Additional payments
Legislation stipulates a co-payment for certain services - the so-called co-payment. This applies to all insured persons aged 18 and over. So that you know what to expect, we give you a quick and transparent overview here.
What are co-payments for - and how much are they?
| Benefits | Co-payment |
|---|---|
| Medicines and dressings | 10% of the price, minimum €5, maximum €10 |
| Remedies (e.g. physiotherapy) | 10% of the costs + €10 per prescription |
| Auxiliary aids (e.g. wheelchair) | 10% of the costs, minimum €5, maximum €10 |
| Hospitalization (inpatient) | 10 per day, max. 28 days per calendar year |
| Rehabilitation/preventive care (inpatient) | 10 € per day, max. 28 days per measure |
| Home nursing care | 10% of the costs + €10 per prescription, max. 28 days per calendar year |
| Home help / sociotherapy | 10% of the costs, minimum €5, maximum €10 per calendar day |
| Travel costs (e.g. to hospital) | 10% of the costs, minimum €5, maximum €10 per single journey |
| Nutritional counseling | 10% of the costs, minimum €5, maximum €10 per consultation unit |
Note: There is no co-payment for certain low-cost medicines.
Find out more: List of co-payment-free medicines
Exemption from co-payment - when the burden becomes too high
Nobody should be overburdened by co-payments. For this reason, you can be exempted from further co-payments under certain conditions.
When is an exemption possible?
The annual limit is:
- 2% of the gross annual income of your household
- 1% for chronically ill people if certain conditions are met
Important: The income of spouses or children in the same household is also included in the calculation. We also take statutory allowances into account.
As soon as you have reached your personal contribution limit, you are exempt for the rest of the year - no further co-payments necessary!
Chronically ill - what applies?
For your chronic illness to be recognized, the following conditions must be met:
- The illness has existed for at least 12 months and is regularly treated by a doctor (continuous treatment).
- In addition, at least one of these criteriamust be met:
- Care level 3, 4 or 5
- Degree of disability (GdB) or reduction in earning capacity (MdE) of at least 60
- Permanently necessary medical care to avoid serious consequences
The requirement can usually be confirmed by a medical certificate or automatically if a care classification already exists.
What do you need to do?
- Always have co-payments receipted (original receipts or collective pharmacy receipts)
- The followingcannot be offset: private co-payments above the fixed amount, non-prescribable medication, unauthorized travel costs
- Submit an application if you have reached your limit
➜ S ubmit: Application, proof of income, co-payment receipts
You can also use our co-payment calculator to easily determine your personal limit.
