital, drugs at fixed cost, home nursing, therapeutic and assistive devices are often excluded. What actually counts toward the deductible is mainly visits to outpatient doctors and ambulatory surgery. Your fund's detailed tariff table shows the specifics - read before signing, since the definition of "in-kind benefit" varies.
Premium refund
If you claim no benefits at all for a full calendar year (doctor, medication, sick pay), the main insured gets 1-3 monthly contributions back - typically €200-400. Preventive exams, dental check-ups and vaccinations are excluded, so you keep using those. The catch: an avoided treatment must not become an expensive one - letting a problem fester usually costs more in the end. Best suited to self-employed members in the voluntary GKV with high contributions; rarely worth it for employees on family coverage.
Practically the premium refund works like this: you pay your regular contribution all year. At year-end the fund checks whether you used in-kind benefits. If not, you get a payout - typically in March or April of the following year. Importantly, preventive and screening exams are explicitly excluded, so you can keep using them all without endangering the bonus. Dental preventive care, vaccinations and PZR (when categorised as preventive) are also harmless.
Risk in this tariff: insured may be tempted to leave a recognisable illness untreated to keep the bonus. This strategy is dangerous and counterproductive - a delayed illness later often costs many times more. The bonus from a single premium refund is quickly absorbed by a later complex treatment. The tariff therefore suits only members with honest self-assessment - anyone who would rush to the doctor at the first cold should not pick the premium refund.
Natural-medicine tariffs
Some health funds offer optional tariffs for special therapy directions like homeopathy, anthroposophic medicine, naturopathy and acupuncture (beyond the GKV standard indications of migraine and chronic pain). These benefits are not in the standard GKV catalogue or only limited - the optional tariff extends benefits either with covered payments or as cost reimbursement. Typical premiums are €5-15/month extra, depending on benefit scope. Useful for insured actively using these methods.
The advantage over a private outpatient supplement: optional tariffs in GKV are often cheaper and simpler to handle, since billing goes through your fund. However, benefits are usually capped (e.g. up to €600/year for naturopaths), while good private supplements reimburse €1,500/year and more. The optional tariff therefore suits occasional users of alternative methods; for intense use (e.g. weekly acupuncture) a private supplement is often better.
Which funds offer which tariffs? AOK Plus and some BKKs have specific natural-medicine optional tariffs. TK and BARMER offer supplementary benefit packages for homeopathy and anthroposophic medicine as statutory benefits - free, but limited. Before choosing a tariff, check specifically which therapies you'll use and which fund offers the best conditions for exactly those benefits. A fund switch may also pay off if your current fund has no fitting optional tariff.
Cost-reimbursement tariff
With the cost-reimbursement tariff you, as a statutory member, get treatment conditions similar to a private patient: you pay the doctor's bill yourself, submit it to the fund and receive the GKV-covered share back. Extra costs above the GKV rate you bear yourself. Advantage: often faster appointments, access to private practices. Disadvantage: with extensive treatments extra costs of several hundred or thousand euros can arise that aren't reimbursed. The tariff suits only insured with high income or a complementary PKV reimbursement insurance.
A concrete example: you visit a privately billing internist. The bill is €180 (factor 2.3 GOÄ). The GKV reimburses about €70 (factor 1.0 GOÄ). You pay €110 from your pocket, plus possibly a fund administrative fee of 5-10 %. With a more elaborate ambulatory operation the difference can quickly be €500-2,000. The tariff makes sense only if you're willing to view these extra costs as an investment in faster or better care.
A special variant: the "cost-reimbursement tariff for inpatient treatment". Here you can be treated in hospital like a private patient - senior doctor, single room, higher treatment standard. Extra costs are settled directly between insurer and hospital without your seeing the bill. This variant typically costs €5-15/month extra and is a cheap alternative to private inpatient supplemental insurance - but with the drawback of being fund-bound and lost on switching.
Who benefits from optional tariffs?
An honest balance: optional tariffs pay off for insured with clearly defined behaviour and sufficient discipline. Deductible tariffs are ideal for young, healthy singles without chronic conditions who can absorb a €500-900 risk buffer. GP tariffs suit insured with a fixed GP relationship and chronic conditions wanting coordination anyway. Premium refund is sensible for self-employed in voluntary GKV with high contributions and rare use of in-kind benefits. Three pitfalls always: minimum term, main-insured binding, and removal of certain extra benefits.
Who shouldn't take it? Families with children should be cautious with deductible tariffs since child treatments are frequent and the deductible burns through fast. Insured with chronic conditions (diabetes, hypertension, asthma) practically always lose with premium refund tariffs because regular visits are unavoidable. Mobile professionals with frequent moves are poorly placed in GP tariffs since binding to one GP is hard. In these cases the standard tariff is often the most economical choice.
A final recommendation: don't be blinded by the headline bonus. A deductible tariff with €500 bonus that costs €800 in a year of illness is a bad bet. A premium refund tariff with €400 bonus that pushes you to skip needed care is risky. Calculate three scenarios for any tariff - healthy, normally susceptible, seriously ill - and only pick if the tariff has a positive expected value in at least two of three. Anyone who can't honestly do that does better with the standard tariff.