Apply for cost absorption for abortion at the statutory health insurance company

If you want to have an abortion and cannot bear the costs yourself, you can apply for cost coverage by the statutory health insurance under certain conditions.

Description

If the abortion is performed for criminological or medical reasons, the costs will be covered by the health insurance and settled by your doctor via the electronic health card (eGK). A prior application for cost coverage is not required. This is the case in the following two constellations:

  • If the termination of the pregnancy is necessary from a medical point of view in order to avert a danger to your life or the risk of serious impairment of your physical or mental state of health, the health insurance fund will cover the costs of the termination of pregnancy. In this case, it is not necessary to apply to the health insurance company for the costs to be covered, as the doctor will make the necessary determination.
  • If the pregnancy is to be terminated because it is the result of a criminal act (rape), the health insurance company will cover the costs of the abortion if no more than 12 weeks have passed since conception. In this case, it is not necessary to apply to the health insurance company for the costs to be covered, as the doctor will make the appropriate determinations.

If the abortion is performed for other reasons, the abortion is illegal if the following requirements are met in full, but it is not punishable:

  • You expressly request the abortion.
  • You prove to the doctor by means of a certificate from a recognized conflict counseling center that you have sought counseling at a pregnancy conflict counseling center at least three days before the procedure.
  • A physician performs the abortion.
  • No more than 12 weeks have passed since conception.

In this case, the health insurance company covers the costs for:

  • the medical consultation on the maintenance and termination of the pregnancy,
  • medical treatment, with the exception of abortion and post-abortion care in case of complications,
  • the provision of medicines, dressings and remedies, and
  • hospital treatment

The costs for the medical performance of the abortion itself as well as for the medical aftercare are not covered by the health insurance.

However, if you have no income or a low income, in certain cases you can apply to your statutory health insurance fund to have the costs of these services covered. This is the case, for example, if you are considered socially needy.

Prerequisites

You are entitled to have your costs covered by the statutory health insurance if

  • you have your domicile or usual place of residence in Germany and
  • after examination by the health insurance fund, you cannot reasonably be expected to bear the costs of the abortion for financial reasons. You can find out the exact requirements and income limits for this from your health insurance fund.

An unreasonable cost burden exists for you in particular if you receive

  • receive assistance for living ("Sozialhilfe") or
  • receive unemployment benefit II;
  • have a disability and receive training support (training support within the framework of the order of the Federal Employment Agency on the individual support of vocational training or on the work and career support of people with disabilities) or
  • a training grant under the Federal Training Assistance Act ("Bafög") or
  • receive benefits under the Asylum Seekers' Benefits Act;
  • are accommodated in a home or similar institution and the costs for this are borne by social welfare or youth welfare.

Procedure

You can submit the application for cost coverage in case of abortion by mail as well as - for many statutory health insurance companies - in person at the office. As a rule, a telephone consultation or consultation at the office on the best possible procedure for submitting the application is possible. Normally, the procedure is as follows:

  • Fill out the application for cost coverage of your statutory health insurance.
  • Submit the application together with the required documents to your health insurance company.
  • You can also submit the application directly to the office of most health insurance companies. As a rule, the application is processed here immediately.
  • The health insurance company will review your application and, if the requirements are met, will issue you with a cost absorption certificate.
  • You should give the cost absorption certificate to your doctor together with the certificate confirming that you have received counseling at a conflict counseling center.
  • Your doctor will settle the abortion with the responsible office. You do not have to pay anything.

Special notes

If you do not have statutory health insurance, you can apply for reimbursement of abortion costs to a statutory health insurance fund in your place of residence or habitual abode.

Deadlines

  • You must apply for coverage of costs before the abortion.
  • The abortion is only possible until the end of the 12th week (in case of a criminological indication as well as in case of an illegal but unpunished abortion).
  • At least 3 days before the unlawful but non-punishable abortion, counseling must have taken place at a pregnancy conflict counseling center.

Processing time

Processing usually takes about 1 to 2 working days.

For rapid processing and decision-making, your health insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time indicated is an average value for all health insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your health insurer by mail.

Required documents

  • Required Documents

    As a rule:

    • Proof of your personal income and financial circumstances, for example current salary statement or bank statement.

    Please contact your health insurance company to find out which documents are required in addition to proof of your personal income and financial circumstances.

Forms

Fees

  • You do not have to pay anything for the application.

Remedy

  • Objection
  • Action before the social court

Related issues

Status: 25.04.2022

Responsible for editing: Bundesministerium für Gesundheit

  • Online transactions, Bavaria-wide
  • Online transactions, locally limited
  • Prefillable Form, Bavaria-wide
  • Legal bases, Bavaria-wide
  • Legal bases, locally limited
  • Fees, Bavaria-wide
  • Fees, locally limited
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