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Advantages and disadvantages of the cost reimbursement methods in case of planned treatment as if you had statutory or private health insurance in Germany

Both variants entail advantages and disadvantages whose consequences may vary, depending on the country where you would like to undergo treatment. You will find an overview below of the areas in which these advantages and disadvantages are to be found as a rule. We will be happy to answer any queries you may have.

Regulation (EC) No 883/2004 (treatment as a patient with statutory health insurance in another EU country)

Advantages Disadvantages
You may receive benefits beyond the range of benefits available in Germany, if they are covered by the range of benefits according to the laws of the state of treatment. You always (thus for every out-patient or in-patient treatment) need prior authorisation from your health insurance fund.
Costs incurred do generally not exceed the co-payment applicable to persons with statutory insurance according to the rules of the state of treatment. An entitlement only arises when a prior authorisation has been granted.
Costs are settled directly between the healthcare provider and the healthcare insurers involved. You may only consult healthcare providers with a contract, e.g. doctors, dentists and hospitals having entered into a contract with the statutory health insurance in that state. Your entitlement is limited to benefits within the range of benefits of statutory insurance in the state of treatment.
In cases of malpractice you will be treated like a person insured with statutory insurance of that system in the state of treatment. Since your German health insurance fund does not have a contract with the healthcare provider in the state of treatment, it will not be able to assist you directly in cases of malpractice.
No costs will incur for translations of invoices.  
If the amount of the treatment costs covered by the health insurance in the state of treatment is lower than the amount the German health insurance fund would have covered for a treatment in Germany, you may request reimbursement of your share from your health insurance fund. However, the German health insurance fund may also, if applicable, deduct the co-payment that would have to be paid for the treatment in Germany.  

Directive 2011/24/EU (treatment as a patient with private health insurance in another EU country)

Advantages Disadvantages
You may also consult private healthcare providers (e.g. private doctors and private hospitals). Costs may exceed the amount that is reimbursed by your German healthcare insurer.
The range of benefits you may receive is not limited to those benefits that persons with statutory health insurance of the state of treatment may receive. You will thus be able to receive benefits that are covered by the range of benefits in Germany, but that are not covered in the state of treatment. You will initially have to pay the costs yourself and you will only subsequently receive reimbursement of a part of the costs.
In many cases, prior authorisation is not necessary. If the invoice was not issued in German, it will have to be translated at your expense.
If no prior authorisation is required, you may quickly receive healthcare services. Liability and warranty claims are exclusively governed by the laws of the state of treatment and have to be pursued by you according to these laws. Your health insurance fund in Germany will not be able to offer you assistance with this.
  Language problems may come up. It may be necessary to arrange for a translation of the results of prior examinations carried out in Germany, parts of your medical records or – after treatment – for a translation of results of your medical records in the other country, at your own expense.

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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