Laser eye surgery and private health insurance: Coverage and important tips for you
4 Apr 2025
5
Minutes
Katrin Straub
CEO at nextsure
Do you dream of a life without glasses or contact lenses? Laser eye surgery can make this wish come true. Find out here how your private health insurance can financially support you and what steps are necessary for cost coverage.
The topic in brief and concise terms
Private health insurances (PKV) generally cover the costs for laser eye surgery since a Federal Court of Justice ruling in 2017, provided there is a medical necessity (visual impairment).
The cost of laser eye surgery varies between eight hundred and three thousand euros per eye, depending on the method and clinic.
The exact amount of reimbursement depends on the individual private health insurance plan; a cost estimate should be submitted in advance.
Understanding Cost Coverage: The BGH Ruling as a Turning Point
The cost coverage for laser eye surgery by private health insurance fundamentally changed. This happened in the year two thousand and seventeen.
A Federal Court of Justice ruling (Az. IV ZR 533/15) clarified this. Poor eyesight is now considered a disease.
Therefore, private health insurers must reimburse costs. This applies when there is medical necessity.
Previously, many insurers rejected applications. They called it a cosmetic procedure.
Also, the reference to glasses or contact lenses as an alternative no longer applies. This improves the situation for policyholders.
Medical necessity is always present with a visual impairment. Check the terms of your private health insurance.
The amount of reimbursement depends on these individual contract details. This is crucial for your planning.
This paradigm shift significantly empowers policyholders.
Around 150,000 people in Germany opt for laser eye surgery every year.
Private health insurance can no longer generally refer to visual aids. Laser eye surgery is a medical treatment.
This development significantly facilitates access to modern corrective procedures. Consider your next steps.
We will now consider specific requirements and usual costs.
Requirements and Budget: What You Need to Plan For
Certain prerequisites must be met for cost coverage.
The most important is medical necessity. Visual impairment fulfills this requirement.
Since the BGH ruling in 2017, this has been clear. Your ophthalmologist certifies the diagnosis.
In addition, you must be at least eighteen years old and your vision must be stable for one year.
Certain eye diseases may exclude the procedure.
The costs of laser eye surgery vary considerably.
They typically range between eight hundred and three thousand euros per eye.
Common procedures include LASIK, Femto-LASIK, PRK/LASEK, and ReLEx SMILE.
Each method has specific advantages, disadvantages, and cost factors.
LASIK costs range from eight hundred to two thousand five hundred euros per eye.
The ReLEx SMILE method can cost between two thousand and three thousand euros.
An estimate of costs is essential before the procedure.
This clarifies the exact reimbursement amount with your PKV.
Many policies have limit sums, for example, one thousand five hundred euros per eye.
Find out about the benefits of private insurance.
We show you how to apply for cost coverage.
Practice Guide: Steps for Reimbursement by Your Private Health Insurance
Reimbursement requires careful preparation.
Have a detailed ophthalmological examination conducted.
This confirms the visual impairment and suitability for the surgery.
Your doctor will prepare an estimate. Submit this along with the medical certificate.
This is done with your private health insurance.
Act before the procedure. Obtain a written approval.
Preliminary ophthalmological examination and consultation on the suitable method.
Obtaining a detailed estimate from the eye clinic.
Submission of the estimate and certificate of medical necessity to your PKV.
Waiting for the written confirmation of benefits from your insurer before the operation.
Performing the laser eye treatment after approval.
Submitting the invoice to your PKV for reimbursement.
Proactive communication with your insurer reduces uncertainties.
Clarify follow-up examinations and medication coverage.
Some policies cover vision aids. This is relevant for residual visual impairment.
Now follow expert tips that will further assist you.
Expert knowledge: Optimise tariffs and avoid pitfalls
Maximise coverage through tariff verification.
Not all tariffs reimburse the full amount.
There are often limits per eye or excess charges.
A premium tariff offers advantages here. Check the contract details carefully.
Expert tip: Confirm in writing with your insurance.
Inquire about specific procedures and cost shares.
A supplementary health insurance can fill gaps in the main private health insurance.
If your private health insurance rejects, file an appeal in writing.
Refer to the BGH judgement IV ZR 533/15.
The prospects of success have increased significantly since the judgement.
Document all steps carefully. Medical reports are important.
Cost estimates and correspondence are also essential. Good documentation is invaluable.
Also think about eye doctor screenings.
These screenings are important regardless of a laser surgery.
With this information, you will master the financial aspect.
Long-term perspective: Laser eye surgery as an investment in quality of life
An eye laser surgery is an investment in quality of life.
Patients report freedom without glasses or contact lenses.
Costs for visual aids accumulate over the years.
Glasses cost between five hundred to seven hundred euros every two to three years.
Contact lenses cause two hundred to four hundred euros annually.
A laser surgery pays for itself after eight to ten years.
The glasses insurance becomes superfluous as a result.
Consider the following aspects in your decision:
Reduced ongoing costs: Elimination of expenses for glasses, contact lenses, and care products.
More comfort in everyday life: No foggy glasses, no slipping glasses, no dry eyes due to lenses.
Freedom in sports and leisure: Unrestricted vision when swimming, skiing, or other activities.
Potential career advantages: Glasses can be a hindrance in some professions.
The statutory health insurance does not cover this.
Private health insurance offers significant benefits.
Processing through private health insurance makes the procedure more affordable.
Consider choosing between voluntary health insurance or private health insurance.
nextsure will gladly advise you on individual options.
Request an individual risk analysis now: Have your insurance situation checked free of charge and receive concrete suggestions for optimization. Over 80% of our clients benefit.
More useful links
The Federal Court of Justice offers a press release on the landmark ruling regarding eye laser surgeries and private health insurance.
Wikipedia provides a comprehensive article on refractive surgery, which includes various eye laser procedures.
LTO.de examines the Federal Court of Justice ruling that clarifies the definition of illness in the context of eye laser surgeries for private health insurance.
Beck-Online provides information on the potential obligation of private health insurers to cover the costs of LASIK eye surgeries following a Federal Court of Justice ruling.
FAQ
Does every private health insurance cover the costs for eye laser surgery?
In principle, private health insurance companies have been obliged to cover costs since the 2017 Federal Court of Justice ruling, if there is a medical necessity. However, the extent of reimbursement (full or partial) largely depends on your individual insurance plan. It's important to check the tariff conditions and obtain a cost approval in advance.
What are the average costs for laser eye surgery?
The cost of laser eye treatment per eye in Germany typically ranges between eight hundred euros and three thousand euros. Prices vary depending on the chosen method (e.g., LASIK, Femto-LASIK, ReLEx SMILE) and the particular clinic.
What happens if my private health insurance rejects the cost coverage?
If your private health insurance rejects cost coverage, file a written objection and refer to the Federal Court of Justice ruling IV ZR 533/15. The chances of retroactive approval have increased since this ruling. Legal advice can also be beneficial.
Do I need to submit a cost estimate to my private health insurance before the eye laser surgery?
Yes, it is highly recommended to submit a detailed cost estimate from the eye clinic to your private health insurance before the operation. This way, you receive written confirmation of the reimbursement amount and avoid financial surprises.
Which eye laser methods are typically reimbursed by private health insurance?
Private health insurance usually reimburses the costs for standard and recognised eye laser procedures such as LASIK, Femto-LASIK, PRK/LASEK or ReLEx SMILE, provided there is a medical necessity and the policy does not exclude the service. It is best to clarify this with your insurance in advance.
Does the statutory health insurance (GKV) also cover costs for laser eye surgery?
No, the statutory health insurance (GKV) generally does not cover the costs for laser eye treatments to correct visual impairments. These procedures are usually considered cosmetic operations or individual health services (IGeL) by the GKV.
