National Contact Point for cross-border healthcare

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Treatment subject to advance approval

You may need advance approval from your health insurer, or you may have to satisfy specific prerequisites for treatment in Germany so that some or all the treatment costs can subsequently be refunded to you.

In accordance with the European Patient Mobility Directive, the Member States can provide for an advance approval system for specific types of treatment in another Member State under certain preconditions, regardless of whether such treatment is also subject to advance approval in their country. This is particularly the case if

- at least one overnight stay in hospital is necessary, or

- particularly high-cost infrastructure is used and the advance approval is to protect the financial balance and planning certainty of the state healthcare system and to guarantee patient safety and public health. Most States in the EU have introduced an advance approval system. Only seven States have refrained from doing so. The latter are Austria, the Czech Republic, Estonia, Finland, Lithuania, the Netherlands and Sweden. This however does not mean that insured persons from these States can always undergo treatment in another Member State without consulting with their health insurers at all and then demand a cost refund from their health insurers. The European Patient Mobility Directive makes it clear that patients who would like to seek treatment in another Member State are always subject to the same preconditions, entitlement criteria and administrative formalities as apply to the same treatment in the insurance state. Whether these conditions are met should always be clarified with the competent health insurer prior to the treatment. Please therefore contact the latter or the National Contact Point of your insurance state.



Pennefeldsweg 12 c
53177 Bonn

+49 228 9530-802/800

+49 228 9530-801
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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.


Information on treatment in Germany at a glance