Laser eye surgery and private health insurance: cost coverage and important tips for you
04.04.25
10
Minutes
Katrin Straub
Managing Director at nextsure
Do you dream of a life without glasses or contact lenses? Eye laser surgery can make that wish come true. Find out here how your private health insurance can provide financial support and which steps are necessary for costs to be covered.
The topic in brief and concise terms
Private health insurance policies (PKV) have generally covered the costs of laser eye surgery since a 2017 Federal Court of Justice ruling, provided there is a medical necessity (visual impairment).
The cost of eye laser treatment varies depending on the method and clinic, ranging from eight hundred to three thousand euros per eye.
The exact reimbursement amount 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 cost coverage for laser eye surgery through private health insurance changed fundamentally. This happened in 2017.
A Federal Court of Justice ruling (case no. IV ZR 533/15) clarified this. Refractive errors are now regarded as an illness.
As a result, private health insurers must reimburse costs. This applies where treatment is medically necessary.
Previously, many insurers rejected applications. They described it as a cosmetic procedure.
The reference to glasses or contact lenses as an alternative no longer applies either. This improves the situation for policyholders.
Medical necessity is always given in the case of impaired vision. Check the policy terms of your private health insurance.
The level 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 simply refer to visual aids. Laser eye surgery is a medical treatment.
This development makes access to modern corrective procedures much easier. Consider the next steps.
We will now look at the specific requirements and typical costs.
Requirements and budget: What you need to factor in
Certain requirements must be met for costs to be covered.
The most important is medical necessity. A refractive error meets this criterion.
Since the BGH ruling in 2017, this has been clear. Your ophthalmologist confirms the diagnosis.
In addition, you must be at least 18 years old. Your vision must be stable for one year.
Certain eye conditions may rule out the procedure.
The costs of laser eye surgery vary considerably.
They typically range from €800 to €3,000 per eye.
Common procedures are LASIK, Femto-LASIK, PRK/LASEK and ReLEx SMILE.
Each method has specific advantages and disadvantages, as well as cost factors.
LASIK costs €800 to €2,500 per eye.
The ReLEx SMILE method can cost €2,000 to €3,000.
A cost estimate is essential before the procedure.
This clarifies the exact reimbursement amount with your private health insurer.
Many policies have coverage limits, e.g. €1,500 per eye.
Find out about the benefits of private health insurance.
We show you how to apply for coverage.
Practical guide: Steps to reimbursement through your private health insurance
Reimbursement requires careful preparation.
Have a detailed ophthalmological examination carried out.
This confirms the refractive error and suitability for the operation.
Your doctor will prepare a cost estimate. Submit this together with a medical certificate.
This is done with your private health insurance.
Act before the procedure. Obtain written approval.
Ophthalmological preliminary examination and advice on the suitable method.
Obtaining a detailed cost estimate from the eye clinic.
Submission of the cost estimate and the medical necessity certificate to your private health insurance (PKV).
Waiting for your insurer's written commitment before the operation.
Carrying out the eye laser treatment after approval.
Submitting the invoice to your private health insurance (PKV) for reimbursement.
Proactive communication with your insurer minimises uncertainties.
Clarify follow-up examinations and medication cover.
Some plans cover visual aids. This is relevant in the case of residual refractive error.
The following expert tips will help you further.
Expert knowledge: optimising tariffs and avoiding pitfalls
Maximise coverage by checking your plan.
Not all plans reimburse the full amount.
There are often limits per eye or deductibles.
A premium plan offers advantages here. Check the contract details carefully.
Expert tip: Clarify this in writing with your insurer.
Ask about specific procedures and cost shares.
Supplementary health insurance can fill gaps in your main private health insurance.
If your PKV rejects it, lodge a written objection.
Refer to the Federal Court of Justice ruling IV ZR 533/15.
The prospects of success have increased significantly since the ruling.
Document all steps carefully. Medical reports are important.
Cost estimates and correspondence are also essential. Good documentation is invaluable.
Also remember the eye specialist check-ups.
This preventive care is important regardless of laser surgery.
With this information, you can handle the financial side.
Long-term perspective: laser eye surgery as an investment in quality of life
Laser eye surgery is an investment in quality of life.
Patients report freedom without glasses or contact lenses.
Costs for vision aids add up over the years.
A pair of glasses costs between five hundred and seven hundred euros every two to three years.
Contact lenses cost between two hundred and four hundred euros a year.
Laser surgery pays for itself after eight to ten years.
The glasses insurance then becomes unnecessary.
Consider the following aspects when making your decision:
Reduced ongoing costs: Elimination of expenses for glasses, contact lenses and care products.
More comfort in everyday life: No fogging of lenses, no slipping glasses, no dry eyes caused by lenses.
Freedom in sport and leisure: Unrestricted vision when swimming, skiing or taking part in other activities.
Potential professional advantages: In some professions, glasses can be a hindrance.
The statutory health insurance fund does not cover it.
Private health insurance offers clear advantages.
Processing it through private health insurance makes the procedure more affordable.
Consider whether voluntary health insurance or private health insurance is the better choice.
nextsure will be happy to advise you on tailored options.
Request your individual risk analysis now: Have your insurance situation checked free of charge and receive concrete recommendations for optimisation. Over 80% of our customers benefit.
More useful links
The Federal Court of Justice offers a press release on the landmark ruling on eye laser operations and private health insurance.
Wikipedia provides a comprehensive article on refractive surgery, which includes various eye laser procedures.
LTO.de examines the BGH ruling, which clarifies the definition of illness in the context of eye laser operations for private health insurance.
Beck-Online reports on the possible obligation of private health insurers to cover the costs of eye LASIK operations following a BGH ruling.
FAQ
Does every private health insurer cover the cost of laser eye surgery?
Basically, private health insurance providers have been obliged to cover costs since the BGH ruling of 2017, where there is a medical necessity. However, the extent of reimbursement (full or partial) depends heavily on your individual insurance plan. It is important to check the tariff conditions and obtain cost approval in advance.
What are the average costs for laser eye treatment?
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 respective clinic.
What happens if my private health insurance declines to cover the costs?
Should your private health insurer refuse to cover the costs, submit a written objection and refer to the BGH ruling IV ZR 533/15. The chances of retrospective approval have increased since this ruling. Legal advice may also be helpful.
Do I need to submit a cost estimate to my private health insurance before laser eye surgery?
Yes, it is strongly recommended that you submit a detailed cost estimate from the eye clinic to your private health insurer before the operation. This will give you written confirmation of the level of costs covered and help you avoid financial surprises.
Which eye laser methods are usually reimbursed by private health insurance?
As a rule, private health insurance reimburses the costs of common and recognised eye laser procedures such as LASIK, Femto-LASIK, PRK/LASEK or ReLEx SMILE, provided there is a medical necessity and the tariff does not exclude the benefit. It is best to clarify this with your insurer in advance.
Does statutory health insurance (GKV) also cover the cost of laser eye surgery?
No, statutory health insurance (GKV) does not usually cover the cost of laser eye treatments to correct refractive errors. Under the GKV, these procedures are generally regarded as cosmetic operations or individual health services (IGeL).
