Apply for reimbursement of costs for abortion from the statutory health insurance company
If the abortion is for criminological or medical reasons, the costs are covered by the health insurance company and billed by your doctor via the electronic health card (eGK). It is not necessary to apply for reimbursement in advance. This is the case in the following two scenarios:
- If the termination of the pregnancy is necessary from a medical point of view in order to avert a danger to your life or the risk of a serious impairment of your physical or mental state of health, the health insurance company will cover the costs of the abortion. In this case, it is not necessary to apply to the health insurance company for the costs to be covered, as the doctor will make the necessary determination.
- If the pregnancy is to be terminated because it is the result of a crime (rape), the health insurance company will cover the costs of the abortion if no more than 12 weeks have passed since conception. In this case, it is not necessary to apply to the health insurance company for the costs to be covered, as the doctor will make the appropriate determinations.
If the abortion is carried out for other reasons, the abortion is unlawful but not punishable if the following conditions are fully met:
- They explicitly request the termination.
- You must prove to the doctor by means of a certificate from a recognised conflict counselling centre that you have sought counselling from a pregnancy conflict counselling centre at least three days before the procedure.
- A doctor performs the abortion.
- A maximum of 12 weeks has passed since conception.
In this case, the health insurance company will cover the costs of:
- medical advice on the preservation and termination of pregnancy,
- medical treatment, with the exception of abortion and follow-up treatment in the event of no complications,
- the supply of medicines, bandages and remedies, as well as
- hospital treatment
The costs for the medical performance of the abortion itself as well as for medical follow-up care are not covered by health insurance.
However, if you have no or low income, you can apply to your statutory health insurance company for these services to cover the costs of these services in certain cases. This is the case, for example, if you are considered socially needy.
Process flow
You can submit the application for reimbursement of costs in the event of an abortion by post or – in the case of many statutory health insurance companies – hand it in in person at the office. As a rule, it is possible to receive advice by telephone or at the office on the best possible procedure for submitting an application. Normally, the procedure is as follows:
- Fill out the application for cost coverage from your statutory health insurance company.
- Submit the application together with the required documents to your health insurance company.
- You can also submit the application to most health insurance companies directly at the office. As a rule, the processing here is immediate.
- The health insurance company will review your application and, if the requirements are met, will issue you with a certificate of assumption of costs.
- You should give the certificate of assumption of costs together with the certificate of the consultation with a conflict counselling centre to your doctor.
- Your doctor will settle the abortion with the competent authority. You don't have to pay anything.
Requirements
There is an entitlement to reimbursement of costs by the statutory health insurance fund if:
- you have your domicile or habitual residence in Germany, and
- After examination by the health insurance company, it is not reasonable for you to assume the costs of the abortion for financial reasons. You can find out the exact requirements and income limits for this from your health insurance company.
An unreasonable cost burden for you exists in particular if you:
- subsistence assistance ("social assistance") or
- receive unemployment benefit II;
- have a disability and receive educational support (training support within the framework of the order of the Federal Employment Agency on the individual promotion of vocational training or on the employment and career promotion of people with disabilities) or
- a training grant in accordance with the Federal Training Assistance Act ("Bafög") or
- receive benefits under the Asylum Seekers Benefits Act;
- are accommodated in a home or similar institution and the costs of this are borne by social assistance or youth welfare.
Which documents are required?
As a rule:
- Proof of your personal income and financial circumstances, for example current salary statement or bank statement
Please contact your health insurance company to find out which additional documents are required in addition to proof of your personal income and financial circumstances.
What are the fees?
You don't have to pay anything for the application.
What deadlines do I have to pay attention to?
- You must apply for reimbursement before the abortion.
- Abortion is only possible up to the end of the 12th week (in the case of criminological indications as well as in the case of an unlawful but unpunished abortion).
- At least 3 days before the unlawful but unpunished abortion, counselling must have taken place at a pregnancy conflict counselling centre.
Processing duration
It usually takes about 1 to 2 business days to process.
In order to process and make a decision quickly, your health insurance company must have the necessary information and, if necessary, documents complete and meaningful.
The health insurance company decides on applications promptly, whereby the statutory processing deadline is observed in order to protect patients' rights.
Please note that the stated processing time is an average value for 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 records are sent to you or your health insurance company by post.
Legal basis
§ 24b Fifth Book of the Social Code (SGB V)
§ 8 Second Law on Farmers' Health Insurance (KVLG 1989)
Applications / forms
- Forms: yes
- Online procedure possible: no
- Written form required: yes
- Personal appearance required: no
Appeal
- Contradiction
- Appeal to the Social Court
What else should I know?
If you do not have statutory health insurance, you can apply for reimbursement of abortion costs with a statutory health insurance company at your place of residence or habitual residence.
Technically approved by
Federal Ministry of Health
Professionally released on
06.12.2021
Author
The text was automatically translated based on the German content.
