Apply for reimbursement of costs for measures to induce pregnancy or for cryopreservation measures for persons with statutory health insurance
Before starting treatment, you must submit a doctor's treatment plan to the health insurance company for approval. The statutory health insurance companies cover 50 percent of the costs of the measures approved with the treatment plan.
Treatments on the man's body are covered by the man's health insurance, treatments on the woman's body are covered by the woman's health insurance.
The key requirements are:
- You can't get pregnant naturally.
- From a medical point of view, artificial insemination measures are suitable for inducing pregnancy
- They are married and use their own eggs and sperm.
- Women must be 25 to 39 years old; Men 25 to 49 years old.
Your attending physician can advise you on the various methods of artificial insemination.
It often takes several attempts at artificial insemination for you to become pregnant. Artificial insemination measures may only be carried out at the expense of the statutory health insurance funds if there is a reasonable prospect that the chosen treatment method will induce pregnancy. Further details are laid down by the Federal Joint Committee in its guidelines on artificial insemination. Accordingly, there is no longer a reasonable prospect of success for the respective treatment measures if they
- in the case of spontaneous insemination up to eight times,
- in the case of insemination after hormonal stimulation up to three times,
- in the case of in vitro fertilization, up to three times,
- in the case of intratutable gamete transfer up to two times,
- for intracytoplasmic sperm injection up to three times
have been carried out in full without a clinically proven pregnancy.
You are entitled to reimbursement of the costs of cryopreservation measures if this appears necessary due to a disease and its treatment with a germ cell-damaging therapy in order to carry out subsequent measures of artificial insemination. You can find out what other requirements must be met for this from your responsible health insurance company.
Normally, the procedure is as follows:
- If fertility treatment has a chance of success for you, your gynaecologist will usually refer you to a fertility center.
- The fertility clinic will draw up a treatment plan.
- The treatment plan serves as an application for cost sharing.
- You can submit the application by post or – in the case of many statutory health insurance companies – hand it in in person at the office.
- The fully completed sample form of the treatment plan with both copies as well as any other necessary documents should be sent by post to the health insurance company of the woman and the man (if you are legally insured with different health insurance companies).
- The health insurance company will review your application and issue you with a certificate of cost coverage.
- Permits are issued on the form and receipts.
- You give the certificate of assumption of costs to your doctor.
- Your doctor will bill your health insurance provider's share directly via your electronic health card. You will receive an invoice for your own contribution.
- Your doctor or health care professional has diagnosed you with a fertility disorder. This means that you cannot get pregnant naturally.
- Your doctor will confirm that fertility treatment has a chance of success.
- Both partners are married.
- Only your own eggs and sperm may be used. The statutory health insurance companies cannot cover artificial insemination with the sperm or egg donation of a third person.
- As a woman, you must be at least 25 years old and no more than 39 years old.
- As a man, you must be at least 25 years old and no more than 49 years old.
The costs of cryopreservation are only covered by the statutory health insurance companies if there is a risk that you will become infertile due to a disease and its therapy. In addition, the following requirements apply:
- There is a desire to have children.
- Women must not be older than 39 years old.
- Men must not be older than 49 years old.
- Subsequent measures of artificial insemination must be possible in principle.
Which documents are required?
- Treatment plan in the original with a report from the attending physician or the fertility center.
Depending on the special case, additional documents may be required. Please contact your health insurance company for more information.
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 submit the application before artificial insemination or before the cryopreservation of your sperm or eggs.
It usually takes about 3 to 14 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.
If necessary, the medical service must be involved. This will take up to an additional 5 weeks to process your request.
Applications / forms
• Forms: yes
• Online procedure possible: Many statutory health insurance companies offer an online procedure.
• Written form required: yes
• Personal appearance required: no
- Appeal to the Social Court
What else should I know?
Under certain conditions, you can receive further subsidies from the federal government and some federal states, for example if you live in a same-sex relationship or are unmarried. Information on this can be found on the "Information Portal for the Desire to Have Children" of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.
In addition to the statutory subsidy of 50 percent of the costs of approved artificial insemination measures, health insurance companies can regulate higher subsidies in their statutes. Simply seek advice from your local health insurance company.
Technically approved by
Federal Ministry of Health
Professionally released on
The text was automatically translated based on the German content.