What is TSS?

Complementary Health Insurance (TSS) is insurance that covers the differential fee, patient co-payment and certain contribution charges that SGK does not pay at contracted private hospitals. Unlike private health insurance, TSS complements the SGK system — it cannot function without it.

How does it work? When you visit a contracted private hospital, SGK pays its share and TSS pays the differential fee directly to the hospital; you are not required to make any additional payment. This means you can receive treatment at a private hospital under SGK coverage without any out-of-pocket expense.

Key requirement: To benefit from Complementary Health Insurance (TSS), you must be an active SGK insured member, a dependent or a retiree. If you do not have SGK registration, TSS is not available to you; in that case, private health insurance is the appropriate alternative.

Coverage scope

What TSS covers

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Private hospital differential fee

The difference between the SGK-set tariff and the hospital's own price at contracted Network Hospitals.

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Patient co-payment

The co-payment contribution that the insured must pay for medications and medical supplies within SGK coverage.

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Diagnostic test differential

The differential fee on laboratory tests and imaging procedures that SGK only partially covers.

Risks excluded from TSS coverage

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Individuals without SGK

TSS cannot be purchased by persons without SGK registration; private health insurance is required for such individuals.

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Dental and optical

Dental and optical treatments outside SGK coverage are generally excluded from a TSS policy as well.

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Aesthetic treatments

Aesthetic procedures carried out without a medical necessity are outside the scope of cover.

TSS or private health? If you have SGK coverage, TSS is generally the more cost-effective option. If you do not have SGK coverage, you need private health insurance. We can help you compare the two.

Group TSS: Employers can arrange Group TSS for their employees; broader coverage and more favourable premiums may be available compared with an individual TSS policy. Speak to your employer; if group cover is unavailable, consider an individual TSS.

General exclusions

Important: The situations listed below are outside the scope of a standard policy. Always read the special conditions of your policy carefully.

  • Individuals without SGK registration (no social security coverage)
  • Treatments outside SGK coverage
  • Treatment of chronic conditions existing before the policy start date (varies by policy)
  • Aesthetic and cosmetic procedures
  • Dental and optical treatments (in general, subject to policy terms)

Who is it for?

  • 4A (SSK) insured members: Private-sector employees — for treatment at private hospitals without paying a differential fee.
  • Retirees: SGK retirees wishing to eliminate the differential fee at private hospitals.
  • Bağ-Kur (4B) insured members: Self-employed individuals and tradespeople.
  • 4C (Civil servant) insured members: Individuals covered by the Government Employees Retirement Fund.

Frequently asked questions

What is the key difference between TSS and private health insurance?
Complementary Health Insurance (TSS) supplements your existing SGK coverage; SGK membership is mandatory. Private health insurance works independently and is not tied to SGK. If you have SGK coverage, TSS is usually more cost-effective; if you do not, you need private health insurance.
Can SGK retirees get TSS?
Yes. SGK retirees can benefit from TSS just like active insured members. TSS is particularly valuable for eliminating patient co-payments and differential fees charged at SGK-contracted private health facilities.
Which hospitals are covered under TSS?
Each insurer has a different network of hospitals. We recommend comparing the network hospitals in your city with the SGK-contracted hospital list.
What is the difference between Group TSS and Individual TSS?
Group TSS is arranged by an employer for its employees on a collective basis and may offer lower premiums and broader coverage. Individual TSS is purchased directly by the individual. If you are not covered by an employer scheme, we recommend exploring the individual option.
What is required to benefit from TSS?
Active SGK registration or retirement status is required. A health declaration is made before signing the policy. A waiting period may apply under certain policies.