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Please present your European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) to the medical professional. The EHIC can generally be found on the rear of your insurance card. If that is not the case, you will need to have the EHIC issued by your healthcare insurer before leaving home. If you are already in Germany and do not have an EHIC with you, you should request your healthcare insurer to issue you with a Provisional Replacement Certificate (PRC), which healthcare providers in Germany can use to bill in exactly the same way as with your EHIC.
The EHIC or PRC entitles you to take up all treatment which is medically necessary within the German benefits system during a temporary stay in Germany, taking the length of your intended stay into account. The medical professional decides on the medical necessity. The range of services here is not restricted to emergency treatment only, but can also go beyond this. There is a difference when it comes to deciding on medical necessity regarding whether you are for instance staying in Germany for two weeks or two years. What is clear is that no one should be forced to terminate their stay in Germany early, or to interrupt it or not to come at all because of otherwise not being able to receive medically-necessary treatment in good time. This also applies as a rule if you have a chronic disease or are pregnant.
What benefits can be offered to you via an EHIC or PRC are in line with the statutory range of benefits in Germany. If the law of your home country provides for the benefit which you are seeking, such as a specific form of treatment, but German law does not, you cannot receive treatment in Germany via the EHIC, but at best as if you had private health insurance. As a rule, healthcare providers in Germany know whether or not they can bill a benefit via the statutory health insurance funds. It may therefore be that you do not receive a benefit in Germany via the EHIC to which you would be entitled in your home country. Conversely, you might receive benefits in Germany which are not available under the benefits system in your home country. Using the EHIC can therefore entail either a restriction in an individual case, or it can open up a broader range of treatment.
If you are insured within the Spanish healthcare system and suffer from bad toothache during your summer holiday in Germany, you can go to a registered contract dentist, to whom you present your EHIC, and receive treatment although dental treatment is not covered by the Spanish benefits system. The German dentist bills his or her costs to a German health insurance fund of your choice. The Spanish healthcare insurer is obliged to pay a German invoice which it receives.
Procedures for patients who have health insurance in another EU country, are staying temporarily in Germany and require medical treatment have been agreed between the National Association of Statutory Health Insurance Funds, the National Association of Statutory Health Insurance Physicians, the National Association of Statutory Health Insurance Dentists, and the German Hospital Federation. We would like to provide you with a brief overview of the core contents of these agreements. You will find more information on this (in German) on the corresponding page of the German Liaison Agency Health Insurance – International or in the link box listed below.
If you develop any symptoms whilst in Germany, please first of all go to a contract doctor or contract dentist. You can consult almost all specialist physicians. If you have a urological problem, for instance, you do not need to start by making an appointment with a general practitioner, but can go directly to a registered urologist. A provider has contract healthcare provider status if the medical professional can be found in the corresponding search engines of the Associations of Statutory Health Insurance Physicians and Associations of Statutory Health Insurance Dentists. Please only go to the registered hospitals in Germany in absolute emergencies. You can naturally also ask the medical professionals directly in advance whether they are permitted to treat persons who have statutory health insurance in Germany at the expense of the health insurance funds.
Present your EHIC or PRC and your identity card to the medical professional. Should you require out-patient hospital treatment or if you are hospitalised, the medical professional will give you a “Patient’s Declaration European Health Insurance”. Dentists use form 81. You must confirm on this form that you did not plan to travel to Germany in order to undergo treatment. You also need to state when you expect to leave Germany. Please also specify in the empty space provided which of the many German health insurance companies you would like to designate as the assisting institution. You can therefore select any German health insurance fund, and are then obliged to remain with this selection for the duration of your treatment. You should therefore remember the name of the health insurance fund.
The medical professional will find the “Patient’s Declaration European Health Insurance” in his or her computer system, or will receive form 81 from his or her Association of Statutory Health Insurance Dentists. The “Patient’s Declaration European Health Insurance” is valid for contract-doctor care, as well as for the out-patient hospital sector and in case of hospitalisation.
The decision on the medically-necessary treatment is taken solely by the medical professional. He or she bills the costs to the assisting German health insurance fund via the responsible Association of Statutory Health Insurance Physicians. The medical professional is to issue certificates of incapacity for work and prescriptions in exactly the same way as for persons who have statutory health insurance in Germany.
Since under German law the assisting German health insurance fund only operates for the healthcare insurer in your home country in an assisting capacity, it has the costs which it has advanced reimbursed by your healthcare insurer. You will notice nothing of this since it is a cost reimbursement procedure operating within the administration.
German legislation provides for co-payments to be paid by patients for benefits within statutory social insurance. Since the EHIC entitles you to be treated as if you had statutory health insurance in Germany, you must pay these in the same amount. This means as a rule that you for instance need to make a co-payment of up to 10.00 Euro per prescription for medicinal products in Germany. If you are aged over 18, you always have to pay 10.00 Euro for each day you stay in hospital, but only for up to a maximum of 28 days per calendar year.
If the medical professional does not accept the EHIC or PRC and you had to pay the invoice in advance yourself, you have the following possibilities as a rule:
The procedure described above with the EHIC or PRC offers you certainty that the lion’s share of the treatment costs will be paid.
You will however need to consider that you may only be treated in Germany by healthcare providers who have a contractual relationship with the statutory health insurance funds there, and may only receive benefits to the extent provided for in Germany.