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Who pays for planned treatment in EU Member States?

If you have health insurance in Germany, you are entitled to receive medical treatment not only in Germany, but also in another Member State or in Switzerland and in the EEA States Iceland, Liechtenstein and Norway. Whether your health insurance fund assumes the cost of treatment in one of these countries however depends on certain preconditions.

If you do not have statutory health insurance, your claims arise from your private health insurance contract. Contact your private healthcare insurer directly to clarify the range of benefits covered by your insurance contract in case of treatment in another Member State or in one of the states mentioned above.

The following statements refer to a situation in which you have statutory health insurance in Germany and are planning to undergo medical treatment in another Member State or in one of the states mentioned above.

Two ways to reach the goal

If you are planning to travel to another Member State or to one of the states mentioned above to undergo medical treatment there and have statutory health insurance in Germany, there are two possibilities open to you:

  • a) You obtain prior authorisation for the treatment from your health insurance fund, and the fund issues you with a form E 112 or S2 for this purpose. This enables you to show in the state of treatment that you wish to be treated as a patient who has statutory health insurance in that country and that your health insurance fund will pay the bill (please see advantages and disadvantages in the linkbox below).
  • b) You want to take up a benefit which your health insurance fund would also pay for in Germany under the same conditions in another Member State or in one of the above mentioned states. You initially pay the costs incurred yourself and are treated as if you had private health insurance. You then apply for a reimbursement (please see advantages and disadvantages in the linkbox below).

The two possibilities differ in terms of the

  • legal basis
  • prerequisites for your entitlement to treatment
  • payment methods of the healthcare provider
  • reimbursement possibilities
  • co-payments and in some other aspects.

In the first case, at a), your entitlement to treatment is regulated in accordance with the European Regulations on the coordination of social security systems (Regulations (EC) 883/2004 and 987/2009). In the second case, at b), your entitlement is based on section 13 subs. 4 to 6 of Book V of the German Social Code (SGB V). Thus the provisions of the European Patient Mobility Directive – Directive 2011/24/EU – have been transposed into German Law.

We would like to give you an overview for both possibilities and point to the differences. Before making your choice, however, you should always seek the advice of your health insurance fund in person.

Documents and Links

Contact

Team EU-PATIENTEN.DE

Pennefeldsweg 12 c
53177 Bonn

Phone
+49 228 9530-802/800

Fax
+49 228 9530-801
Online contact form

Find National Contact Points of other EU countries

You will find here a list of National Contact Points of the EU with several contact informations.

Regional sources of information

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National information media

You will find more national information available here if you want to find out what treatment is available for specific diseases, or if you need further information on the topic of health.

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Information on treatment in another EU country at a glance