Health care costs not covered by statutory health insurance

Introduction

Health insurance (Krankenversicherung) is a fundamental part of the healthcare system in Germany and is designed to provide necessary medical care for all citizens and residents. However, there are certain costs that are not covered by statutory health insurance. It is therefore important for individuals to understand the scope of their coverage in order to avoid unexpected financial burdens.

1. Cosmetic surgery (Schönheitsoperationen)

Statutory health insurance does not normally cover the costs of cosmetic surgery, unless the procedure is medically necessary, for example to correct deformities or injuries. If an operation is carried out solely for aesthetic reasons without a medical indication, the patient must bear all associated costs.

2. Travel vaccinations (Reiseimpfungen)

Vaccinations required for travelling to certain countries – such as vaccination against yellow fever – are generally not covered by statutory health insurance. Travellers usually have to pay for these vaccines themselves. Some health insurance funds may reimburse part of the costs as a voluntary extra benefit, but this depends on the individual insurer’s policy.

3. Alternative medical treatments (Alternativmedizin)

Alternative treatments, such as certain forms of acupuncture, herbal medicine or other complementary therapies, are generally not fully covered by statutory health insurance. Although some insurers offer partial coverage or special programmes for alternative medicine, this is entirely dependent on the internal rules and additional benefits of each health insurance provider.

4. Dental prostheses (Zahnersatz)

Statutory health insurance normally covers only part of the cost of dental prostheses. To obtain a higher level of reimbursement, it is advisable to keep a so-called bonus booklet (Bonusheft), in which regular dental check-ups are documented. The more consistently and regularly these preventive check-ups are recorded over the years, the higher the potential contribution of the health insurance fund towards dental prosthesis costs.

5. Daily hospital charge (Tagespauschale)

For an inpatient stay in hospital, a daily charge of 10 euros is usually levied. While statutory health insurance covers the medical treatment costs, this daily co-payment is considered a personal contribution and must be paid by the patient, up to the legally defined maximum limits per year.

6. Over-the-counter medicines (Nicht verschreibungspflichtige Medikamente)

Medicines that can be purchased without a doctor’s prescription – such as many cold remedies or over-the-counter painkillers – are not normally covered by statutory health insurance. Patients are generally required to pay the full cost of such medications themselves.

Conclusion

Statutory health insurance in Germany provides broad, but not unlimited, coverage. There are a number of services and costs that are not covered or only partially reimbursed. It is therefore essential for insured persons to be aware of which expenses they must pay out of pocket, so they can plan their finances accordingly. It is always advisable to review the exact terms and conditions of the chosen health insurance policy and to contact the insurer directly in case of any uncertainty.

The editorial team of this website strives to provide accurate and up-to-date information based on thorough research and multiple sources. Nevertheless, errors may occur or some information may not be fully verified. Therefore, the information presented in these articles should be regarded as an initial point of reference only, and readers are advised to contact the competent authorities for definitive and legally binding information.