Co-payments are the amount of the costs that the insured person has to pay for medical services. When insured persons have reached the age of 18, they have to pay the co-payment. There is an exception for travel costs – co-payments must also be made by children and young people who have not yet reached the age of 18.
The amount of an additional payment is generally 10% of the costs, with a minimum of 5 € and a maximum of 10 €. More details about the amount of the co-payment can be found in the list under the question “Which services are subject to co-payment?”.
Which co-payments frequently occur?
- For hospital treatment the insured person makes a co-payment of 10 € for each day, but for maximum of 28 days per calendar year. The co-payment is invoiced directly by the hospital.
- For women who are in hospital for childbirth, no co-payment is required.
Med. travelling costs
In medically justified cases (e.g. emergency car) we cover the travel costs and for these you have to pay an additional payment.
Prescription drugs (pink prescription)
- The doctor prescribes medicines required for treatment. Some medicines are exempt from this co-payment requirement.
- The insured person receives the medicines by presenting the doctor’s prescription to the pharmacy. A co-payment is to be made there.
- Only in exceptional cases may the doctor prescribe non-prescription medicines that are not covered by the social health insurance (e.g. some medicines for flu or headaches). These costs are not reimbursable.
- There is an easy way to check which kind of prescription is covered by the social health insurance an which isn’t:
Pink prescription: covered except co-payment
Blue, green and white prescription: not covered
Remedies and aids
Co-payments of differing amounts must be paid for doctor-prescribed remedies and aids such as physiotherapy, inserts, crutches, etc. The doctor also issues a prescription for this. The insured person the receives these services from the respective provider (e.g. orthopedic shoemaker) where the co-payment is also paid.
- Pink prescription: covered except co-payment
- Blue, green and white prescription: not covered
Which services are subject to co-payment?
The following table gives you an overview of the services requiring co-payment.
|Kind of benefit||Amount of the co-payment|
|Prescription drugs (pink prescription)||10 % min. 5 € and max. 10 € / each medicine|
|med. travelling costs||10 % min. 5 € and max. 10 € / each trip|
|med. remedies (e.g. physiotherapy)||10 € once for prescription and 10 % for each treatment|
|med. aids (e.g. crutches)||10 % min. 5 € and max. 10 € / each product|
|Consumable med. aids (e.g. catheters)||10 % max. 10 € / month|
|Hospitalization||10 € / day (max. 28 days a year)|
|Outpatient rehabilitation||10 € / day|
|Inpatient rehabilitation||10 € / day|
|Rehabilitation commencing within 14 days subsequent to hospitalization (this is a kind of reha that is usually necessary after an operation)||10 € / day|
|Medical prevention and rehabilitation for parents (mother or father) accompanied by their child(ren)||10 € / day|
|med. surgical dressings (products for wound care)||10 % min. 5 € and max. 10 € / each|