Whether chief physician treatment is worth it in private health insurance (PKV) depends on your tariff. The tariff determines whether and to what extent optional services are reimbursed. Billing follows the Scale of Fees for Physicians (GOÄ). For personal medical services, the threshold rate is 2.3 times the standard rate and the maximum rate 3.5 times. How much of this your insurer reimburses is set by your tariff.
The key points at a glance
- The doctor bills under the GOÄ. For personal medical services, the threshold rate is 2.3 and the maximum rate is 3.5.
- Above the threshold rate, the doctor must justify each service in writing on the bill.
- Above the maximum rate, a written fee agreement is needed before treatment begins. In an emergency, it is excluded.
- The amount reimbursed depends on your tariff. Ask in advance whether, and to what extent, it includes chief physician treatment.
- A GOÄ reform with fixed euro amounts is planned. Until then, the existing fee schedule applies.
What is chief physician treatment?
With chief physician treatment, the head physician of a clinical department treats you personally or takes responsibility for your treatment. It is one of the optional services in hospital. Which services your tariff provides for it is set out in the policy conditions. An overview of tariffs and modules is given in the article on private health insurance benefits for students (in German).
What does chief physician treatment cost in private health insurance?
There is no fixed price. The costs depend on the service, its number of points, and the rate factor. A single service is calculated as follows: the standard rate is the number of points multiplied by the point value of 5.82873 cents, and the doctor then multiplies it by a factor.
| Type of service | Threshold rate | Maximum rate |
|---|---|---|
| Personal medical services | 2.3 | 3.5 |
| Medical-technical services | 1.8 | 2.5 |
| Laboratory services | 1.15 | 1.3 |
Example: a medical service with 100 points, where the number of points is an assumption. The standard rate is about 5.83 euros. At the threshold rate of 2.3 it is about 13.41 euros, and at the maximum rate of 3.5 about 20.40 euros. A treatment consists of many such services, so the total depends on the scope and the factor.
When must the doctor justify the factor?
Up to the threshold rate, the doctor does not need to give a reason. Above it, the doctor must justify each service in writing on the bill, related to the patient, the illness, or the circumstances. Generic wording is not enough. Within the range, the doctor sets the fee at their reasonable discretion.
Above the maximum rate, a written fee agreement under section 2 GOÄ is needed before treatment begins. It is excluded in emergencies and for acute pain treatment. Ask for the bill and its justification before you submit it to your insurer. The article on claims settlement in private health insurance (in German) shows how to read a statement.
Who pays the bill, and how does reimbursement work?
Privately insured patients first pay the doctor’s bill themselves and submit it to the insurer. There is no direct contractual relationship between doctor and insurer. For inpatient treatment, direct billing between the hospital and the insurer is the rule. Whether this also applies to the fee of the chief physician can be clarified before admission. How much is reimbursed depends on your tariff.
You can submit the bill within three years from the end of the year in which it was issued. For a bill from March 2026, the deadline runs until 31 December 2029. The article on private health insurance in hospital (in German) explains the inpatient process.
Chief physician or senior physician: what matters?
What counts for the outcome is who actually carries out the treatment and how experienced the team is. The title alone says little about that. Before admission, clarify in writing which doctor is responsible, which services will be billed, and which factor applies. A cost estimate from the hospital brings clarity.
When is chief physician treatment worth it for students?
You set the course when you choose the tariff. Check these points before you sign a contract.
- Whether the tariff includes chief physician treatment, and up to which factor it reimburses.
- Which reimbursement rate the tariff applies and whether there are maximum amounts.
- Whether a deductible applies and how high it is.
- How the contribution changes with entry age and health status.
Contributions in private health insurance can rise. A tariff that is cheap today can cost much more later. Some insurers offer student tariffs for young first-time policyholders, where the contribution depends on entry age. If you are exempted from compulsory insurance for this, you generally cannot return to statutory insurance during your studies. The application contains health questions that you must answer truthfully. The steps for switching are described in the article on switching to private insurance as a student (in German). Beforehand you can make an anonymous risk enquiry.
The GOÄ is currently being revised. The Federal Chamber of Physicians and the PKV association have submitted an updated draft to the Federal Ministry of Health, which provides for fixed euro amounts instead of rate factors. The project is planned, and a start on 1 January 2028 is a target without commitment. Until then, the existing GOÄ applies.
Frequently asked questions
What does chief physician treatment cost in private health insurance?
There is no flat price. Doctors bill services under the GOÄ, up to the threshold rate of 2.3 without justification and up to the maximum rate of 3.5 with justification. The total depends on the scope and the factors. Your insurer reimburses according to your tariff.
Does private health insurance pay for chief physician treatment?
That depends on your tariff. Reimbursement follows the terms of your contract, including the deductible and reimbursement rate. Before you go into hospital, check whether optional services are included or ask your insurer.
Chief physician or senior physician: which is better?
What matters is who carries out your treatment and how experienced the team is. The title mainly describes the function. Before admission, ask who will treat you and what will be billed.
Is chief physician treatment worth it for students?
That depends on your tariff and your situation. Whether chief physician treatment is included is set out in the conditions. When choosing a tariff, look at the contribution, deductible and benefits as a whole, especially since private contributions can rise. Bills generally have to be paid by you first.
So what do you do now?
- Check in the tariff conditions whether chief physician treatment is included and how much is reimbursed.
- Before planned surgery, ask in writing who will treat you, which services are billed, and which factor applies.
- Check bills for justifications as soon as the factor is above 2.3.
- Submit the bill on time and keep the three-year deadline in view.
- If you want to talk through your situation, you will find the way to advice on the Academycon homepage.
You can read reviews of us on ProvenExpert, Trustlocal and Trustindex. Academycon was also mentioned, among other places, in a press release on Nachrichten Heute (in German). An overview of all mentions is on the press page (in German).
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- Supplementary insurance for students: which add-ons are worth it (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
