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Medically-necessary benefits in kind if you have a chronic disease

As a person with a chronic disease, you naturally also have a right of freedom of movement. You can therefore naturally also come to Germany to study, travel or work. We would like to explain below what particularities you need to take into account.

The European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) entitles you to all benefits in kind which are medically necessary within the German benefits system during a temporary stay in Germany, taking the length of your stay into account. Medical benefits are not only necessary after an accident or where illnesses occur suddenly. You also need to receive suitable medical care for pre-existing conditions during your stay in Germany. This is the case for instance if your condition requires you to take certain medicines.

Since the EHIC or PRC affords you the same status as if you had statutory health insurance in Germany, you need to adhere to the procedures provided for here. This means as a rule that you first need to consult a contract doctor, who will examine you and treat you as necessary or prescribe the medicines that you need. The medicine which you have been using therefore needs to be approved in Germany, and must be billable at the expense of the German health insurance funds. The medical professional in Germany can also prescribe a different medicinal product to you if it is equally effective but cheaper. He or she can however also refrain from prescribing anything at all if he or she is of the opinion that no medicine should be prescribed from a medical point of view. You are very welcome to approach us if you have any questions on this matter.

Vital medical treatment

Vital medical treatment can as a rule only be provided in specialised medical facilities. The following, among others, are regarded as vital medical treatment:

  • kidney dialysis,
  • oxygen therapy,
  • special asthma treatment,
  • echocardiography in case of chronic autoimmune diseases, and
  • chemotherapy.

The local availability of such treatment is particularly important. Please therefore contact the appropriate healthcare provider in advance. Ascertain from the provider whether sufficient capacities and the form of treatment which you need (e.g. haemodialysis) are available during your planned stay.

In certain cases, you may not have the time because of your illness to undergo the procedure provided in Germany for persons with statutory health insurance. This might be the case for instance if you need oxygen immediately after flying to Germany. In this case, you should contact a German health insurance fund of your choosing at the latest two weeks before your stay in Germany. Let them have all the necessary information (duration of stay, holiday address) and send them a medical prescription from the doctor in attendance in your home country. Enclose a copy of your identity card and of the valid EHIC with the letter. The health insurance fund will endeavour to find a pragmatic solution for you. It may for instance contact a suitable oxygen provider and try to come to a one-off arrangement with them. If it manages to do so, it will commission the provider to supply you with the oxygen. If no solution is found, you can still first pay the costs yourself and submit them to your health insurance fund at home for a (partial) reimbursement. You are welcome to contact us should you have any queries in this regard.

Exemption from co-payments once the burden limit has been reached

You need to count on making a co-payment of up to 10.00 Euro for each medicinal product dispensed by a pharmacy in Germany. Since the EHIC entitles you to be treated in Germany in exactly the same way as a person with statutory health insurance, these arrangements also apply to you. You will find more information on the co-payment rules in Germany on the appropriate website of the Federal Ministry of Health.

Please enquire of the healthcare insurer or of the National Contact Point of your home country to what degree the co-payments that have been advanced in Germany might be considered when it comes to an exemption from co-payment under the legislation there.

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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