Apply for coverage of abortion costs for statutory health insurance policyholders

If an abortion is necessary, you can apply to your statutory health insurance fund to cover the costs under certain conditions.

If the termination of pregnancy is performed for criminological or medical reasons, the costs are covered by the health insurance fund and billed by your doctor via the electronic health card (eGK). A prior application for cost coverage is not required. This is the case in the following two scenarios:

• If the termination of the pregnancy is medically necessary to avert a danger to your life or the risk of serious impairment to your physical or mental health, the health insurance fund will cover the costs of the termination. In this case, it is not necessary to apply to the health insurance fund for coverage, as the doctor makes the necessary determination.
• If the pregnancy is to be terminated because it is the result of a crime against sexual self-determination, such as rape, the health insurance fund will cover the costs of the abortion if no more than 12 weeks have passed since conception. In this case, applying to the health insurance fund for cost coverage is not necessary, as the physician makes the relevant determinations.

If the termination of pregnancy is carried out for other reasons, the termination is unlawful if all of the following conditions are fully met, but it is not punishable:

• You prove to the doctor by means of a certificate from a recognized conflict counseling center that you received counseling at a pregnancy conflict counseling center at least 3 days before the procedure.
• A doctor performs the termination. 
• No more than 12 weeks have passed since conception. 

In this case, the health insurance company will cover the costs for: 

• medical counseling regarding the continuation and termination of pregnancy,
• medical treatment with the exception of the performance of the termination and follow-up care in the event of an uncomplicated course,
• the provision of medicinal products, dressings, and remedies, as well as
• hospital treatment

The costs for the medical performance of the abortion itself as well as for medical aftercare in the event of an uncomplicated course are not covered by health insurance. 

However, if you have no or a low income, in certain cases you can apply to your statutory health insurance fund to cover the costs of these services. This is the case, for example, if you are considered in need of social assistance.

You can submit the application for coverage of the costs of an abortion by mail, as well as—with many statutory health insurance funds—submit it online or drop it off in person at the branch office. As a rule, telephone consultation or consultation at the branch office regarding the best possible procedure for submitting the application is available. Normally, the procedure is as follows:

• Fill out the application for cost coverage from your statutory health insurance.
• Submit the application along with the required documents to your health insurance company.
• You can also submit the application directly at the branch office of most health insurance funds. As a rule, processing takes place there immediately.
• The health insurance company will review your application and issue a cost-coverage certificate if the requirements are met.
• Submit the certificate of coverage along with the certificate confirming that you received counseling at a conflict counseling center to your doctor.
• Your doctor will bill the competent authority for the termination of pregnancy. You do not have to pay anything. 

• Note (for further information on the deadline): You must submit the application for assumption of costs before the abortion. 
• The termination is only possible until the end of the 12th week (in the case of a criminological indication as well as for an unlawful but unpunished termination of pregnancy). 
• At least 3 days before the unlawful, but unpunished termination, counseling at a pregnancy conflict counseling center must have taken place. 

You do not have to pay anything for the application.

• Objection
• Lawsuit before the social court