Definition. Cost reimbursement (Kostenerstattung) is the procedure in private health insurance in which you first pay your medical bills yourself and then submit them to your insurer. The insurer reimburses the share agreed in your tariff. In statutory health insurance, by contrast, the benefits-in-kind principle usually applies, under which the fund settles directly with the doctor.
How reimbursement works
- You receive treatment and pay the bill directly at the practice or clinic.
- You submit the bill to your insurer, using the claim form or digitally.
- The insurer checks the service against your tariff and transfers the agreed share to your account.
Figures 2026 and their sources
Reimbursement rates and deductibles depend on the tariff, so no general figure applies. For comparison, statutory health insurance uses the benefits-in-kind principle. Its general contribution rate is 14.6 percent in 2026 (§ 241 SGB V, GKV-Spitzenverband, fact sheet on 2026 reference figures). Contributions and reimbursement relate to different benefits, so do not treat them as equivalent.
An example at the dentist
You have a filling and pay the bill on the spot. You then submit it with your reimbursement claim to your insurer. The insurer checks which part is reimbursable under your tariff and transfers the amount. You bear the rest yourself, depending on your deductible.
Related terms
- Cost reimbursement in detail: How cost reimbursement works in private health insurance (in German)
- Submitting PKV bills: How to submit private health insurance bills correctly (in German)
- Benefit statement: Benefit statements in private health insurance (in German)
- Deductible: Deductibles in private health insurance explained (in German)
Frequently asked questions
Do I always have to pay in advance in private health insurance?
In principle yes: under cost reimbursement you first pay the bill yourself. Some insurers also offer direct billing, so check this in advance.
How long do I have to submit a bill?
Your tariff sets the submission deadlines. Submit bills promptly so that no claim lapses.
Is cost reimbursement common in statutory insurance?
In statutory health insurance the benefits-in-kind principle usually applies, under which the fund settles directly. For privately insured people, cost reimbursement is the usual route.
Last updated: October 2026. This entry is general information, not individual advice. The German version is authoritative.
Sources: § 241 SGB V, GKV-Spitzenverband, fact sheet on 2026 reference figures, terms of the respective insurer.
