Anyone who wants to submit private health insurance invoices goes through three steps. You pay the doctor’s bill first, send it to your insurer via the app, the online portal or by post, and receive the amount according to your tariff. You have up to three years after the end of the year in which the invoice was issued to submit it. An invoice from March 2026, for example, can be submitted until 31 December 2029. If you send it straight away, however, you keep a better overview and do not have to pre-finance for long.
Key points at a glance
- Privately insured people pay the doctor’s bill first and then submit it to the insurer. For inpatient treatment, the hospital usually bills the insurer directly.
- The submission deadline is three years from the end of the invoice year. The earlier you submit, the easier it is to clear up queries.
- How much comes back depends on your tariff: the reimbursement rate, the excess and the scope of benefits.
- A lost invoice is not a disaster: the practice can issue a duplicate.
- How quickly your insurer pays depends on the provider. You will find typical processing times in its portal, or you can ask.
How does reimbursement work in private health insurance?
Private health insurance works on the cost reimbursement principle. You pay the bill at the doctor’s, the dentist’s or the pharmacy and then claim the money back from the insurer. There is no direct contractual relationship between the practice and the insurer, so you usually have to submit the claim yourself. A detailed explanation is available in the cost reimbursement principle of the PKV (in German).
The exception is inpatient treatment. Here, direct billing between the hospital and the insurer is the rule, and depending on your tariff you usually pay only for premium services or co-payments.
What finally lands in your account is determined by your tariff: the reimbursement rate, the excess and the scope of benefits. Which services are usual for students is shown in the overview of PKV benefits for students (in German).
What must appear on the invoice for the insurer to pay?
The insurer checks the invoice against your tariff and against the Scale of Fees for Medical Services (GOÄ). To avoid queries, the invoice should be legible and complete. Check these points before you submit:
- Your name and the date of treatment are on the invoice.
- Every billed service is listed individually and described clearly.
- The multiplication factor is stated. If it is above the threshold, each affected service needs a written justification on the invoice.
- The name and address of the practice or facility are recognisable.
The fee range follows from the GOÄ. The basic rate is points multiplied by the point value of 5.82873 cents, and the multiplication factor is applied to it. Up to the threshold, the doctor needs no justification. Above it, they must justify each service in relation to the patient or the circumstances. Generic justifications are not enough.
| Type of service | Threshold | Maximum rate |
|---|---|---|
| Personal medical services | 2.3-fold | 3.5-fold |
| Medical-technical services | 1.8-fold | 2.5-fold |
| Laboratory services | 1.15-fold | 1.3-fold |
Above the maximum rate, a written fee agreement is required before treatment. The Federal Agency for Civic Education explains the rules in more detail. A reform of the GOÄ is planned, but no date has been set. Until then, the existing scale of fees applies.
How do you submit private health insurance invoices via app, portal or post?
Many insurers offer an app or a customer portal. There you photograph the invoice or upload it as a PDF. Submitting by post also remains possible. Which routes your insurer accepts is set out in its portal and in your contract documents.
- Pay the invoice and make a copy or photo for your records.
- Check whether all the details from the checklist above are present.
- Upload the receipt in the app or portal. For paper invoices, send the invoice with your insurance number to the claims department.
- Wait for the confirmation of receipt and note the submission date.
- Check the insurer’s benefit statement as soon as it arrives.
Legibility counts when you upload: straight angle, good light, all pages. Unreadable photos easily lead to queries, which delay the reimbursement. If the practice issued several pages, upload them together.
What is the deadline for submitting?
You can submit an invoice within three years from the end of the year in which it was issued. For the invoice from March 2026, the deadline ends on 31 December 2029. Also check your tariff conditions, in case they set shorter deadlines or special requirements.
Still, do not wait until the end of the year. Small amounts add up, receipts get lost, and after months the practice remembers the treatment less well when there are queries.
How long does private health insurance reimbursement take?
No fixed duration can be given. It depends on the insurer, the route you use and whether queries arise. Complete, legible documents speed up processing. How quickly your insurer usually pays is set out in its customer portal, or you will learn it on request.
If you have heard nothing for a while, first check the processing status in the portal. If that does not help, ask customer service with your insurance number and the submission date.
What do you do if a private health insurance invoice is lost?
Ask the practice for a duplicate of the invoice. Give the date of treatment so that they can find the record. If you have already submitted the original and the receipt is simply missing from your records, ask the insurer whether the invoice arrived there.
In future, make a digital copy straight after treatment. A photo on your smartphone is enough as a backup.
Why should you check the insurer’s benefit statement?
After processing, the insurer sends a benefit statement. It shows which amount was reimbursed, what was deducted and why. The article understanding the PKV benefit statement (in German) explains how to read it.
If a deduction is unclear, compare it with the invoice and your tariff. If the multiplication factor is above the threshold, the doctor’s justification may be missing. In that case, the practice can correct the invoice. With ongoing psychotherapy, invoices build up regularly. What the tariff covers for this is set out under therapy and PKV (in German).
Is it worth not submitting small invoices?
Some tariffs pay a premium refund if you have submitted no invoices for a year. With the performance-related variant, the payment depends on the insurer’s surpluses. Whether holding back pays off depends on the amount of the refund and on your invoices. The figures are in the tariff conditions. To put contributions in perspective, look at what PKV costs for students (in German).
Important: the refund reduces the deductible special expenses in the year of payment.
How do you organise your PKV receipts?
A simple structure is enough. Create one digital folder per year and keep a table in which you enter each invoice. That way you always see what is still open.
| Column | Entry |
|---|---|
| Date of treatment | When was the appointment? |
| Invoice amount | How much did you pay? |
| Submitted on | Date of the upload or the postmark |
| Reimbursed on and amount | Comparison with the benefit statement |
Frequently asked questions
Can I submit private health insurance invoices via the app?
Many private health insurers offer an app or an online portal for this. You photograph the invoice or upload a PDF file. Whether and how this works for you is set out in your insurer’s documents. For paper invoices, the postal route remains, but always keep a copy.
How do I apply for reimbursement?
You usually do not need a separate application. Submitting the paid invoice starts the check. Which further details your insurer requires, such as a form or your insurance number, you will find in the portal or on the insurer’s website.
How long does PKV reimbursement take?
That depends on the insurer. Complete and legible documents save queries and therefore time. Your insurer states typical processing times in its customer portal. If you have heard nothing for a while, ask with your insurance number and the submission date.
What do I do if the invoice is lost?
Ask the practice or clinic for a duplicate and give the date of treatment. If the invoice was already submitted, ask the insurer whether it is on file there. In future, make a digital copy straight after paying.
Here is what to do now
- Collect all open invoices and check them against the checklist.
- Upload them in the app or portal, or send them by post with a copy for yourself.
- Note the submission date and keep a table of open and reimbursed amounts.
- Compare the benefit statement with the invoice and your tariff, and ask if anything is unclear.
- If you want to talk through your situation, you will find the route to advice on the Academycon homepage.
You can find reviews of us on ProvenExpert, Trustlocal and Trustindex. Academycon was mentioned, among other places, in a report in the VersicherungsJournal. An overview of all mentions is on the press page.
Related articles
- PKV benefits for students: the overview (in German)
- Benefit statement in the PKV: how to read invoice and reimbursement (in German)
- Cost reimbursement in the PKV: how the principle works (in German)
- What does PKV cost for students? Premiums at a glance (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
