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Medically-necessary benefits in kind in case of pregnancy

There may be a variety of reasons why you are in Germany during your pregnancy, and not in your home country. The important aspect for the assumption of costs via the European Health Insurance Card is that obtaining medical benefits during pregnancy or childbirth is not the only reason for your stay in Germany.

The range of benefits available

The European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) entitles you to all benefits which are medically necessary and which are available in Germany related to pregnancy or childbirth. The medical benefits are hence not restricted to acute health problems. This means that you can receive the screening examinations during your stay in Germany which are planned in accordance with the Maternity Directive for the appropriate stage of pregnancy. If there are any risks involved in your pregnancy, or if risks arise, the German healthcare provider must take all medically-necessary measures to remedy or minimise them.

The difference as against planned treatment

The EHIC does not entitle you to take up medical benefits during pregnancy in Germany if the birth or the examinations or medical treatment necessary in connection with it are the only reason for your stay in Germany. This would constitute planned treatment in Germany. Different conditions apply, and you need different proof of entitlement.

You live in Poland on the border to Germany. The closest hospital is in Germany, and you would like to give birth in the closest hospital in Germany.

You cannot receive the medical benefits in Germany with your EHIC. The only reason for your stays in Germany is to take up medical benefits. This constitutes planned treatment. Please consult your Polish healthcare insurer as to whether it is willing to issue a form E 112 or S2, or to reimburse at least some of the treatment costs.

Childbirth via the European Health Insurance Card

Even if you know the due date well in advance, you can still give birth in Germany via the EHIC in special constellations. This is always the case if you would like to have your child in Germany simply because of your particular family situation. With regard to these situations, the European Commission clarifies it its Explanatory Notes on necessary care (you can find these Notes in the “documents and links” box below):

“...Special attention should be granted to the situation of migrant women who wish to go back to their home country to give birth there in order to take advantage of the help offered by their families. The purpose of the stay in their home country is not only to give birth but also to return to a familiar environment where they can count on the support of their relatives in the period before and after the birth of their child. Health care provided in this situation to mother and child should be considered as being necessary care and therefore covered by the European Health Insurance Card.

A similar situation is the one where a woman wants to give birth in the State of residence of her husband or partner. In most of the cases, the future mother will not just go to the State of residence of her husband or partner to give birth and return immediately afterwards to her State of residence, but she will often stay with her husband or partner for a certain period before and after the birth of the child. Healthcare provided during the stay of the woman in the State of residence of her husband or partner (including care given to the child) is to be considered as necessary care and is covered by the European Health Insurance Card. ...”

The situations listed in the European Commission’s Explanatory notes are those which occur most frequently in practice. There may be other constellations which also need to be assessed.

You live and work in the United Kingdom, together with the child’s father. Your parents have already died. The parents of the child’s father live in Germany. Because of the extensive work commitments of the children’s father, he would be unable to look after you in the period before, during and after childbirth. You would therefore like to give birth close to the parents of the child’s father and also to stay there several weeks before and after the due date.

You are therefore only thinking about giving birth in Germany because your parents-in-law who could support you live here. The primary reason for your stay in Germany is therefore not to give birth as such, but the opportunity in your specific family situation to be able to avail yourself of the assistance of the parents of the child’s father. It should therefore be possible to use the EHIC to give birth.

It has been revealed in practice that problems repeatedly occur in these constellations. Please therefore contact the hospital in Germany where the birth is to take place in good time in order to consult them as to whether it is possible to give birth there via your EHIC in your situation. If the hospital requires a form E 112 or S2 to be presented in such cases, please ask the healthcare insurer in your home country whether it is willing to issue this form. Should this not be the case, please contact the German health insurance fund which you would like to select as the assisting German health insurance fund. Explain your situation, referring to Decision S3 and to the Explanatory notes of the Commission on Necessary care, and ask it to help you assert your claims via the EHIC. Please contact us should there be any further difficulties.

Midwifery benefits

You can use your EHIC to take up midwifery benefits to the same degree before, during and after birth as persons who have statutory health insurance in Germany. Ask the midwife to send her invoices to the German health insurance fund which you appointed as the assisting insurer when completing the Patient’s Declaration in the gynaecologist’s practice or at the hospital in form 81 K.

Contact

Team EU-PATIENTEN.DE

Pennefeldsweg 12 c
53177 Bonn

Phone
+49 228 9530-802/800

Fax
+49 228 9530-801
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