GENERAL TERMS AND CONDITIONS

Section 1 Scope

Unless otherwise agreed, these General Terms and Conditions apply to the contractual relationship between Klinik Manhagen and its patients. They apply to the following forms of service: full inpatient, day and partial inpatient, pre-admission and post-discharge, and outpatient day-clinic services provided by Klinik Manhagen, as well as outpatient surgery, other procedures that replace inpatient care and other treatments that replace inpatient care.

Section 2 Legal relationships

(1) The legal relationships between the hospital and the patient1 are governed by private law.

(2) In accordance with Sections 305 et seq. of the German Civil Code (BGB), these General Terms and Conditions become effective for patients if they

• have been expressly informed of them or, where an express notice would be possible only with disproportionate difficulty due to the way in which the contract is concluded, have been informed by a clearly visible notice at the place where the contract is concluded,

• have been given a reasonable opportunity to become familiar with their content in a manner that also appropriately accommodates any physical disability of the other contracting party that is apparent to the user of these General Terms and Conditions,

• have agreed that they apply.

Section 3 Scope of hospital services

(1) Full inpatient and outpatient day-clinic hospital services, including day and partial inpatient, pre-admission and post-discharge hospital services, comprise

a) general hospital services provided by employed and non-permanently employed doctors in accordance with Section 2 of the German Hospital Remuneration Act (KHEntgG).

b) elective medical services provided by employed doctors in accordance with Section 2 KHEntgG to whom the hospital has granted the right to bill patients directly.

(2) Outpatient surgery services pursuant to Section 115b of Book V of the German Social Code (SGB V) comprise the surgical procedures agreed jointly by the National Association of Statutory Health Insurance Funds, the German Hospital Federation or the federal associations of hospital operators, and the National Association of Statutory Health Insurance Physicians, known as catalogue procedures. These procedures are performed on an outpatient basis at the hospital by contracted physicians in private practice under a contractual cooperation arrangement with the hospital. General hospital services are the services that, taking account of the hospital’s capabilities and the type and severity of the patient’s condition in each individual case, are necessary to provide medically appropriate and adequate care. Subject to these conditions, they also include third-party services arranged by the hospital as part of the orthopaedic and therapeutic services to be provided by the hospital, and the admission of an accompanying person where medically necessary.

(3) Optional services are the hospital services listed individually in Section 6(1) of these General Terms and Conditions.

(4) The hospital’s contractual offer extends only to services for which the hospital has the necessary staff and equipment in accordance with its medical remit.

(5) The following are not part of general hospital services and are not covered by the hospital’s case-based payments:

a) for private patients, services ordered, provided and supervised by the hospital’s elective-service doctors and billed by those doctors in accordance with the German Medical Fee Schedule (GOÄ).

b) aids supplied to the patient on loan or against reimbursement at the end of their hospital stay, or which are not included in the hospital’s case-based payments, such as wheelchairs. 1For ease of reading, the masculine form is used throughout the German text for personal designations and nouns referring to persons. This wording is not intended to convey any judgement and, in the interests of equal treatment, applies to all genders.

Section 4 Admission, transfer and discharge

(1) Within the limits of the hospital’s capabilities, patients are admitted if they require full inpatient or outpatient day-clinic treatment, or an outpatient procedure pursuant to Section 115b SGB V. The order of admission is determined by the severity and urgency of the condition and is decided by the hospital’s employed chief physicians within the treatment capacity available to them.

(2) An accompanying person is admitted where, in the opinion of the attending doctor, this is medically necessary for the patient’s treatment and accommodation at the hospital is possible. At the patient’s request, an accompanying person may also be admitted as an optional service under Section 6, provided that sufficient accommodation is available, hospital operations are not disrupted and there are no medical reasons to the contrary.

(3) Where medically necessary, particularly in an emergency, patients may be transferred to another hospital. Where possible, the transfer will be agreed with the patient in advance. Pursuant to Section 60 SGB V, a transfer requested by a patient with statutory health insurance to a hospital near their home at the expense of the statutory health insurance fund requires the fund’s consent unless the transfer is necessary for compelling medical reasons. If the statutory health insurance fund refuses consent, the transfer will take place only at the patient’s express request and at their own expense. The hospital will inform the patient accordingly.

(4) A patient is discharged

a) when, in the attending doctor’s opinion, hospital treatment is no longer required, or

b) when the patient expressly requests discharge. If a patient insists on being discharged against medical advice or leaves the hospital without authorisation, neither the hospital nor its doctors are liable for any resulting consequences. An accompanying person will be discharged when the conditions in paragraph 2 no longer apply.

(5) The hospital’s obligation to provide services under the treatment contract ends on discharge.

Section 5a Pre-admission and post-discharge treatment

(1) Where hospital treatment has been prescribed by a referral for hospital admission, the hospital may, within the limits of its capabilities and in medically suitable cases, treat patients without providing accommodation and meals in order to

a) determine whether full inpatient hospital treatment is required or prepare for full inpatient hospital treatment (pre-admission treatment),

b) secure or consolidate the success of treatment following full inpatient hospital treatment (post-discharge treatment).

(2) Pre-admission hospital treatment, which must not exceed three treatment days within the five calendar days before inpatient treatment begins, ends

a) when the patient is admitted for full inpatient treatment, or b) if it becomes apparent that full inpatient hospital treatment is not required or will not be required until after the pre-admission period,

c) if the patient expressly requests that treatment end or discontinues treatment. In cases b) and c), the treatment contract also ends.

(3) Post-discharge hospital treatment, which must not exceed seven treatment days within 14 calendar days, ends

a) when, in the hospital doctor’s opinion, the success of treatment has been secured or consolidated, or

b) when the patient expressly requests that treatment end or discontinues treatment. The treatment contract ends at the same time. In medically justified individual cases, the 14-calendar-day period may be extended by agreement with the referring doctor.

(4) Any necessary medical treatment outside the hospital during pre-admission and post-discharge treatment is provided, as part of the statutory duty to ensure care, by doctors participating in statutory outpatient care and does not form part of the hospital services.

(5) The hospital will promptly inform the referring doctor about the patient’s pre-admission and post-discharge treatment. It will also inform the patient and the doctors involved in the patient’s further medical care about follow-up examinations and their results.

(6) Medical responsibility for providing the services under Section 5(1) of these General Terms and Conditions lies with the hospital and with the permanently and non-permanently employed doctors referred to in Section 2 KHEntgG in relation to their respective patients.

Section 5b Day inpatient treatment

(1) In medically suitable cases, and where the patient’s home care situation permits, the hospital may, with the patient’s consent, provide day inpatient treatment without an overnight stay instead of full inpatient treatment. Day inpatient treatment is voluntary for both the hospital and the patient. It requires an indication for inpatient somatic treatment. The patient must also remain in the hospital for at least six hours each day, during which predominantly medical or nursing treatment is provided. The hospital may discontinue day inpatient treatment at any time and continue treatment on a full inpatient basis.

Section 6 Charges

Charges for hospital services are governed by the applicable statutory provisions and the DRG/PEPP tariff in its current version, which forms part of these General Terms and Conditions as an annex.

Section 7 Billing patients with statutory health insurance and persons entitled to medical welfare benefits

(1) Where a public-law payer, such as a health insurance fund, is obliged under the applicable statutory provisions to pay the charges for hospital services, the hospital will bill that payer directly. At the hospital’s request, the patient must provide a declaration of cost coverage from the payer covering all services that are necessary for hospital care in the individual case, taking account of the type and severity of the condition.

(2) From the beginning of full inpatient hospital treatment, patients with statutory health insurance who have reached the age of 18 must make a co-payment for no more than 28 days within a calendar year in accordance with Section 39(4) SGB V. The hospital forwards this payment to the health insurance fund. Further details are set out in the DRG/PEPP tariff.

(3) Patients receiving hospital treatment within the meaning of Section 39(1) SGB V who declare that they wish to be informed about the services provided by the hospital and the charges payable for them by the health insurance funds will receive this information in writing or electronically within four weeks after hospital treatment ends, provided that they or their legal representatives expressly notify the hospital administration no later than two weeks after treatment ends.

Section 8 Billing self-paying patients

(1) Where the patient has no statutory health insurance cover or uses optional services not covered by statutory health insurance, no public-law payer, such as a health insurance fund, is obliged to pay under the applicable statutory provisions. In this case, the patient is a self-paying patient in relation to the hospital.

(2) Self-paying patients are required to pay the charges for hospital services. If a patient with private health insurance or a patient entitled to government medical aid uses the option of direct billing between the hospital and the private health insurer or aid agency, invoices will be issued directly to the private health insurer or aid agency. Direct billing requires the insured person’s express consent to the transmission of their data to the private health insurer or aid agency.

(3) Interim invoices may be issued for hospital services. A final invoice will be issued after treatment ends.

(4) The hospital reserves the right to charge subsequently for services not included in the final invoice and to correct errors.

(5) The invoiced amount becomes due upon receipt of the invoice.

(6) In the event of late payment, interest may be charged at five percentage points above the basic rate of interest per year in accordance with Section 288(1) BGB. Klinik Manhagen also reserves the right to charge reminder fees unless the patient proves that no loss or substantially less loss was incurred.

(7) Set-off against claims that are disputed or have not been finally established by a court is excluded.

Section 9 Advance payments and payments on account

(1) Where the hospital bills on the basis of Diagnosis Related Groups (DRG) under Section 17b or PEPP charges under Section 17d of the German Hospital Financing Act (KHG), it may require an appropriate advance payment for a hospital stay if and to the extent that health insurance cover has not been demonstrated (Section 8(4) of the Federal Hospital Care Rate Ordinance, BPflV, or Section 8(7) KHEntgG).

(2) From the eighth day of the hospital stay, the hospital may require an appropriate payment on account. Its amount will be based on the services provided to date in conjunction with the charges expected to be payable (Section 8(4) BPflV or Section 8(7) KHEntgG).

Section 10 Optional services

(1) Within the hospital’s capabilities and subject to the detailed provisions of the hospital care tariff, the hospital and patient may agree on the following optional services and bill them separately, provided that this does not adversely affect general hospital services:

a) accommodation in a single or double room with additional services,

b) accommodation and meals for an accompanying person,

c) provision of a special-duty nurse,

d) other additional services.

(2) If the patient requests an agreement for elective medical services, it must be concluded directly with the principal treating doctor and the elective-service doctors, provided that this has previously been agreed with the hospital in the admission and treatment contract. The hospital’s elective-service doctors who provide services under such an agreement include all employed doctors to whom the hospital operator has granted the right to bill patients directly (the internal elective-service chain), and doctors and medically managed facilities outside the hospital whose services are arranged by those doctors (the external elective-service chain). Like doctors in the internal elective-service chain, those external providers may bill patients who have selected elective medical services directly in accordance with the German Medical Fee Schedule (GOÄ). Elective medical services are not part of the general hospital services billed through the hospital’s case-based payment.

(3) For patients who have not selected elective medical services and receive only general hospital services, all services required during the hospital stay from other doctors and medically managed facilities outside the hospital constitute third-party services under Section 2(2), sentence 2, no. 2 KHEntgG. The costs of these services are included in the hospital’s case-based payments and are not payable separately.

(4) Elective medical services that may be billed separately are provided by the elective-service doctors themselves or under their supervision and professional direction (Section 4(2), sentence 1 GOÄ). If an elective-service doctor is unavailable for reasons that could not have been foreseen when the optional-services agreement was concluded, the doctor’s duties for the relevant specialty will be assumed by the permanent medical representative named in the agreement.

(5) Private medical services must be agreed in writing before they are provided.

Section 11 Leave of absence

During inpatient treatment, patients may leave the hospital only for compelling reasons and with the consent of the doctor responsible for them.

Section 12 Medical procedures

(1) Procedures affecting a patient’s physical or mental integrity will be performed only after the patient has been informed of the significance and scope of the procedure and has given consent.

(2) If the patient is unable to give consent, the procedure will be performed without consent if, in the responsible doctor’s opinion, it is immediately necessary to avert an imminent danger to life or an imminent serious deterioration in the patient’s health.

(3) Paragraph 2 applies accordingly if, in the case of a patient with limited or no legal capacity, an authorised representative, such as a legal guardian or person holding a power of attorney, cannot be reached or cannot be reached in time, or if their declaration opposing the procedure must be disregarded in view of Section 323c of the German Criminal Code.

Section 13 Records and data

(1) Medical records, including patient files, examination findings, X-rays and other records, are the property of the hospital.

(2) Patients are not entitled to receive the original documents referred to in paragraph 1. Any differing statutory provisions remain unaffected. The rights of the patient or a person authorised by the patient to inspect the records and, where applicable, receive copies, including in electronic form, pursuant to Section 630g BGB remain unaffected. The patient is also entitled to information. Data is processed and disclosed in compliance with the statutory provisions, particularly data protection law, medical confidentiality and the obligations arising from the rules on social secrecy.

Section 14 House Rules

The hospital has established rules of conduct for the duration of the hospital stay. Patients must comply with the House Rules issued by the hospital.

Section 15 Personal belongings

(1) Only necessary clothing and personal items should be brought into the hospital.

(2) Money and valuables should be brought only where absolutely necessary. Secure storage in a safe in the patient’s room cannot be guaranteed.

(3) Items left behind become the property of the hospital and will be made available for social or charitable purposes if they are not collected within 12 weeks of a request to do so. Owners can be notified only if their identity is known.

(4) Paragraph 3 does not apply to items, money and valuables held in safekeeping by the hospital.

Section 16 Limitation of liability

(1) For personal belongings that remain in the patient’s custody and for patients’ vehicles parked on hospital property or in a car park provided by the hospital, the hospital operator is liable only in cases of intent or gross negligence. The same applies to the loss of money and valuables that were not handed to the hospital for safekeeping.

(2) Claims for loss of or damage to money and valuables held in safekeeping by the hospital must be submitted in writing within three months after the person concerned becomes aware of the loss or damage. The period begins when the patient is discharged.

Section 17 Place of payment and jurisdiction

The person liable for payment must fulfil their payment obligation at their own risk and expense at the relevant principal place of business of the hospital operator. The place of jurisdiction is also the operator’s principal place of business. Outstanding payments will be recovered by a debt collection agency after an appropriate reminder procedure.

Section 18 Entry into force

These General Terms and Conditions entered into force on 1 February 1997 and apply in their latest version. Großhansdorf, 1 August 2025. Axel Post, Jan Zabel.