Co-Payments and Exemption from Co-Payments

In some areas of medical treatment, people with statutory health insurance must make co-payments. These co-payments should not place an undue burden on anyone. Therefore, adults do not have to pay more than two percent of their annual gross income. 

The co-payments

Prescription medicine and dressings
Co-payment of 10 percent of the price, with a minimum of 5 euros and a maximum of 10 euros per drug. In any case, not exceeding the actual cost of the drug.

Remedies and at-home nursing care
Co-payment of 10 percent of the cost of the remedy or service plus 10 euros per prescription (limited to 28 days per calendar year for at-home nursing care). For example, if six massages are prescribed on one prescription, the co-payment is 10 euros for that prescription plus 10 percent of the cost of the massages.

Aids
Co-payment of 10 percent for each aid (for example, hearing aid or wheelchair), with a minimum of 5 euros and a maximum of 10 euros. In any case, not exceeding the cost of the aid. Exception: aids intended for consumption (for example, incontinence aids), have a co-payment of 10 percent per unit of consumption, but not more than 10 euros per month.

Hospitalization
Co-payment of 10 euros per day, limited to a maximum of 28 days per calendar year.

Inpatient preventive care and rehabilitation
Co-payment of 10 euros per day limited to 28 days for follow-up treatments.

Medical rehabilitation for mothers and fathers
Co-payment of 10 euros per day.

Use of home help
Co-payment of 10 percent per day, with a minimum of 5 euros and a maximum of 10 euros per day.

Artificial insemination
Three attempts, each paid 50 percent by the statutory health insurance. The other 50 percent is borne by the insured person. The age limit for women is between 25 and 40 years, and for men up to 50 years. Many statutory health insurance companies cover part of the cost as a supplementary benefit

Contraception
Contraception is only covered up to the 20th birthday; from the age of 18, a co-payment must be made.

Dentures
Statutory health insurance companies pay fixed subsidies towards the cost of dentures; the co-payment is based on the dental diagnosis, not the chosen treatment method. The insured person bears the remaining costs.

Caps on co-payments

Co-payments for purchasing medication or other services are capped. The sum of the insured person's annual co-payments may not exceed 2 percent of gross income. For chronically ill people, the limit is 1 percent of gross income.

If the insured person can see that their co-payments will exceed the cap, an exemption from co-payments can be applied for in advance. They would then pay the co-payments to the statutory health insurance company up to the capped amount for the following year, and receive an exemption card for the next year.

These costs are borne by the insured person alone

Non-prescription medicine
Non-prescription medicines are generally not paid for by statutory health insurance. Exception: When treating serious illnesses, if such medicines are part of the standard therapy. In this case, a co-payment of 10 percent of the price, with a minimum of 5 euros and a maximum of 10 euros per drug, is due. In any case, not exceeding the cost of the drug. Other exceptions: Prescriptions for children under the age of 12, and for adolescents with developmental disorders.

Lifestyle preparations
Drugs that are mainly used to improve the private lifestyle (for example, Viagra) are not reimbursed.

Travel costs for outpatient treatment
Travel costs for outpatient treatment are not covered by statutory health insurance. Exception: If there are compelling medical reasons, statutory health insurance funds may grant approval in exceptional cases and cover the travel costs. Travel costs for inpatient treatment are usually covered.

Eyeglasses and vision aids
Normally, statutory health insurance does not cover the cost of eyeglasses. However, children and adolescents under the age of 18 and people with severe visual impairments are still entitled to benefits

Sterilization
No coverage of the cost of sterilizations for the purpose of personal life planning. For medically necessary sterilizations, the costs are covered by statutory health insurance.