Co-payments in the statutory health insurance; application for exemption
If you have paid more than 2 percent of your gross family income as statutory co-payments in the current calendar year (1 percent for the chronically ill), you may be exempt for the rest of the year.
- You have already paid at least 2 percent of your gross income for living expenses for statutory co-payments.
- If you are seriously chronically ill, a limit of 1 percent applies.
- You are considered to have a serious chronic illness if you have been treated by a doctor for the illness at least once every quarter for at least one year and at least one of the following characteristics applies to you:
- You are in need of care and have a care degree of at least 3;
- You have a degree of disability of at least 60 percent due to the illness or your earning capacity is reduced by at least 60 percent;
- You require certain medical treatment on a permanent basis because otherwise your health condition would deteriorate in a life-threatening manner or there would be a reduction in life expectancy or a permanent impairment of quality of life due to your illness.
Exceptions to copayment include these cases:
- Children under the age of 18 do not have to make copayments (exception: travel expenses).
- If you are pregnant, you do not have to pay co-payments for medicines, bandages, remedies and aids if you need them due to your pregnancy; your hospital stay during childbirth or due to common pregnancy complications is also free of co-payments.
To be exempted from the co-payments in the statutory health insurance, proceed as follows:
- Collect the receipts of your statutory co-payments.
- If you have reached the annual burden limit, submit an application for exemption from co-payments to your statutory health insurance fund.
- You can submit the application for exemption from co-payments by mail and - for many statutory health insurers - in person at the office or online.
- Your health insurance company will issue you with a certificate stating that you no longer have to make co-payments. Any excess co-payments already made will be refunded to you.
- Alternatively, many health insurance companies allow you to pay in the amount of your annual co-payment limit in advance. Then you do not have to collect receipts and your health insurance company will issue you directly with a certificate of co-payment exemption.
- If you and your dependents living in the same household are insured with different health insurers, you can submit the application jointly to one of the health insurers. The health insurance fund will determine the burden limit for your family, issue you with an exemption certificate and reimburse you for the excess co-payments on a pro rata basis. You can then use the health insurance fund's decision to inform your relatives' health insurance funds, which will also issue the exemption notices for your relatives and also reimburse them proportionately for the excess co-payments.
You can apply for exemption from co-payments retroactively for up to 4 years.
Processing usually takes about 4 to 8 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.
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Responsible for editing:Bundesministerium für Gesundheit
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