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Supplementary dental insurance for those insured by statutory health especially in the case of dental crowns, dental bridges and removable dentures), necessary
insurance companies anesthesia, radiological, functional analysis and functional therapy services in direct connection
with the dentures as well as laboratory costs. For high-quality plastic fillings, the insurer
AVB AstraZahn 2022 with the tariff levels Perfect/Plus/ reimburses 100% of the reimbursable invoice amount in all tariff levels together with the
Mega/Winner advance payment from the GKV or another cost bearer.

Insurer: astra Versicherung AG Missing Teeth

Dudenstrasse 46, 68167 Mannheim Applications are eligible with up to three missing and unreplaced teeth, with only one missing
tooth being covered. A contract cannot be concluded if more than three teeth are missing and
Tariff benefits of the tariff AstraZahn 2022 with the tariff levels Perfect/ not replaced. Section 6. Limitations at the start of the contract (benefit scales) lists the maximum
Plus/Mega/Winner limits for total reimbursement from the sum of the expenses for dental treatment, dentures and
orthodontics within the periods of 0 - 48 months. The number of missing and not replaced teeth
is also taken into account in the performance scales.
insurance benefits

The insurer reimburses within the framework of the tariff and the general insurance conditions

1. Dentures for
dental services including dental services and a treatment and cost plan together with the
advance payment* of the statutory health insurance (GKV) 75% of the reimbursable invoice
amount in the Perfect tariff level 80% of the reimbursable invoice amount in the Plus tariff level
90% of the reimbursable invoice amount in tariff level Mega 100% of the reimbursable invoice
amount in the tariff level Winner.
*A deductible agreed with the GKV for the insured person (GKV elective tariff with deductible)
or a remaining deductible because an orthodontic treatment was discontinued also counts as
an advance payment from the GKV.
2. Dental treatment for
dental treatment services and a treatment and cost plan together with the advance payment*
from the GKV or another cost bearer 100% of the reimbursable invoice amount in all four tariff
levels.

The insurer reimburses 100% of the expenses for dental prosthesis measures in all four tariff
levels together with the advance payment from the statutory health insurance (GKV) or another
cost bearer, if no private dentist remuneration shares are calculated for this according to GOZ
(fee schedule for dentists) (standard care) .
If the GKV does not provide any advance payment because a dentist was selected without a
health insurance license or if the policyholder does not make use of a possible advance
payment from the GKV or another payer, the tariff reimbursement rate is reduced by 30
percentage points.
are considered dentures
Dental prostheses, dental crowns, dental bridges, pivot teeth, inlays, onlays, veneers, implant-
supported dentures, implants, high-quality plastic fillings, implantological services including
those necessary for this
Measures for bone formation, ceramic veneers up to tooth 8 and the restoration of the function
of the denture (repairs,
a) Dental treatment includes tooth
fillings (unless listed under dentures), periodontal treatment, mucous membrane transplantation,
root canal treatment, root tip resection, services for the integration of bite aids and splints
(insofar as they do not fall under the special services of grinding and bite splints and DROS
splints) as well as necessary Anaesthetic, radiological, functional analysis and functional
therapy services directly related to dental treatment.
If the GKV does not provide any advance payment because a dentist was selected without a
health insurance license or if the policyholder does not make use of a possible advance
payment from the GKV or another payer, the tariff reimbursement rate is reduced by 30
percentage points.
b) For the following special services of dental treatment, different reimbursement rates
(previous year = insurance year) apply in the tariff levels together with the advance payment
of the GKV or another cost bearer:

Perfect Plus Mega winner

Laser treatment 75% general anesthesia for treatments 80% 90% 100%
75% max. 150 € in the previous year. 80% max. €175 in previous year 90% max. €200 in previous year 100% max. €250 in previous year
Acupuncture for pain relief 75% max. €150 in the previous year 80% max. €175 in the previous 90% max. €200 in the previous 100% max. €250 in the previous
Hypnosis for pain relief 75% max. €150 in the previous year year 80% max. €175 in the year 90% max. €200 in the year 100% max. €250 in the
Surgical microscope 75% CEREC treatment 75% previous year 80% 80% 80% 80% previous year 90% 90% 90% 90% previous year 100% 100% 100%
Cone beam tomography 75% vector technology b. 100%
Periodontosis 75% Photo-activated chemotherapy for
periodontosis Bacteria analysis and DNA test for
periodontosis Root length measurement per service75% 80% 90% 100%
case

75% 80% 90% 100%

100% up to €300 100% up to €400 100% up to €800 100% up to €1000

Crunch and bite splints 75% 80% 90% 100%

DROS rails - - - 100%

The benefits for grinding splints and bite splints can be claimed at the earliest 2 years after the *A deductible agreed with the GKV for the insured person (GKV elective tariff with deductible)
first reimbursable treatment and then at least every 2 years after the last reimbursable or a remaining deductible because an orthodontic treatment was discontinued also counts as
treatment. They are each limited to EUR 150 in the Perfect tariff level, EUR 200 in the Plus an advance payment from the GKV.
tariff level, EUR 300 in the Mega tariff level and EUR 600 in the Winner tariff level. In the winner
tariff level (not in the other three tariff levels), the insurer also reimburses DROS rails at 100%,
limited to 600 euros. In this case, the 2-year regulation for benefits for grinding splints and bite
splints applies accordingly.
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3. Dental prophylaxis 80% of the refundable invoice amount in the Plus tariff level, for the entire contract period a
for expenses for caries risk diagnostics, fluoridation, oral hygiene status and fissure sealing in maximum of 1500 euros 90% of the refundable invoice amount in the Mega tariff level, for the
all four tariff levels 100% of the reimbursable invoice amount.
entire contract period a maximum of 2500 euros 100% of the refundable invoice amount in the
Winner tariff level, for the entire contract period a maximum of 4000 Euro.
Expenses for professional teeth cleaning are limited to EUR 160 per insurance year in the
Perfect and Plus tariff levels, EUR 180 in the Mega tariff level and EUR 200 in the Sieger tariff
level.
Individual invoices are only refundable up to an amount of up to 100 euros.
*A deductible agreed with the GKV for the insured person (GKV elective tariff with deductible)
or a remaining deductible because an orthodontic treatment was discontinued also counts as
an advance payment from the GKV.
Expenses for teeth whitening are reimbursable for the first treatment from the 25th month after
the start of the contract, thereafter at the earliest 2 years after the first reimbursable treatment
and then at intervals of at least 2 years after the last reimbursable treatment. The reimbursable
6. Limitations at the start of the contract (service scales)
expenses per completed treatment are limited in the tariff levels as follows:
Maximum limits of the total reimbursement from the sum of the expenses for dental treatment,
dentures and orthodontics within the periods of 0 - 48 months.

Perfect Plus Accident-related tariff benefits are not taken into account.
Mega winner
Dental treatment = ZB
dentures = ZE orthodontics
0 - 25 years €0 €0 €0 €0
26 - 30 years €0 €50 €0 €0 = KFO
31 - 35 years €50 €30 €0 €300
tariff level Perfect/Plus Mega winner
36 - 40 years €30 €100 €100 €200
41 - 45 years €50 €50 €50 €300 ZB, ZE, KFO ZB, ZE, KFO Eg, ZE, KFO
46 - 50 years €100 €30 €100 €200 Performance scale 1
0 - 12 months €1000 €1250 €1500
51 - 55 years €100 €100 €0 €400
0 - 24 months €2000 €2500 €3000
56 - 60 years €100 €100 €0 €200
0 - 36 months €3000 €3750 €4500
from 61 years €50 €100 €0 €50
0 - 48 months €4000 €5000 €6000

4. Orthodontics for children and young people for

Performance season 2 (2 missing, not replaced teeth)
orthodontic services including material costs, treatment and cost plan and for dental services 0 - 12 months €500 €750 €1000
such as Invisalign therapy, lingual technology, mini brackets, plastic brackets, ceramic 0 - 24 months €1000 €1500 €2000
brackets, retainers, colorless archwires and necessary anesthesia , radiological, functional 0 - 36 months €1500 €2250 €3000
analysis and functional therapy services in direct connection with orthodontic services, provided 0 - 48 months €2000 €3000 €4000
that the treatment was started before the age of 18: If the orthodontic indication groups (KIG)
3 to 5 are present, the insurer sets this up together with the Advance payment* by the GKV or
Performance season 3 (3 missing, not replaced teeth)
another cost bearer 75% of the reimbursable invoice amount in the Perfect tariff level, for the 0 - 12 months €100 €300 €500
entire contract period a maximum of 700 euros 80% of the reimbursable invoice amount in the 0 - 24 months €200 €600 €1000
Plus tariff level, for the entire contract period a maximum of 750 euros 90% of the reimbursable 0 - 36 months €300 €900 €1500
invoice amount in Mega tariff level, maximum 1250 euros for the entire contract period 100% of 0 - 48 months €400 €1200 €2000

the reimbursable invoice amount in the Sieger tariff level, maximum 2000 euros for the entire
contract period.
7. Benefits for requested evidence If the insurer requests
additional dental evidence as part of the examination of a claim for benefits, the costs billed to
the policyholder for this by the treatment provider (reimbursement of expenses) can be
reimbursed to the same extent as dental treatment in accordance with Section 2 a).

The same regulations apply to orthodontics caused by an accident.

If the orthodontic indication group (KIG) 2 is present, the

insurer

75% of the refundable invoice amount in the Perfect tariff level, for the entire contract period a
maximum of 1250 euros 80% of the refundable invoice amount in the Plus tariff level, for the

entire contract period a maximum of 1500 euros 90% of the refundable invoice amount in the
Mega tariff level, for the entire contract period a maximum of 2500 euros 100% of the

reimbursable invoice amount in the winner tariff level, for the entire contract period a maximum
of 4000 euros.

The same regulations apply to orthodontics caused by an accident.

*A deductible agreed with the GKV for the insured person (GKV elective tariff with deductible)
or a remaining deductible because an orthodontic treatment was discontinued also counts as
an advance payment from the GKV.

5. Orthodontics for adults for

orthodontic services resulting from an accident, including material costs, treatment and cost
plan and dental services such as Invisalign therapy, lingual technology, mini brackets, plastic
brackets, ceramic brackets, retainers, colorless arches and necessary anesthetic, radiological,
Functional analytical and functional therapeutic services in direct connection with orthodontic
services, provided that the treatment was started after the age of 18. The insurer reimburses
together with the advance payment* of the GKV or another cost bearer over the entire contract
period: 75% of the reimbursable invoice amount in the perfect tariff level, for the entire contract
period a maximum of 1250 euros
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General insurance conditions for supplementary dental
insurance (AVB AstraZahn 2022)
§ 1 Object, scope and scope of the insurance cover, right of exchange 1.1.
The insurer provides insurance cover for illnesses, accidents and other events
specified in the contract. In the event of an insured event, he reimburses expenses
for medical treatment and other agreed benefits.
1.2. Insured event is the medically necessary treatment of an insured person due
to illness or the consequences of an accident. The insured event begins with the
medical treatment; it ends when, according to medical findings, there is no longer
any need for treatment. If the curative treatment has to be extended to an illness
or the consequences of an accident that is not causally related to the one previously
treated, a new insured event arises in this respect.
1.3 Eligible persons are those who have their permanent place of residence in
the Federal Republic of Germany. Eligible for insurance are members of the
German statutory health insurance (GKV) or persons who are entitled to benefits
from a German statutory health insurance provider as part of family insurance. A
contract cannot be concluded if more than three teeth are missing and not replaced
at the time the application is submitted. The insured person is no longer insurable
under the AstraZahn 2022 tariff at the end of the month in which their insurance
with the GKV ends. The same applies to a co-insured person under the age of 18
if the insurance relationship of the policyholder insured in the same insurance
contract ends. The insurance relationship of an insured person ends when they no
longer qualify for insurance under the AstraZahn 2022 tariff.
1.4 If an insured person relocates their habitual residence to another member
state of the European Union, to another state party to the Agreement on the
European Economic Area or to Switzerland, the insurance relationship continues
provided that membership in the German statutory health insurance or the There
is still a right to benefits from a German statutory health insurance provider as part
of family insurance. In this case, the insurer is only obliged to provide those
benefits that he would have to provide for a stay in Germany.
If an insured person relocates their usual place of residence outside of a country
specified in sentence 1, the insurance relationship ends at the end of the month
in which their usual place of residence is relocated.
1.5.
a) The scope of the insurance cover results from the insurance policy, subsequent
written agreements, these General Insurance Conditions for supplementary dental
insurance (AVB AstraZahn 2022), the agreed tariff level and the statutory
provisions. The insurance relationship is subject to German law. b) The policyholder
may request that the insurer accept applications to switch to other tariffs with
similar insurance cover, taking into account the rights acquired from the contract;
if the benefits in the tariff to which the policyholder wants to switch are higher or
more comprehensive than in the previous tariff, the insurer can demand exclusion
of benefits or an appropriate risk surcharge for the additional benefit and also a
waiting period; the policyholder can avoid the agreement of a risk surcharge and a
waiting period by agreeing on an exclusion of benefits with regard to the additional
benefit. For insured events that are ongoing at the time of the change, the benefits
covered by the previous tariff also apply after the change.
1.6 The insurance cover applies worldwide. For insured events abroad, the
contractual regulations specified in Section 1.5 apply, with the proviso that if
German statutory health insurance does not contribute to the reimbursable invoice
amount, the tariff reimbursement rate for services for dentures and orthodontic
treatment is reduced by 30% points and for dental treatment measures by 30%
points will.
§ 2 Conclusion and duration of contract, start of insurance cover 2.1
The insurance contract comes into effect upon acceptance of the application.
The duration of the insurance is 24 months (2 insurance years) from the beginning
and is extended by 12 months (1 insurance year) if this is not requested in text
form (e.g. paper form, e-mail, fax) with a notice period of 3 months is terminated at
the end of the contract period. Within the respective extension period, the
policyholder can terminate the insurance contract with a notice period of 3 months
to the end of the contract period.
2.2 The insurance cover begins at the point in time specified in the insurance
certificate (start of insurance), but not before the conclusion of the
insurance contract (in particular receipt of the insurance certificate or a written
declaration of acceptance). No benefits will be paid for insured events that occurred
before the start of the insurance cover. This also applies to treatment that the
policyholder or the insured person knew was necessary before the insurance
contract was concluded or that was recommended by a dentist or doctor before
the insurance contract was concluded. Insured events that occur after conclusion
of the insurance contract are only excluded from the obligation to provide benefits
for the part that occurs in the period before the start of the insurance.
2.3 In the case of newborns, insurance cover begins when the child is born if one
parent is insured with the insurer for at least three months on the day of the birth
and the insurance is registered no later than two months after the day of the birth,
retrospectively to the first of the month of the birth. Newborns are assigned to
benefit scale 1 with regard to the tariff classification under 6. Limitations at the
start of the contract (benefit scales).
2.4 Adoption is equivalent to the birth of a child if the child is still a minor at the
time of adoption. Deciduous teeth or wisdom teeth are not taken into account for
their tariff classification under 6. Limitations at the start of the contract (performance
scales).
§ 3 Waiver of waiting
times The insurer waives waiting times. A special regulation applies to the dental
bleaching tariff (see section 3 of the tariff benefits).
§ 4 Scope of the obligation to provide benefits,
area of application 4.1 The type and amount of the insurance benefits result from
these AVB AstraZahn 2022 and the agreed tariff level. The insurer reimburses the
reimbursable expenses insofar as the fees are within the framework of the
maximum rates of the applicable official German fee schedule for dentists (GOZ)
and correspond to their assessment principles.
GOZ Future Guarantee:
The insurer guarantees that medically necessary dental or orthodontic treatment
measures that are newly added to the GOZ - i.e. unknown at the time the contract
was concluded - are also insured in the future.
4.2 The insured person is free to choose from licensed dentists. The insured
person can also receive treatment from licensed dentists in medical care centers
(MVZ) in accordance with Section 95 (1) SGB V (see appendix) or in hospital and
emergency departments.
4.3 Abroad, the dentists licensed for dental treatment in the respective country can
be used.
4.4 The services included in the insurance cover are attributed to the time at
which they were rendered, received or used.
§ 5 Limitation of the obligation to
provide benefits 5.1 There is no obligation
to provide benefits a) for illnesses including their consequences and for the
consequences of accidents that are recognized as damage caused by military
service and are not expressly included in the insurance cover;
b) for illnesses and accidents caused by intent, including
Consequences;
c) for treatment by dentists and hospitals whose invoices the insurer has excluded
from reimbursement for good cause if the insured event occurs after the
policyholder has been informed of the exclusion from benefits. If an insured event
is pending at the time of notification, there is no obligation to pay benefits for the
expenses incurred three months after notification;
d) for treatment by spouses, parents or children. Proven material costs will be
reimbursed according to the tariff;
5.2 If a treatment or other measure for which benefits have been agreed exceeds
what is medically necessary, the insurer can reduce its benefits to a reasonable
amount. If the expenses for the treatment or other benefits are noticeably
disproportionate to the benefits provided, the insurer is not obliged to pay in this
respect. In Germany, there is no obligation to pay for those parts of the liquidation
that do not correspond to the provisions of the valid official German fee schedule
for dentists or exceed the maximum rates.
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5.3 If there is an entitlement to benefits from statutory accident insurance or
statutory pension insurance, statutory medical care or accident care, the
insurer is only liable within the scope of the AVB Astra Zahn2022 and the
concluded tariff level for the expenses that remain necessary despite the
statutory benefits.
5.4 If the insured person has a claim against another party liable for
reimbursement because of the same insured event, this claim takes precedence
over the claim against the insurer.
5.5 If the insured person has a claim against several reimbursers for the same
insured event, the total reimbursement may not exceed the total expenses.
§ 6 Payment of insurance benefits, treatment and cost plan 6.1
The insurer is only obliged to pay if the evidence required of it has been
provided; these become the property of the insurer.
Photos or scans of the original invoices can be used as evidence. However,
the insurer reserves the right to also request the submission of the original
invoices. Duplicate invoices with reimbursement notes from another insurance
company are treated as originals. The invoices must contain: the name of the
person treated, description of the illness, services provided by the dentist (in
the case of curative treatment in Germany with numbers from the schedule of
fees) and the respective treatment date.
6.2 Otherwise, the conditions for the due date of the insurer's benefits result
from § 14 VVG (see appendix).
6.3 The costs incurred in a foreign currency are converted into euros at the
current rate of the day on which the receipts are received by the insurer. The
exchange rate of the day is the official euro exchange rate of the European
Central Bank. For currencies that are not traded and for which no reference
rates have been set, the exchange rate according to the “Exchange Rate
Statistics”, published by the Deutsche Bundesbank, Frankfurt/Main, applies
according to the latest version, unless the insured person can provide bank
documentation to prove that she has acquired the foreign currency necessary
to pay the bills at an unfavorable exchange rate.
6.4 Costs for transferring the insurance benefits and for translations can be
deducted from the benefits. Transfers to an account in Germany nominated by
the policyholder are free of charge.
6.5 A legally compliant assignment or pledging is only effective vis-à-vis the
insurer if it has been notified to the insurer in text form by the previously entitled
party.
6.6 The insurer recommends submitting a treatment and cost plan from the
dentist to the insurer before the actual treatment (dentures, orthodontics). This
gives the insurer the opportunity to inform the policyholder of the expected
reimbursement amount. A reduction in the tariff benefit solely due to a missing
treatment and cost plan does not take place.
§ 7 End of insurance coverage The
insurance coverage ends - also for pending insured events - with the termination
of the insurance relationship.
§ 8 Payment of
premiums 8.1 The first premium is to be paid immediately two weeks after
receipt of the insurance certificate, or at the point in time in the event of a later
start of insurance.
8.2 If the policyholder does not pay the first monthly premium on time, but at
a later point in time, the insurance cover only begins from this point in time,
provided that this legal consequence has been clearly drawn attention to and
the policyholder is responsible for the non-payment. In addition, the insurer
can withdraw from the contract unless the policyholder proves that he is not
responsible for the non-payment
8.3 The monthly follow-up payments are due on the first of the month.
8.4 If a follow-up premium is not paid on time, the policyholder will be in
default without a reminder being issued, unless the policyholder is not
responsible for the late payment. The insurer will request payment from the
policyholder in text form at the policyholder's expense and will set the
policyholder a payment period of at least two weeks. This setting of a deadline
is only effective if the insurer specifies the outstanding amounts of the premium
as well as the interest and costs in detail and states the legal consequences
associated with the expiry of the deadline. The dunning costs for each reminder
are EUR 2.50. The policyholder reserves the right to prove that the insurer has
suffered less damage or no damage at all. In addition, can
Interest on arrears and the costs and fees charged by third parties (e.g. return
fees, court costs) will be charged.
8.5 If the policyholder is still in arrears with the payment after this payment
period has expired, there is no insurance cover from this point in time until
payment is made if the policyholder was informed of this with the payment
request. In addition, the insurer can terminate the contract without notice if the
insurer has informed the policyholder of this in the request for payment. If the
insurer has canceled and the policyholder then pays the reminded premium
within one month, the contract continues. However, there is no insurance cover
for insured events that occurred between receipt of the notice of cancellation
and payment.
8.6 If the collection of the premium from an account has been agreed (direct
debit), the payment is deemed to be on time if the premium can be collected
on the due date and no objection is raised. If the premium payer revokes his
direct debit authorization, the premium is to be paid to the account specified by
the insurer.
If there are two or more unsuccessful direct debit attempts, the insurer can
request payment of the outstanding and future premiums by bank transfer.
8.7 If the insurance relationship is terminated before the end of the contract
term, the insurer is only entitled to that part of the premium for this contract
term that corresponds to the period in which the insurance cover existed. If the
insurance relationship is terminated as a result of rescission on the basis of §
19 Para. 2 VVG (see appendix) or through rescission by the insurer due to
fraudulent misrepresentation, the insurer is entitled to the premium until the
declaration of rescission or rescission becomes effective. If the insurer
withdraws because the first premium is not paid on time, he can demand a
reasonable business fee.
8.8 The premiums are to be paid to the bank account specified by the insurer.
§ 8a Premium calculation and premium adjustment, insurance tax
8a.1 The premiums are calculated according to recognized actuarial principles
and are defined in the insurer's technical bases of calculation. The monthly
contributions are calculated without an aging reserve and are based on the
contribution group of the age reached. The age attained is the difference
between the current calendar year and the year of birth of the insured person.
If the insured person reaches the first age of the following contribution group,
the contribution applicable to this higher contribution group is to be paid from
February of the relevant calendar year.
The contributions are divided separately for the age intervals of 0-15 years,
16-20 years, 21-25 years, 26-30 years, 31-35 years, 36-40 years, 41-45 years,
46-50 years, 51 -55 years, 56-60 years and over 61 years determined.
The premium to be paid can be found in the currently valid insurance policy.
The currently valid contribution groups can be found in the table at the end of
these AVB.
Due to the change to a different age interval, the policyholder can terminate
the insurance relationship with regard to the affected insured person within
two months of the change at the time it came into effect. This change in
premium does not count as a premium increase according to 8a.2.
8a.2 Expenditure on medical treatment measures may change, for example
due to rising health care costs or more frequent use of medical treatment
measures.
Accordingly, the insurer compares the required insurance benefits with those
calculated in the technical calculation bases separately for each of the eleven
age groups of the four tariff levels (observation units). If the comparison for the
observation unit shows a deviation of more than five percent, all premiums for
this observation unit will be reviewed by the insurer and, if necessary, adjusted
with the approval of an independent trustee.
Premiums will not be adjusted if the insurer and the independent trustee agree
that the change in insurance benefits is temporary.
The insurer will notify the policyholder of the change in premiums in text form,
stating the relevant reasons. The changes will take effect at the beginning of
the second month following the insurer's notification.
If the premium increases, the policyholder can cancel the insurance contract
within 2 months of receiving notification of the change at the point in time at
which the premium increase takes effect.
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8a.3 Pursuant to Section 4 of the Insurance Tax Act (see Appendix), the
insurance contract is not subject to insurance tax if it extends to persons from
the group of people listed in the Appendix (Section 7 of the Caregiver Leave
Act, Section 15 of the Fiscal Code). It is not possible to conclude an insurance
contract for persons not listed there. If the insurance relationship of a person
who is not subject to insurance tax becomes subject to insurance tax during the
term of the contract, the policyholder must notify the insurer of this in good time.
The insurance relationship is then converted into an insurance contract subject
to insurance tax.
§ 9 Obligations 9.1
At the request of the insurer, the policyholder and the insured person must
provide any information that is necessary to determine the insured event or the
insurer's obligation to provide benefits and their scope.
9.2 At the request of the insurer, the insured person is obliged to be examined
by a dentist commissioned by the insurer in order to determine the benefit event.
The dentists who have treated or examined the insured person - also for other
reasons - as well as other insurers, insurance carriers and authorities must be
authorized to provide all necessary information.
9.3 The insured person must ensure that the damage is reduced as far as
possible and refrain from any actions that could impede recovery.
9.4 Additional medical expenses insurance, which also includes benefits for
dental treatment in Germany, may only be taken out with another insurer with
the consent of the insurer (astra Versicherung AG).
§ 10 Consequences of breaches of
obligations 10.1 With the restrictions stipulated in § 28 Para. 2 to 4 VVG (see
appendix), the insurer is fully or partially released from the obligation to pay if
one of the obligations specified in § 9 Para. 1 to 4 get hurt.
10.2 If the obligation specified in Section 9 (4) is breached, the insurer can
terminate the contract within one month of the breach of obligation becoming
known, subject to the requirement of Section 28 (1) Insurance Contract Act (see
appendix) without observing a notice period.
10.3 The knowledge and fault of the insured person are equivalent to the
knowledge and fault of the policyholder.
Section 11 Obligations and consequences of breaches of obligations in the
event of claims against third parties 11.1 If the policyholder or an insured person
has claims for damages against third parties, then without prejudice to the statutory
subrogation of claims pursuant to Section 86 Insurance Contract Act (see appendix),
there is an obligation to assert these claims by Amount in which compensation
(reimbursement of costs as well as goods and services) is provided under the
insurance contract is to be assigned to the insurer in text form.
11.2 The policyholder or insured person has his (her)
to protect a claim for compensation or a right serving to secure this claim, taking
into account the applicable form and deadline regulations and to cooperate with
the insurer to the extent necessary in its enforcement.
11.3 If the policyholder or an insured person intentionally violates the obligations
specified in paragraphs 1 and 2, the insurer is not obliged to pay benefits insofar
as he cannot obtain compensation from the third party as a result. In the event
of a grossly negligent violation of the obligation, the insurer is entitled to reduce
its benefits in proportion to the severity of the fault.
11.4 If the policyholder or an insured person is entitled to reimbursement of
premiums paid without legal basis against the provider of benefits for which the
insurer has paid reimbursements on the basis of the insurance contract,
paragraphs 1 to 3 shall apply accordingly.
§ 12 Offsetting
The policyholder can only offset against claims of the insurer if the counterclaim
is undisputed or has been legally established.
§ 13 Cancellation by the policyholder 13.1 The
policyholder can cancel the insurance relationship in accordance with the
provisions under § 2.1.
13.2 Termination can be restricted to individual insured persons.
13.3 If the insurer only declares the rescission, withdrawal or termination for
individual insured persons, the policyholder can request cancellation of the
remaining part of the insurance within two weeks of receipt of this declaration at
the end of the month in which he declaration of the insurer has been received,
in the event of cancellation at the time at which this becomes effective.
13.4 If the policyholder terminates the insurance relationship as a whole or for
individual persons, the insured persons have the right to continue the insurance
relationship by naming the future policyholder. The declaration must be submitted
within three months after termination of the insurance.
The termination is only effective if the policyholder proves that the affected
insured persons have become aware of the notice of termination. This also
applies to termination due to an age-related change to a higher age group and
to termination within the scope of Section 8a. 2 of these AVB AstraZahn 2022.
13.5 The policyholder's rights of termination in the event of premium increases
can be found in § 8a.1 and § 8a.2.
§ 14 Termination by the insurer 14.1
The insurer waives its ordinary right of termination.
14.2 The statutory provisions on the extraordinary right of termination remain
unaffected.
14.3 Extraordinary termination can be limited to individual insured persons.
14.4 If the insurer terminates the insurance relationship extraordinarily as a
whole or for individual insured persons, Section 13.4 sentences 1 and 2 shall
apply accordingly.
§ 15 Other reasons for termination
15.1 The insurance relationship ends with the death of the policyholder.
However, the insured persons have the right to continue the insurance
relationship by naming the future policyholder. The declaration must be
submitted within two months after the death of the policyholder.
15.2 In the event of the death of an insured person, the insurance relationship
ends.
15.3 If an insured person relocates their habitual place of residence to a country
other than those named in § 1.4, the insurance relationship ends in this respect,
unless it is continued on the basis of a different agreement. The insurer can
demand an appropriate premium surcharge within the framework of this other
agreement.
15.4 If there is a divorce decree, each spouse has the right to continue their
parts of the contract as an independent insurance relationship.
The same applies if the spouses live separately.
15.5 The insurance relationship of an insured person ends when they cease to
be insurable. The insured person is no longer eligible for insurance at the end of
the month in which their insurance with the GKV ends. The insurer must be
notified immediately of the loss of insurability.
§ 16 Declarations of intent and notifications, change of address and name
16.1 Declarations of intent and notifications to the insurer must be in text form.
16.2 The policyholder must report changes to his address or name immediately.
If notification is not forthcoming, declarations that the insurer sends by registered
letter to the last known address are deemed to have been received three days
after dispatch.
§ 17 Place of
jurisdiction 17.1 The court at the place where the policyholder has his domicile
or, in the absence of such, his habitual abode, is responsible for actions against
the policyholder arising from the insurance relationship.
17.2 Actions against the insurer can be brought before the court at the domicile
or usual place of residence of the policyholder or at the court at the insurer's
registered office.
Machine Translated by Google

17.3 If, after conclusion of the contract, the policyholder moves his domicile or
habitual abode to a country that is not a member state of the European Union or a
state party to the Agreement on the European Economic Area or to Switzerland,
or if his domicile or habitual abode is not known at the time the action is filed, the
court at the registered office of the insurer has jurisdiction.

§ 18 Amendment of the General Insurance Conditions 18.1 If

a provision in the General Insurance Conditions has been declared invalid by a
supreme court decision or by a final administrative act, the insurer can replace it
with a new regulation if this is necessary to continue the contract or if adherence
to the contract would represent unreasonable hardship for one contracting party
without a new provision, also taking into account the interests of the other
contracting party. The new rule is only effective if it takes the interests of the
policyholders into account appropriately while maintaining the contractual objective.
It becomes part of the contract two weeks after the policyholder has been informed
of the new regulation and the relevant reasons for it.

18.2 In the event of a change in health care conditions that is not only to be
regarded as temporary, insurance conditions can be adjusted to the changed
conditions if the changes appear necessary to adequately safeguard the interests
of the policyholder and an independent trustee has reviewed the requirements for
the changes and confirmed their appropriateness .

The insurer will notify the policyholder of changes to insurance conditions in text
form, stating the relevant reasons. The changes will take effect at the beginning of
the 2nd month following this notice.

Contribution groups at the beginning of the contract

tariff level Perfect Plus Mega Winner

Up to 15 years €14.09 €17.56 €25.61 €35.13
16 to 20 years 21 €15.90 €19.10 €26.50 €35.24
to 25 years 26 to €9.67 €10.68 €13.02 €15.78
30 years 31 to 35 €9.52 €12.05 €12.64 €15.21
years 36 to 40 €12.17 €12.83 €14.91 €27.99
years 41 to 45 €12.87 €16.81 €20.79 €28.69
years 46 to 50 €15.27 €17.48 €22.58 €36.54
years 51 to 55 €18.41 €18.87 €27.28 €37.78
years 56 to 60 €20.79 €24.22 €29.02 €51.12
years €22.89 €27.06 €33.51 €51.26
From 61 years €23.65 €32.29 €41.77 €59.37

Status: 01/25/2022
Machine Translated by Google
Attachment
SGB V (Social Security Code V)
Section 95 Participation in panel doctor care (excerpt)
95.1 Approved doctors and approved medical care centers as well as authorized
doctors and authorized institutions participate in the contractual medical care.
Medical care centers are medically managed facilities in which doctors who are
entered in the register of doctors in accordance with paragraph 2 sentence 3
work as employees or contract doctors.
The medical director must work in the medical care center himself as an employed
doctor or as a panel doctor; he is not bound by instructions in medical matters. If
members of different professional groups who participate in contract medical care
work in a medical care center, cooperative management is also possible. Approval
is granted for the location of the establishment as a doctor or the location of the
establishment as a medical care center (appointed doctor).
VVG (Insurance Contract Act)
§ 14 Due date for the cash
payment 14.1 Cash payments by the insurer are due upon completion of the
surveys necessary to determine the insured event and the scope of the insurer's
payment.
14.2 If these surveys have not been completed by the end of one month after
notification of the insured event, the policyholder can demand advance payments
in the amount that the insurer is likely to have to pay as a minimum. The period
is suspended as long as the surveys cannot be completed due to the fault of the
policyholder.
14.3 An agreement by which the insurer is released from the obligation to pay
default interest is void.
Section 19 Obligation to notify (excerpt)
19.1 Before submitting his contractual declaration, the policyholder must notify
the insurer of any risk circumstances known to him that are relevant to the
insurer’s decision to conclude the contract with the agreed content and about
which the insurer has asked in text form. If the insurer asks questions within the
meaning of sentence 1 after the policyholder has declared the contract but before
accepting the contract, the policyholder is also obliged to report this. 19.2 If the
policyholder breaches his duty of disclosure in accordance with paragraph 1, the
insurer can withdraw from the contract.
Section 28 Breach of a contractual obligation (excerpt)
28.1 In the event of a breach of a contractual obligation that the policyholder has
to fulfill towards the insurer before the insured event occurs, the insurer can
terminate the contract without notice within one month of learning of the breach,
unless , the violation is not based on intent or gross negligence.
28.2 If the contract stipulates that the insurer is not obliged to pay out in the event
of a breach of a contractual obligation to be fulfilled by the policyholder, the insurer
is released from payment if the policyholder intentionally breached the obligation.
In the event of a grossly negligent violation of the obligation, the insurer is entitled
to reduce its benefit in proportion to the severity of the fault of the policyholder;
the policyholder bears the burden of proof for the absence of gross negligence.
28.3 Contrary to paragraph 2, the insurer is obliged to pay if the breach of the
obligation is not the cause of the occurrence or the determination of the insured
event or the determination or the scope of the insurer's obligation to pay. Sentence
1 does not apply if the policyholder has fraudulently violated the obligation.
28.4 The complete or partial release of the insurer from performance according
to paragraph 2 in the event of a breach of an obligation to provide information or
clarification after the occurrence of the insured event is subject to the condition
that the insurer has informed the policyholder of this legal consequence in a
separate notification in text form.
§ 86 Transfer of compensation claims
86.1 If the policyholder is entitled to a compensation claim against a third party,
this claim is transferred to the insurer to the extent that the insurer compensates
for the damage. The transition cannot be asserted to the detriment of the
policyholder.
86.2 The policyholder must safeguard his claim for compensation or a right that
serves to secure this claim, taking into account the applicable form and deadline
regulations and to cooperate with the insurer to enforce it as far as necessary.
Breached the insurance
If the recipient of this obligation intentionally, the insurer is not obliged to perform
to the extent that he cannot obtain compensation from the third party as a result.
In the event of a grossly negligent breach of the obligation, the insurer is entitled
to reduce its benefit in proportion to the severity of the fault of the policyholder;
the policyholder bears the burden of proof for the absence of gross negligence.
86.3 If the policyholder's claim for compensation is directed against a person with
whom he lives in the same household when the damage occurs, the transfer
pursuant to paragraph 1 cannot be asserted unless this person intentionally
caused the damage.
Insurance Tax Act (VersStG 2021) excerpt
§ 4 Exemptions from taxation (1) The
payment of the insurance premium for […]
5. for an insurance through which claims to capital, pension or other benefits are
established a) in the event of death, survival or old age or b) in the event of
illness, the need for care, occupational or er incapacity for work or reduced
earning capacity, provided these entitlements to care for the natural person in
whom the insured risk materializes (person at risk), or for care for their close
relatives within the meaning of Section 7 of the Nursing Care Leave Act or for
their relatives within the meaning of Section 15 of the tax code. [...]
Section 9 Refund, subsequent payment of
tax […]
7. If the tax has to be paid subsequently in accordance with paragraphs 5 and 6,
the insurer is entitled, for the purpose of paying the tax, to subsequently request
the tax from the policyholder or, in the event of a claim, to reduce the insurance
benefit accordingly.
Nursing leave law (Pflegezeitgesetz - PflegeZG) excerpt
§ 7 Definition of terms (3)
Close relatives within the meaning of this law are 1.
grandparents, parents, parents-in-law, step-parents,
2. spouses, life partners, partners in a marriage-like or life-partnership-like
community, siblings, spouses of siblings and siblings of spouses, life partners of
siblings and siblings of the life partner, 3. children, adopted or foster children, the
children, adopted or foster children of the spouse or life partner, children-in-law
and grandchildren.
Tax code §15
(1) Dependents are:
1. the fiancé, 2. the
spouse or partner, 3. relatives and
relatives by marriage, 4. siblings, 5. the children of
the siblings, 6. the spouse or partner of the siblings
and siblings of the spouse or partner , 7. Siblings
of the parents, 8. Persons who are connected to each other through a long-term
care relationship with a domestic community such as parents and child (foster
parents and foster children).
(2) The persons listed in paragraph 1 are also relatives if 1. in the cases of
numbers 2, 3 and 6 the marriage or civil partnership on which the relationship
was based no longer exists; 2. in the cases of numbers 3 to 7, the relationship or
affinity has expired through adoption as a child; 3. in the case of number 8, the
domestic community no longer exists if the people are still connected to each
other like parents and child.
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Ordinance on the Implementation of the Insurance Tax Act (Insurance Tax

Implementing Ordinance - VersStDV 2021) Excerpt

§ 4 Right to information of the tax payment debtor To ensure a

proper taxation procedure, the tax payment debtor is entitled to request information
about the facts relevant to taxation from all those involved in the establishment or
implementation of an insurance relationship. This includes in particular

1. the occurrence of circumstances after the establishment of the insurance

relationship that lead to a tax liability for the payment of insurance premiums; [...]

3. the occurrence of the circumstances relevant for subsequent taxation within the
meaning of Section 9 (5) and (6) of the Act; [...]

As of 01/25/2022