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Who pays for unplanned treatment in another EU country?

You are in another EU country temporarily and need to undergo medical treatment because of a medical condition. Whether and to what degree your health insurance fund will meet the cost of the treatment however depends on specific preconditions.

If you do not have statutory health insurance, your entitlement is derived from your private health insurance contract. Contact your private healthcare insurer directly in order to ascertain what range of benefits is covered by your insurance contract if you undergo treatment in another Member State or in one of the abovenamed states.

The information below relates to cases in which you have statutory health insurance in Germany and unexpectedly need to undergo medical treatment during a temporary stay in another EU country. It also applies to persons with chronic illnesses and to pregnant women. You will find more information for these groups under the appropriate heading.

The various cost reimbursement procedures

Different cost reimbursement procedures are available should you need medical assistance during a temporary stay in another EU country:

  • a) Present a European Health Insurance Card (EHIC) to a healthcare provider in another EU country who is entitled to treat persons who are insured in that country’s health system. This will enable you to document in the treatment state that you would like to be treated as if you had statutory health insurance there and that your healthcare insurer will pay the cost (see Advantages and disadvantages in the linkbox below).
  • b) If you would like or need to take up a benefit in another Member State or in one of the abovenamed states for which your health insurance fund would also pay in Germany under the same conditions, you initially pay the costs incurred yourself and are treated as if you had private health insurance. You can subsequently apply for a reimbursement (see Advantages and disadvantages in the linkbox below).

These two methods differ in terms of the

  • legal basis
  • preconditions for your entitlement to treatment
  • payment methods applied by the healthcare provider
  • methods for a reimbursement
  • co-payments, as well as with regard to several other aspects.

In the first case, at a), your entitlements to treatment are derived directly from the European Regulations on the coordination of social security systems (Regulations (EC) 883/2004 and 987/2009). In the second case, at b), they are derived from section 13 subsections (4)-(6) of the Fifth Book of the German Social Code (Fünftes Buch Sozialgesetzbuch - SGB V). This is where the German legislature has transposed the stipulations contained in the European Patient Mobility Directive, Directive 2011/24/EU, into national law.

We would like to give you an overview for both methods and to point to the differences, as well as to the advantages and disadvantages. You should nonetheless always seek the advice of your healthcare insurer in person before deciding between the two methods.

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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

You are living in a border region and you are searching for further regional information sources. Click here for an overview of institutions that could be helpful.

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.

Checklists

Information on treatment in another EU country at a glance