As of January 1, 2004, any insured person aged 18 or older is required to pay an office charge / Praxisgebühr of EUR 10.00 per quarter year for visiting a general practitioner/ Allgemeinmediziner, specialist doctor, dentist, or psychotherapist.
This office charge does not need to be paid when the general practitioner refers / überweisen the patient to a specialist.
No charge needs to be paid for preventive medical check-ups, selected vaccinations, or the annual dental check-up.
Medicines / Drugs, Dressing / Bandaging, Health Aids
Patients requiring prescription-only medicines / drugs, dressing / bandages, health aids (e.g., insteps, arch-supports) will have to pay 10 percent of the costs themselves in the future. The minimum extra charge is EUR 5, the maximum is EUR 10 per prescription.
Example: If a patient gets medicine worth EUR 80, the extra charge is EUR 8. However, if an ointment costs EUR 7, the extra charge is not 70 cents, but rather EUR 5. While very expensive medicine for EUR 150 will not cost the patient EUR 15, but only EUR 10. Subsidies for vision and optical aids (glasses/contact lenses) will only be available for children under 18 years of age and for insured patients with serious sight impairments. The optician or health insurance company will advise on how much the subsidy is.
Patients seeking in-patient treatment (hospital or rehab clinic) must immediately present their insurance card when they go for treatment. The health insurance company will pay the costs for in-patient treatment in the general care category in a hospital/clinic which has been licensed by the statutory health insurance company. Patients are free to choose among all licensed hospitals / clinics. But: Insured persons who are 18 years of age or over must pay a daily private contribution of EUR 10 from the first day of in-patient treatment (including the release day). However, this extra charge has been limited to 28 days per calendar year (maximum extra charge of EUR 280 per calendar year for in-patient treatment).
Therapies and Domestic Nursing Care
Patients personally have to pay 10 percent of the costs for treatments such as physiotherapy, ergo therapy, speech therapy, or massages. In addition, they pay EUR 10 per prescription. This means: If a doctor prescribes six therapy units, the patient pays 10 percent of the treatment costs and EUR 10 for the prescription.
Important: Before you decide to have any specific type of dental prosthetic treatment, please make sure that your dentist provides you with a treatment and cost schedule and that you contact your health insurance company for advice beforehand.
Pregnancy and Childbirth
In case of pregnancy or childbirth, the health insurance company will pay the following costs:
- medical care (e.g., provided by ante-natal check-ups) and care provided by a midwife,
- provision of medicines / drugs,
- dressing / bandages, health aids,
- childbirth in a maternity clinic / ward (general care category)
Accompanying Spouse and Children
As a rule, family members (spouse without own income or children) can be insured with the statutory health insurance company at no additional costs.
Note: Make sure that you keep all receipts!
Doctors, chemists / pharmacists, therapists, and clinics must issue receipts for any extra charges. Anybody who reaches his or her personal financial limit will receive an appropriate certificate from the health insurance company and then needs to pay no more extra charges for the rest of the year. Please contact your health insurance company to find out what your personal financial limit is (calculated on the basis of your gross income). Some health insurance companies have special forms to make it easier to document the extra charges which have been paid. Please ask your health insurance company for such a form and the details.
All the rules mentioned in this chapter are valid for the statutory health insurance only. Private health insurances have different regulations.