What will my health insurance pay?
The assumption of the costs for artificial insemination by the private and statutory health insurance
If the wish for a child cannot be fulfilled by classical methods of treatment, then artificial insemination is taken into consideration, particularly in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). The reimbursement of the cost of treatment by the health insurance companies as well as the reimbursement by the Beihilfe [supplementary health insurance] is as follows:
50% of the cost is assumed by the statutory health insurance. Since the Gesundheitsmodernisierungsgesetztes [Healthcare Modernisation Act] took effect on 01 January 2004, the methods of assisted reproduction (intrauterine insemination, IVF, IVF/ICSI) are no longer borne to the previous extent by the statutory health insurance.
Given the proper framework conditions (the partners must be married to each other and both must be at least 25 years old; the woman must be under 40, the man under 50), up to three treatment cycles of IVF or IVF/ICSI will be financed to 50% upon application. Patients currently must bear 50% of the treatment costs themselves. To confirm the assumption of costs, a so-called "treatment plan" must be presented to the health insurance companies. This treatment plan will be issued upon diagnosis by your treating physician.
Some health insurance companies have been willing to grant a higher contribution (different amount) since 01 January 2012. Some health insurance companies assume the costs if one or both partners are under 25 years of age or the age limit is exceeded slightly upwards. You must ask your health insurance company about this.
The Gebührenordnung für Ärzte (GOÄ) [schedule of fees for physicians] applies to self-paying patients as well as for private patients.
Private health insurance as a rule assumes all costs – usually upon request. This means that the total costs of treatment of both partners are assumed regardless of which insurance company the partner is with. For this, however, is it necessary that there is a chance of success of more than 15% per treatment. Marital status and age are not considered here.
You can find more information in our detailed patient information (19 kB) and the document
Judgements on financial support or reimbursement of fertility treatment (IVF and ICSI treatments) (75 kB) .
If one partner is insured by the statutory health insurance fund and the other by private health insurance, the so-called "polluter pays"principle is used for the reimbursement of expenses. According to the diagnosis, we will be happy to help you with the generation of a doctor's certificate or treatment application.
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