Apply for cost absorption for abortion at the statutory health insurance company
If the abortion is performed for criminological or medical reasons, the costs will be covered by the health insurance fund and settled 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 constellations:
- If the termination of the pregnancy is necessary from a medical point of view in order to avert a danger to your life or the risk of a serious impairment of your physical or mental state of health, the health insurance fund will cover the costs of the termination of pregnancy. In this case, it is not necessary to apply to the health insurance fund for the costs to be covered, as the doctor will make the necessary determination.
- If the pregnancy is to be terminated because it is the result of a criminal offence (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, it is not necessary to apply to the health insurance fund for the costs to be covered, as the doctor will make the relevant findings.
If the abortion is carried out for other reasons, the abortion is illegal if the following requirements are met in full, but it is not punishable:
- You expressly request the abortion.
- You prove to the doctor by means of a certificate from a recognised conflict counselling centre that you have sought counselling from a pregnancy conflict counselling centre at least three days before the procedure.
- A doctor will perform the abortion.
- No more than 12 weeks have passed since conception.
In this case, the health insurance company covers the costs for:
- the medical consultation on the maintenance and termination of the pregnancy,
- medical treatment, with the exception of abortion and post-abortion care in the event of no complications,
- the supply of medicines, dressings and remedies, and
- hospital treatment
The costs for the medical performance of the abortion itself as well as for the medical aftercare are not covered by the health insurance.
However, if you have a low income or no income at all, you can apply to your statutory health insurance fund to have the costs of these services covered in certain cases. This is the case, for example, if you are considered socially needy.
Details
Prerequisite
You are entitled to have your costs covered by the statutory health insurance if
- you have your domicile or usual place of residence in Germany and
- after examination by the health insurance fund, you cannot reasonably be expected to bear the costs of the abortion for financial reasons. You can find out the exact requirements and income limits for this from your health insurance fund.
An unreasonable cost burden exists for you in particular if you receive
- receive help to live ("Sozialhilfe") or
- receive unemployment benefit II;
- have a disability and receive training assistance (training assistance within the framework of the order of the Federal Employment Agency on the individual promotion of vocational training or on the promotion of work and careers for people with disabilities) or
- a training grant under the Federal Training Assistance Act ("Bafög") or
- receive benefits under the Asylum Seekers' Benefits Act;
- are accommodated in a home or similar institution and the costs for this are borne by social welfare or youth welfare.
Procedure
You can submit the application for the assumption of costs in the event of an abortion by post or - in the case of many statutory health insurance funds - in person at the office. As a rule, a telephone consultation or consultation at the office on the best possible procedure for submitting the application is possible. Normally, the procedure is as follows:
- Fill out the application for cost coverage of your statutory health insurance.
- Submit the application together with the required documents to your health insurance company.
- You can also submit the application directly to the office of most health insurance companies. As a rule, the application is processed immediately.
- The health insurance fund will check your application and, if the requirements are met, will issue you with a certificate of cost coverage.
- You should give the cost absorption certificate to your doctor together with the certificate confirming that you have received counselling at a conflict counselling centre.
- Your doctor will settle the costs of the abortion with the relevant office. You do not have to pay anything.
Deadlines
- You must submit the application for cost coverage before the abortion.
- The abortion is only possible until the end of the 12th week (in the case of a criminological indication as well as in the case of an illegal but non-punishable abortion).
- At least 3 days before the unlawful but unpunished abortion, a consultation must have taken place at a pregnancy conflict counselling centre.
Required documents
As a rule:
- Proof of your personal income and financial circumstances, for example current salary statement or bank statement.
Please contact your health insurance company to find out which documents are required in addition to proof of your personal income and financial circumstances.
Costs
You do not have to pay anything for the application.
Processing time
The processing usually takes about 1 to 2 working days.
For rapid processing and decision-making, your health insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
The health insurance fund decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time indicated is an average value for all health insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your health insurer by post.
Miscellaneous
If you do not have statutory health insurance, you can apply for reimbursement of the costs of an abortion from a statutory health insurance fund in your place of residence or usual place of stay.
Release note
Federal Ministry of Health