What Is Complementary Health Insurance (TSS) in Turkey and What Does It Cover?

1. What Is Complementary Health Insurance and How Does It Work?

TSS is insurance built on top of the SGK system. SGK pays part of the treatment and the insurer pays the rest. So you must be covered by SGK, and the hospital must be contracted with SGK.

What is the extra fee (fark ücreti)?

Private hospitals contracted with SGK may charge the patient an additional fee on top of what SGK pays. This is called the extra fee (fark ücreti) and can be up to twice the SGK tariff. Especially for surgery and hospital stays, this difference can be a large amount. Complementary health insurance pays it for you.

How do you use complementary health insurance?

• Choose a hospital from your insurer’s contracted hospital list and make an appointment.
• Show your ID at the hospital; the hospital gets approval (provision) from SGK and the insurer.
• Have your examination and treatment; the extra fee is billed directly to the insurer.
• Only the SGK co-payment and any co-payment in your policy are left for you.

Who can get complementary health insurance?

• Employees covered by SGK (4/a), the self-employed (4/b) and civil servants (4/c)
• Retirees receiving health services from SGK, and dependent spouses and children
• Foreigners with a work permit who are covered by SGK

There is an upper age limit for joining, which varies by insurer; at older ages a policy may not be issued or the premium rises. For foreigners without a work permit, health insurance for foreigners is issued instead of complementary insurance.

Can family members be added to the policy?

Yes. You can add your spouse and children to the same policy or take out a separate policy for each. An individual policy does not automatically cover family members. Insurers have set periods and conditions for adding newborn babies.

2. Complementary Health Insurance Covers

TSS packages are built on two basic covers: inpatient and outpatient treatment. Inpatient treatment is in every package; outpatient and maternity covers are optional.

What is inpatient cover?

It covers treatment that requires a hospital stay: surgery, stay and room costs, intensive care, chemotherapy, radiotherapy, dialysis and procedures such as angiography. The real value of TSS is in this cover, because extra fees are highest for surgery and hospital stays. Most packages have no annual limit for inpatient treatment, or a very high one.

What is outpatient cover?

It covers doctor visits without a hospital stay, tests such as blood tests, X-ray, ultrasound, MRI and CT, and physiotherapy. Outpatient cover usually comes with a set number of uses per year (between 6 and 10 in most packages). One visit includes the tests and scans the doctor orders during that visit.

Does TSS cover childbirth?

Maternity cover is not in every package; it is added as an option. It covers normal and caesarean birth, but there is usually a waiting period of about a year after the policy starts. If the pregnancy began before the policy, the birth is usually not covered. If you are planning a baby, it is important to add maternity cover early.

3. What Does Complementary Health Insurance Not Cover?

TSS pays the extra fee for treatments SGK covers. So treatments SGK does not cover and health problems that existed before the policy are usually excluded.

What does TSS not cover?

• Treatment at hospitals not contracted with SGK
• Treatments and medicines SGK does not cover
• Conditions that existed before the policy started (depending on the health declaration)
• Cosmetic surgery (except repair after an accident)
• Check-ups and preventive screening
• Dental treatment, glasses and contact lenses
• IVF and infertility treatment

Some insurers may offer services such as dental care and check-ups as extra benefits in the package; we compare these at the quote stage.

What is the health declaration and why does it matter?

When taking out a policy, you report your known conditions and past operations on a health declaration form. Based on this, the insurer issues the policy on standard terms, excludes some conditions, or asks for an extra premium. An incomplete or incorrect declaration can lead to a claim being rejected later, so it is important to fill in the form carefully and accurately.

What is a waiting period?

Some treatments are covered not immediately after the policy starts, but only after a set time. For childbirth and some operations such as hernia, tonsils, gallbladder and uterus, insurers usually apply waiting periods from a few months to a year. There is no waiting period for treatment resulting from an accident.

4. Complementary vs Private Health Insurance

Both let you be treated at a private hospital, but they work differently and cost differently.

Which should you choose?

• If you are covered by SGK and budget matters, complementary health insurance meets most needs.
• If it is fine for you that your hospital must be contracted with SGK, TSS is enough.
• If you are not covered by SGK, or you want treatments SGK does not cover and a wider hospital network, private health insurance is the better fit.

5. Complementary Health Insurance Price and Benefits

TSS prices vary widely by insurer, package and person. Since prices for the same person can differ significantly between two insurers, comparing them is important.

What determines the TSS price?

• Age and gender
• The province you live in
• The breadth of the contracted hospital network (package level)
• Whether outpatient and maternity covers are added, and the number of outpatient visits
• Your health declaration and any extra premiums

What is a renewal guarantee?

Policies run for 1 year and are renewed every year. Many insurers give a lifetime renewal guarantee to people who stay insured without a break for a set period and are not diagnosed with certain conditions during that time. This guarantee removes the risk of your policy not being renewed because of conditions that may arise later. When changing insurer, always check whether this right is kept.

Does complementary health insurance give a tax advantage?

Yes. Health insurance premiums you pay for yourself, your spouse and your minor children can be deducted from your income tax base within legal limits. If you are an employee, this deduction is applied through your payroll by your employer. We recommend asking your accountant about the amount and conditions.

6. Frequently Asked Questions About Complementary Health Insurance