Laser eye surgery and private health insurance: Cost coverage and important tips for you
4 Apr 2025
Katrin Straub
Managing Director 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 support you financially and what steps are necessary for cost coverage.
The topic in brief and concise terms
Private health insurances (PKV) usually cover the costs for laser eye surgeries 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 level of reimbursement depends on the individual private health insurance plan; an estimate should be submitted in advance.
Understanding Cost Coverage: The BGH Ruling as a Turning Point
The coverage for laser eye surgery by private health insurance changed fundamentally. This occurred in the year two thousand and seventeen.
A ruling by the German Federal Court of Justice (BGH) (File ref. IV ZR 533/15) clarified this. Visual impairment is now considered a disease.
Therefore, private health insurers must reimburse costs. This applies when there is a medical necessity.
Previously, many insurers rejected applications. They referred to it as a cosmetic procedure.
The reference to glasses or contact lenses as an alternative no longer applies. This improves the situation for policyholders.
The medical necessity is always present with vision impairment. Check your private health insurance conditions.
The amount of reimbursement depends on these individual contract details. This is crucial for your planning.
This paradigm shift significantly strengthens 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 correction procedures. Consider your next steps.
We now look at specific requirements and typical costs.
Requirements and Budget: What You Need to Plan
Certain conditions must be met for cost coverage.
The most important is medical necessity. A visual impairment meets this criterion.
Since the BGH ruling in 2017, this has been clear. Your ophthalmologist will certify the diagnosis.
Additionally, you must be at least eighteen years old. Your vision must have been stable for one year.
Certain eye diseases can exclude the procedure.
The costs of laser eye surgery vary significantly.
They typically range from eight hundred to three thousand euros per eye.
Common procedures include LASIK, Femto-LASIK, PRK/LASEK, and ReLEx SMILE.
Each method has specific advantages and disadvantages as well as cost points.
A LASIK costs eight hundred to two thousand five hundred euros per eye.
The ReLEx SMILE method can cost two thousand to three thousand euros.
A cost estimate is essential before the procedure.
This clarifies the exact reimbursement amount with your private health insurance.
Many policies have coverage limits, e.g., one thousand five hundred euros per eye.
Find out more about the benefits of private insurance.
We show how to apply for cost coverage.
Practical 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 a cost estimate. Submit this along with a medical certificate.
This is done with your private health insurance.
Act before the procedure. Obtain written approval.
Ophthalmological pre-examination and consultation on the appropriate method.
Obtaining a detailed cost estimate from the eye clinic.
Submission of the cost estimate and certificate of medical necessity to your PKV (private health insurance).
Awaiting written confirmation of benefits from your insurer before the operation.
Performing the laser eye treatment after approval.
Submitting the invoice to your PKV (private health insurance) for reimbursement.
Proactive communication with your insurer minimizes uncertainties.
Clarify follow-up examinations and medication coverage.
Some policies cover visual aids. This is relevant in case of residual visual impairment.
Now follow expert tips that will help you further.
Expert knowledge: Optimise tariffs and avoid pitfalls
Maximise coverage through tariff review.
Not all tariffs reimburse the full amount.
There are often maximum limits per eye or deductibles.
A premium tariff offers advantages here. Examine contract details closely.
Expert tip: Confirm with your insurer in writing.
Ask about specific procedures and cost shares.
A supplementary health insurance can fill gaps in your main private health insurance.
If your private health insurance declines, submit a written objection.
Refer to BGH ruling IV ZR 533/15.
Chances of success have significantly increased since the ruling.
Document all steps carefully. Medical reports are important.
Quotes and correspondence are also essential. Good documentation is invaluable.
Also, remember eye doctor preventive care.
This care is important regardless of laser surgery.
With this information, you will master the financial aspect.
More useful links
Der Bundesgerichtshof provides a press release on the landmark ruling regarding eye laser surgeries and private health insurance.
Wikipedia delivers a comprehensive article on refractive surgery, which includes various eye laser procedures.
LTO.de sheds light on the BGH ruling that clarifies the concept of illness in the context of eye laser surgeries for private health insurance.
Beck-Online provides information on the possible obligation of private health insurers to cover the costs of LASIK eye surgeries following a BGH ruling.
FAQ
Übernimmt jede private Krankenkasse die Kosten für das Augenlasern?
Grundsätzlich sind private Krankenversicherungen seit dem BGH-Urteil von zweitausendsiebzehn zur Kostenübernahme verpflichtet, wenn eine medizinische Notwendigkeit besteht. Der Umfang der Erstattung (vollständig oder teilweise) hängt jedoch stark von Ihrem individuellen Versicherungstarif ab. Es ist wichtig, die Tarifbedingungen zu prüfen und vorab eine Kostenzusage einzuholen.
Wie hoch sind die durchschnittlichen Kosten für eine Augenlaser-Behandlung?
Die Kosten für eine Augenlaser-Behandlung pro Auge liegen in Deutschland typischerweise zwischen achthundert Euro und dreitausend Euro. Die Preise variieren je nach gewählter Methode (z.B. LASIK, Femto-LASIK, ReLEx SMILE) und der jeweiligen Klinik.
Was passiert, wenn meine private Krankenkasse die Kostenübernahme ablehnt?
Sollte Ihre PKV die Kostenübernahme ablehnen, legen Sie schriftlich Widerspruch ein und beziehen Sie sich auf das BGH-Urteil IV ZR 533/15. Die Chancen auf eine nachträgliche Genehmigung sind seit diesem Urteil gestiegen. Eine anwaltliche Beratung kann ebenfalls hilfreich sein.
Muss ich vor der Augenlaser-OP einen Kostenvoranschlag bei meiner PKV einreichen?
Ja, es wird dringend empfohlen, vor der Operation einen detaillierten Kostenvoranschlag der Augenklinik bei Ihrer privaten Krankenkasse einzureichen. So erhalten Sie eine schriftliche Zusage über die Höhe der Kostenübernahme und vermeiden finanzielle Überraschungen.
Welche Augenlaser-Methoden werden in der Regel von der PKV erstattet?
Die PKV erstattet in der Regel die Kosten für gängige und anerkannte Augenlaser-Verfahren wie LASIK, Femto-LASIK, PRK/LASEK oder ReLEx SMILE, sofern die medizinische Notwendigkeit gegeben ist und der Tarif die Leistung nicht ausschließt. Klären Sie dies am besten vorab mit Ihrer Versicherung.
Übernimmt die gesetzliche Krankenkasse (GKV) auch Kosten für das Augenlasern?
Nein, die gesetzliche Krankenkasse (GKV) übernimmt die Kosten für Augenlaser-Behandlungen zur Korrektur von Fehlsichtigkeiten in aller Regel nicht. Diese Eingriffe gelten bei der GKV meist als kosmetische Operationen oder individuelle Gesundheitsleistungen (IGeL).
