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Apply for cost coverage for measures to induce pregnancy or for cryopreservation measures for persons insured under the statutory health insurance scheme
Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6PLus)
Before starting treatment, you must submit a treatment plan drawn up by a doctor to the health insurance fund for approval. The statutory health insurance companies cover 50 percent of the costs of the measures approved with the treatment plan.
Treatments on the man's body are covered by the man's health insurance, treatments on the woman's body are covered by the woman's health insurance.
Key requirements are:
- You cannot become pregnant naturally.
- Artificial insemination measures are suitable from a medical point of view to bring about a pregnancy.
- You are married and use your own eggs and sperm.
- Women must be 25 to 39 years old; men 25 to 49 years old.
Your attending physician can advise you about the various methods of artificial insemination.
It often takes several attempts at artificial insemination for you to become pregnant. Artificial insemination measures may only be carried out at the expense of the statutory health insurance funds if there is sufficient prospect that the chosen treatment method will result in pregnancy. The Federal Joint Committee lays down further details in its guidelines on artificial insemination. According to these guidelines, there is no longer sufficient prospect of success for the respective treatment measures if they are
- in the case of insemination in a spontaneous cycle up to eight times,
- in the case of insemination after hormonal stimulation up to three times,
- up to three times in the case of in vitro fertilization,
- in intratubal gamete transfer up to two times,
- Intracytoplasmic sperm injection up to three times without clinical
have been fully performed without a clinically proven pregnancy.
You are entitled to the assumption of costs for cryopreservation measures if this appears to be necessary due to a disease and its treatment with a germ cell-damaging therapy in order to carry out subsequent artificial insemination measures. You can find out what other requirements must be met for this from your relevant health insurance fund.
Normally, the procedure is as follows:
- If fertility treatment has a chance of success for you, your gynecologist will usually refer you to a fertility center.
- The fertility center will draw up a treatment plan.
- The treatment plan serves as an application for cost sharing.
- You can submit the application by mail or - in the case of many public health insurance companies - in person at the office.
- The completed sample form of the treatment plan with both copies as well as any other required documents should be sent by mail to the health insurance company of the woman and the man (if you are insured with different health insurance companies).
- The health insurance company will check your application and issue you with a cost coverage certificate.
- The authorizations are issued on a form and a form of paper.
- You will give the certificate to your doctor.
Your doctor will bill your health insurance company directly for your share via your electronic health card. You will receive an invoice for your co-payment.
- Your doctor has diagnosed you with a fertility disorder. This means that you cannot get pregnant naturally.
- Your doctor confirms that fertility treatment has a chance of success.
- Both partners are married.
- Only your own egg and sperm cells may be used. The statutory health insurance funds cannot cover artificial insemination using the sperm or egg donation of a third person.
- As a woman, you must be at least 25 years old and no more than 39 years old.
- As a man, you must be at least 25 years old and no more than 49 years old.
The costs of a cryopreservation are only covered by the statutory health insurances if there is a risk that you will become infertile due to a disease and its therapy. In addition, the following conditions apply:
- Desire to have children is present.
- Women must not be older than 39 years.
- Men must not be older than 49 years.
- Subsequent artificial insemination measures must be possible on the merits.
Which documents are required?
- Original treatment plan with a copy from the attending physician or the fertility center.
Depending on the special case, further documents may be required. Please contact your health insurance company for more information.
What are the fees?
You do not have to pay anything for the application.
What deadlines do I have to pay attention to?
You must submit the application before artificial insemination or cryopreservation of your sperm or eggs.
Processing usually takes about 3 to 14 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 company decides on applications promptly, while adhering to the statutory processing time limit 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 mail.
If necessary, the Medical Service must be involved. This will take up to an additional 5 weeks to process your request.
Action before the social court
Applications / forms
- Forms: yes
- Online procedure possible: Many statutory health insurers offer an online procedure.
- Written form required: yes
- Personal appearance required: no
What else should I know?
Under certain conditions, you can receive further subsidies from the federal government and some federal states, for example if you live in a same-sex relationship or are unmarried. Information on this can be found, among other places, on the "Informationsportal Kinderwunsch" of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.
In addition to the legally stipulated subsidy of 50 percent of the costs of approved artificial insemination measures, health insurance companies can stipulate higher subsidies in their statutes. Simply ask your health insurance provider for advice on this.
Technically approved by
Federal Ministry of Health