Treatment Costs

For Publicly Insured Couples

General Conditions and Requirements for Cost Coverage

In 2004, the legal requirements regarding fertility treatment for women covered by the public healthcare systems were changed.

Health insurances in Germany still provide full funding for:

• Consultations
• Diagnostic evaluation for infertility
• Treatment, as long as it is purely based on hormones.

There are certain conditions for assisted reproduction techniques (insemination or in-vitro fertilisation) that must be fulfilled for a health insurance provider to fund 50% of the treatment costs (medications, doctor’s fees, laboratory work):

• The planned treatment must have a chance of success and there is no other way to overcome infertility.
• The couple must be married.
• The woman must be between 25 and 40 years of age with a male partner between 25 and 50.
• Tests show that the woman is sufficiently protected against rubella and that both partners are hepatitis- and HIV-negative.
• An application for funding the fertility treatment costs (so-called treatment plan) must have been submitted and approved by the health insurance provider BEFORE treatment begins.
  This plan may only be issued by physicians qualified in reproductive medicine.

The health insurance providers will generally not fund the treatment if infertility is the result of a previous sterilisation procedure with either partner.

Co-Payment

The following table provides an overview of the following: a) which medical services (artificial reproduction techniques) fall under the special paragraph of the German Code of Social Law [Sozialgesetzbuch V (SGB V), § 27a]; b) the approximate amount of co-payment that members of compulsory health insurances in Germany will be charged; and c) the maximum number of treatment cycles the health insurer is willing to fund if the requirements mentioned above are met. The cost figures in the table include the costs for medical and laboratory services.

* The third IVF or ICSI treatment will only be granted if fertilisation has taken place during the first two treatments.
Patients who became pregnant are eligible for another 50% coverage of a further treatment cycle, i.e., the treatment which led to the pregnancy may be repeated. If it takes more than three treatment cycles to achieve pregnancy, the couple is of course free to continue the treatment at their own cost.

The costs shown in the table are average sums, which may vary depending on the medication prescribed and the required dosage.

As the patients already pay 50% of the medication costs, they are exempt from having to pay the usual co-payment on medications otherwise required by German public insurers for other forms of medical treatment.

The above requirements apply only in those cases where a treatment plan has been approved and is being (partially) covered by the health insurer. There are no restrictions for fertility treatments that you pay on your own.

Costs for self-funded treatments are tax-deductible as “extraordinary expenses”.

For Privately Insured Patients

This applies if at least one of the partners is insured in a private scheme.

Coverage is subject to individual requirements.

Private health insurers will only reimburse the treatment costs if the privately insured person is also responsible for the involuntary childlessness (the so-called “costs-by-cause principle”).

You should in any case apply for reimbursement. We will complete the application form and submit it to your health insurer

There are several ways of applying for reimbursement of treatment costs. It depends on your specific health insurance constellation (e.g. one partner is a member of a compulsory, the other of a private health insurance) and the causes of infertility. We will assist you in any case!

Should your private health insurer refuse reimbursement, you may still start treatment at any time, but you will be responsible for the costs.