Statutory health insurance

Statutory health insurance

As of January 1, 2004, 50% of the costs of fertility treatment for those with statutory health insurance must be borne by the couple themselves. Both the consultation and a large part of the diagnostics in the run-up to the treatment will continue to be covered bythe insurance companies without any restrictions. Hormone treatments, which take place exclusively to improve egg maturation and not in preparation for fertility treatment (see measures listed below), will also continue to be exempt from co-payment.In addition, the woman must have sufficient protection against rubella infection, and both partners must be tested for hepatitis B and HIV.

Measures and number of possible attempts at statutory health insurance (SHI):

1. Insemination in non-stimulated cycle up to max. 8 attempts, own contribution approx. 100 Euro
2. Insemination in stimulated cycle up to max. 3 attempts, own contribution approx. 500 Euro
3. In vitro fertilization (IVF) up to max. 3 attempts, own contribution approx. 1500 Euro
4. Intracytoplasmic sperm injection (ICSI) up to max. 3 attempts, own contribution approx. 1800 Euro

Cost absorption for persons with statutory health insurance

Requirements for cost coverage for persons with statutory health insurance

Before treatment begins, you must have a cost and treatment plan approved by your health insurance company. This will be issued to you by your doctor at the fertility clinic after checking the criteria listed below.The statutory health insurance fund is only obliged to pay benefits if the following conditions are met:

• Patients must be married to each other.
• Wife and husband must have reached the age of 25 before the start of therapy. The wife must not have reached the age of 40 at the start of therapy, and the husband must not have reached the age of 50.
• The wife must have an immune protection against rubella, and both spouses must have a negative HIV test.
• The couple must have been previously counseled about the medical, psychological, and social aspects of artificial insemination by a physician who does not perform the procedures himself.
• For ICSI treatment, 2 current spermiograms (at least 12 weeks apart) must be available that meet the ICSI criteria. The sperm is evaluated according to the valid WHO guidelines.
• Neither wife nor husband may be sterilized.

You will receive an invoice from us for the 50% co-payment of the medical services. The other half of the treatment costs will be settled directly via your insurance card. You will pay the 50% co-payment for medications when you cash in your prescriptions at your pharmacy.If you as a couple do not meet the above requirements, only private billing of the fertility treatment is possible. The billing will be done according to the "Gebührenordnung für Ärzte (GOÄ)".