Here we will provide you a general example of what public health insurance should cover. Each health insurance company has the statutory coverage. Benefits differ from company to company, please check with the insurance provider directly.
Expatrio provides the best and fairest rated health insurance fund, Techniker Krankenkasse (TK), below are some of the statutory treatments provided:
- Visits to the Doctor
- How do I get my prescribed medication?
- Dental Treatment & Prosthesis
- Emergency Treatment
- Hospital stays for up to 28 days
Visits to the Doctor
For visits to the doctor you should—if possible call to arrange an appointment beforehand. If you do not, you may have to wait in the queue.
You will be treated after a check-in at the receptionist with your EHIC at the doctors office or the hospital.
How do I get my prescribed medication?
When a medical prescription is required for treatment, the insured person has to make a co-payment for this. The co-payment charge generally amounts to 10% of the dispensing price, a minimum of €5 and a maximum of €10.
In other words, you will only have to pay 10% of what the prescription costs and it must be in between €5 to €10. Please note that some medicines are exempt from this co-payment requirement. In exceptional cases, a doctor may prescribe non-prescription medications at the health insurance company’s expense.
Once you have received a doctor’s prescription, you must go to a pharmacy, “Apotheke” in German. You can show your prescription and it should be ready within the day. If not they will ask you to come back within the following business days.
Dental Treatment & Prosthesis
If you need to see a dentist for treatment, it is always recommended to call and ask if your treatment is fully or partially covered.
For example, a simple yearly clean is covered but more intensive clean is not and may require full payment or co-payment.
If a dental prosthesis is required, the dentist will give you an estimated quote on the treatment and prosthesis. It is then submitted to the health insurance company prior to the dental fitting. In most cases, this requires a co-payment based upon pre-checkups of the dental prosthesis fitting.
The dentist will then bill you directly for the amount not covered by health insurance. Please note that it may happen that you have to privately pay extra for fillings or check-ups because the health insurance companies can only take a specific share of costs for these treatments.
If hospital treatment is necessary, the doctor will refer you for hospitalization. In acute cases, such as an accident or a sudden serious illness, hospital admission is also possible without a doctor’s referral.
There are also medical care centers and hospital ambulances accredited for medical treatment that is covered too.
Hospital stays for up to 28 days
When you are sick and you have to stay in a hospital, the health insurer covers the treatment. You must only pay €10 as a co-payment for a maximum of 28 days per the calendar year.
You can simply apply via the Expatrio platform just like you did with the Blocked Account.