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

If you need medical treatment during a temporary stay in Germany, you can take up the benefits using your European Health Insurance Card (as if you had statutory health insurance in Germany), or privately, for which you will have to pay in advance. We will show you below what the advantages and disadvantages of the various procedures for you are and what you need to bear in mind.

EC Regulation No 883/2004 (treatment as if you had statutory health insurance in Germany)

Advantages Disadvantages
You may receive benefits beyond the range of benefits available in your country which are however covered by the range of benefits in Germany. The German list of benefits may contain fewer benefits than that of your home country.
As a rule, you will only incur costs in the amount of the co-payments provided for in Germany. The German legal system may provide for co-payments which do not exist in your home country or which would be lower there. The healthcare provider in Germany furthermore decides whether the treatment which you would like to undergo is medically necessary, taking the length of your stay into account.
Costs are settled directly between the healthcare provider and the assisting German health insurance fund which you have selected. You may only consult healthcare providers with a contract, that is only doctors, dentists and hospitals which have been registered by the competent Association of Statutory Health Insurance Physicians or Dentists (-> Glossary) to treat persons with statutory health insurance. Your entitlement is limited to benefits which are included in the statutory list of benefits in Germany.
In cases of medical malpractice, you will be treated like a person insured with statutory insurance in Germany. If your healthcare insurer in your home country is entitled to support you in cases of malpractice, this possibility does not apply in case of malpractice in Germany.
There are no translation costs for invoices. Were the European Health Insurance Card not to be accepted, so that you subsequently apply to the healthcare insurer in your home country for a reimbursement, you might have to pay any shortfall towards the German insurance fund rate yourself.

Directive 2011/24/EU (treatment as if you had private health insurance in Germany)

Advantages Disadvantages
You may also consult private healthcare providers (e.g. private doctors and hospitals). The costs may exceed the amount that is reimbursed by the healthcare insurer in your home country.
The benefits you may receive are not restricted to what is available to persons with statutory health insurance in Germany. You will thus be able to also receive benefits that are covered by the statutory range of benefits in your home country, but not in Germany. You will initially have to pay the costs yourself, and will only subsequently receive a reimbursement of at least a part of the costs.
There is no need to have the costs authorised in many cases. The invoice may have to be translated at your expense if it was not drawn up in your country’s language.
If no prior authorisation is required, healthcare can be taken up quickly. Unless otherwise agreed by contract, liability and warranty claims are exclusively governed by the German legislation, and you need to pursue them before the German courts.
  There may be language difficulties. It may be necessary to arrange for a translation of the results of prior examinations from your home country, for instance parts of your medical records and – after the treatment – also the results of your foreign medical files, at your own expense.

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Team EU-PATIENTEN.DE

Pennefeldsweg 12 c
53177 Bonn

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+49 228 9530-802/800

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+49 228 9530-801
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