Apply for exemption from co-payments in statutory health insurance

To be exempted from co-payments in statutory health insurance, proceed as follows:

• Collect the receipts of your statutory co-payments.  
• If you have reached the annual load 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 post and – with many statutory health insurance companies – hand it in personally at the office or submit it online.
• Your health insurance company will issue you with a certificate stating that you no longer have to make co-payments. Any additional payments already made in excess will be refunded to you.
• Alternatively, you can pay the amount in advance at your annual co-payment limit with many health insurance companies. Then you do not have to collect receipts and your health insurance company will directly issue you with a certificate of exemption from co-payment.
• If you and your relatives living in the same household are insured with different health insurance companies, you can submit the application together to one of the health insurance companies. The health insurance company determines the load limit for your family, issues you an exemption certificate and reimburses you proportionately for the overpayments made. With the decision of the health insurance company, you can then inform the health insurance companies of your relatives, which also issue the exemption notices for your relatives and reimburse them proportionately for the overpayments made.
   

• 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 be seriously chronically ill if you have been treated for the illness by a doctor at least once a 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 degree of care 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 need a certain medical treatment permanently, because otherwise your state of health would deteriorate life-threatening or a reduction in life expectancy or a permanent impairment of quality of life due to your illness would occur.

There are exceptions to the co-payment in these cases, among others:

• Children under the age of 18 do not have to make any co-payments (exception: travel expenses).
• If you are pregnant, you do not have to make a co-payment for medicines, bandages, remedies and aids if you need them due to your pregnancy; Your hospitalization during childbirth or due to common pregnancy complications is also free of co-payment.
   

• Proof of income
• Proof of co-payments already made, e.g. invoices, receipts or copy of bank statements
• Chronically ill people: proof of a serious chronic illness from your doctor

In individual cases, further documents may be required. Please contact your health insurance company for more information.
 

You do not have to pay anything for the application for co-payment exemption.

You can apply for exemption from co-payments up to 4 years retroactively.

Processing usually takes about 4 to 8 business days.

For a quick processing and decision, your health insurance company must have the necessary information and, if necessary, necessary documents complete and meaningful.
The health insurance company decides on applications promptly, whereby the statutory processing deadline is observed to protect patients' rights.
Please note that the stated processing time is an average value of all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or documents are sent by post to you or your health insurance company.
 

• Forms: yes
• Online procedure possible: Many statutory health insurance companies offer an online procedure.
• Written form required: no
• Personal appearance required: no
   

• Contradiction
• Action before the Social Court

Federal Ministry of Health
 

30.11.2021

The text was automatically translated based on the German content.