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Assumption of costs in case of planned treatment as if you had statutory health insurance in Germany (form E 112 or S2)

What benefits can I receive in Germany? What do I have to clarify with my healthcare insurer prior to undergoing treatment in Germany? What do I do once I am in Germany? Might I have to pay all or only a part of the treatment costs myself? We will be answering these questions below.

You seek authorisation for the treatment from your healthcare insurer in your home country in advance. Your healthcare insurer issues an E 112 or S2 form for this. This will enable you to document that you would like to be treated as if you had statutory health insurance in Germany and that your healthcare insurer will pay the cost. You will always need to have treatment that you would like to take up on the basis of an E112 or S2 form approved by your healthcare insurer before the treatment starts.

Range of benefits

What benefits you can take up within the EC regulations depends on the statutory range of benefits of the treatment state. If you undergo treatment in Germany, you can therefore only take up benefits to which persons who have statutory health insurance in Germany would also be entitled if they satisfied the same preconditions. If the law of your home country provides for the benefit which you are seeking, such as a certain form of treatment, but German law does not, you can also not undergo this treatment in Germany. The fastest way for you to find out what benefits Germany provides for persons with statutory health insurance is by enquiring to the statutory health insurance funds or healthcare providers. You are also welcome to address your questions to us.

Proceeding within the EC regulations can therefore entail either a restriction in an individual case, or it can open up a broader range of treatment to you. If for instance German law provides for a benefit for persons with statutory health insurance which is unknown under the law of your home country, your healthcare insurer may nonetheless authorise you to undergo the treatment in Germany. However, it is not obliged to do so.

Authorisation

In order to be able to take up benefits within the EC regulations to which persons with statutory health insurance in Germany are entitled, you always require the authorisation of your healthcare insurer. You must present the authorisation to one of the many German health insurance funds before commencing treatment. You can therefore select a German health insurance fund. This also applies to treatment which your healthcare insurer would not have to authorise for you were you to have the treatment carried out in your own country.

It is generally at the discretion of your healthcare insurer whether it authorises a specific treatment in a Member State. It is not obliged to authorise treatment if

  • suitable treatment could be provided in your own country, or
  • the benefit which you are seeking is not included within the range of its statutory benefits.

Your healthcare insurer may however also give its authorisation in such cases.

It is obliged to give its authorisation in certain instances. This applies if the treatment which you wished to receive is provided in accordance with the legislation of your country for your disease and cannot be provided in your home country within a period which is medically justified. The assessment of the justifiable period is dependent on your state of health and on the prognosis of your disease.

Issuing a form E 112 or S2

If your healthcare insurer authorises the treatment in Germany in advance, it will issue you with a form E 112 or S2 as documentation of the authorisation. Your healthcare insurer can issue this authorisation either for the treatment for which you have applied, or indeed for a specific healthcare provider, and for a specific place and a specific duration.

Assume that you would like to have a computer tomography carried out in Germany and would not have to have this examination authorised by your healthcare insurer if you went to a physician in your home country. Assume also that you have selected a healthcare provider in Germany whose surgery is easier for you to reach than that of a provider in your home country, and that the physician whom you have selected is a contract doctor who is registered in Germany.

You can apply to your healthcare insurer to be treated as if you had statutory health insurance in Germany. If your healthcare insurer authorises your treatment, it issues you with a form E 112 or S2. It can restrict authorisation either to this treatment or to this healthcare provider, and for a specific duration, but is not obliged to make any such restriction.

The healthcare provider (e.g. doctor) whom you have selected may establish that the treatment that has been authorised is not sufficient. If your healthcare insurer has restricted the authorisation to a specific treatment when issuing the first form, you now need to apply for a fresh authorisation, that is a new form E 112 or S2.

Selecting a German health insurance fund

If you have received authorisation in the context of the EC regulations to take up a medical benefit in Germany, please take this authorisation to one of the many German health insurance funds. You will find an overview of the health insurance funds in Germany in the linkbox below.

Costs and co-payments

If you have opted to receive treatment within the EC regulation, we recommend you to arrange with the German health insurance fund which you have selected, prior to undergoing treatment, what costs can be assumed or reimbursed according to the legislation applying to that fund. If there are costs which you have had to pay yourself, you can apply for a full or partial reimbursement once the treatment is over. You can make the application either

  • directly to a health insurance fund in Germany which you have selected, or
  • to your foreign healthcare insurer.

Co-payments are also provided for under the German legislation in certain cases (for instance for patient transport, hospital treatment or dispensing prescriptions). As the form E112 or S2 enables you to be treated exactly as if you had statutory health insurance in Germany, you initially have to meet these costs yourself. The co-payments do not exceed 10.00 Euro per benefit. You will find more information in the linkbox below.

Once the treatment is over, you can try to file an application to your healthcare insurer in your home country to have the remaining co-payments reimbursed.

If you have received authorisation from your healthcare insurer to undergo in-patient treatment in Germany (form E 112 or S2), and have submitted the authorisation to a German health insurance fund, which in turn has issued you with a billing certificate for the hospital in Germany, the hospital can use this to bill for its costs to the German health insurance fund which you have selected.

A co-payment of 10,00 Euro per day is due in Germany as a rule for each day spent in hospital, for up to a maximum of 28 days.

You should submit the remaining co-payments to your healthcare insurer, who will examine whether they can reimburse these to you in full or in part. They can be reimbursed if your healthcare insurer would have paid a higher amount for this benefit in your home country.

Whether overnight costs and travel expenses or additional costs related to cross-border healthcare are reimbursed depends on a large number of factors, and can therefore not be answered in general terms. Please clarify any questions you may have directly with your healthcare insurer.

Advantages and disadvantages of being treated as if you had statutory health insurance (form E 112 or S2)

The above authorisation procedure offers you the certainty that the cost of the treatment will largely be met.

You must however always obtain the authorisation of your health insurance fund before undergoing treatment in Germany. You may furthermore only be treated in Germany by healthcare providers who have a contractual arrangement with the German statutory health insurance funds.

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Pennefeldsweg 12 c
53177 Bonn

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+49 228 9530-802/800

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+49 228 9530-801
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