Where does IVF occur
Assumption of costs by
When does the health insurance company pay?
The costs for the consultation and for the examinations for the cause of the infertility are covered by the statutory health insurance. Hormone therapies for women to support egg cell maturation are completely covered by statutory health insurance. Inseminations or IVF / ICSI treatments have been covered by at least half of the health insurances since 01.01.2004, some health insurances also completely. In the consultation, we will explain the costs that may arise in individual cases. The prerequisite for statutory health insurance is that the partners are married, at least 25 years old, the woman under 40 and the man under 50 years old.
We are happy to support you in clarifying with the health insurance companies and also offer you the option of payment in installments.
Statutory health insurance benefits
At least 50 percent of the treatment and medication costs for a total of:
- 8 cycles of insemination in a spontaneous cycle
- 3 cycles of insemination with hormonal stimulation and
- 3 cycles of IVF / ICSI treatment.
Requirements for fifty percent reimbursement of costs
- The woman must be at least 25 years old and not more than 39 years old.
- The man must not be older than 49 years old.
- The couple must be married to each other.
- Before the start of treatment, a written declaration of cost coverage (so-called treatment plan) must be submitted to the health insurance company. You will receive this treatment plan from us.
- If a clinically proven pregnancy occurs within the approved treatment attempts, there is an entitlement to fifty percent reimbursement of costs for further therapy.
- If the treatment results in the birth of a child, there is a renewed entitlement to all benefits.
- Cryopreservation (freezing) of fertilized egg cells, sperm or testicular tissue is not a service provided by the statutory health insurance companies.
Private health insurance
The contracts of private health insurers are not standardized. In principle, the application for reimbursement of costs must be submitted to the insurance company of the partner who is the cause of the sterility. We will be happy to send you a letter of application after the treatment method has been determined. We recommend submitting the application in good time so that the assumption of costs can be clarified before the start of therapy.
Couples who pay for themselves are couples who do not meet the requirements for the statutory health insurance to cover 50 percent of the costs, couples from abroad or those who are privately insured who cannot be covered by their private health insurance.
The costs can be deducted for tax purposes under certain circumstances.
insemination = Semen transmissionIVF = in vitro fertilization = artificial inseminationin vitro = Latin In the glasICSI = Intracytoplasmic sperm injectionCycles = Treatment attemptsSpontaneous cycle = Attempted treatment without hormonal stimulation
IN DETAIL - BASIC REGULATIONS
For those with statutory health insurance, the requirements result from the regulations in Section 27a of the Book V of the Social Code and other guidelines. After that, one must before treatment Treatment plan be submitted to the health insurance company. The partners need to be with each other married be. Also there is Age limits. Both partners must have reached at least the 25th year of life, whereby the woman must not be over 40 and the man must not be over 50 years of age. It will be for at most three attempts an IVF or ICSI treatment or for eight inseminations, 50% of the treatment costs are borne. It is essential that that Person principle applies. This means that a health insurance company only reimburses those costs that arise for the treatment of its insurance member. How the partner is insured is irrelevant.
Private health insurance
In the case of privately insured persons, the specific insurance contract is decisive. The specific general insurance conditions and the tariff conditions regulate whether or to what extent costs in the area of "artificial insemination" are reimbursed. These must be examined! Basically there is no previous one Approval required. The partners do not have to work together either married be. It applies here Causation principle. This means that, in addition to other conditions, the health insurance is only liable to reimbursement if the insured person caused the treatment. In this case, the treatment costs are generally increased 100% reimbursed if additional certain Chances of success are present. In addition, the BGH ruled that a medical probability of 15% must be achieved. As long as this is achieved, it is often the Number of attempts not restricted.
For those entitled to aid, the regulations in the state aid regulations of the individual federal states and the federal government as well as their administrative regulations apply. It is the same for all state aid regulations that the regulations in § 27a SGB V should apply. Thus, the aid can basically be seen like a statutory health insurance fund with the aforementioned regulations in Section 27a of the Book V of the Social Code.
In the meantime, fertility treatment is recognized as a medically necessary curative treatment and not rejected because the maintenance of the ability to serve and military service of police officers and soldiers is not affected. The Federal Administrative Court has decided that the law on state aid is to be applied in principle.
A taxpayer can in principle receive a reduction in income tax because of the costs of fertility treatment. According to the case law of the Federal Fiscal Court, the costs of non-marital cohabitation and heterologous treatment with donor sperm are also recognized.
More help with the desire to have children - NRW supports couples with artificial insemination
Dusseldorf. North Rhine-Westphalia financially supports couples who do not wish to have children with expensive medical treatments. For the first time this year, the state is taking part in a corresponding federal program and is providing 3.7 million euros, said Family Minister Joachim Stamp (FDP) on Tuesday. "The desire to have children must not fail because of money."
So far, health insurance companies have paid half of the treatment costs for the first three attempts at artificial insemination - and that only for married couples. Unmarried couples do not receive any allowance. In future, the state government will support married couples and unmarried couples with their main residence in North Rhine-Westphalia in the first four attempts at treatment in North Rhine-Westphalia.
The costs are between 2500 and 5000 euros per treatment, depending on the method. In the case of married couples, the state and the federal government will in future take on half of the co-payment. Unmarried couples receive 25 percent of their own contribution for the first to third attempts and up to 50 percent for the fourth attempt.
The state of North Rhine-Westphalia also subsidizes them with a maximum of 270 euros each for the first three attempts. According to the information, applications can be submitted online from August 30th.
Source: WDR from July 2nd, 2019
All information at:
Due to the different derivation of the reimbursement of treatment costs shown, problems arise most when "Mixing ratios"Are available. This applies if both partners are not insured with the same health insurance, or if one partner has statutory health insurance and the other has private health insurance. This is where the rigid regulations in Section 27a of Book V of the Social Code come up against the private system of the causation principle and the chances of success. If a partner is also eligible for subsidies, they arise Claims against multiple payersthat should be known. The network requires an unconditional individual examination.
The Co-causation The fertility treatment by both partners should be checked. A private health insurance company often claims that its member is not causing the treatment. But this does not necessarily mean that the other partner has no chance.
The most common problems are due to private health insurance claims Indication of treatment do not exist for the treatment that Causation lie with the other partner or the chances of success are under 15%. Also is the AMH value used or recently often the evaluation of the Semen analysis. Here medicine and law must work together on the basis of the specific findings.
It should be noted that the Referral to another insurance company is illegal. The BGH and the BSG have ruled that one insurance company cannot make its reimbursement dependent on the performance of another. No health insurance can do this Information and documents about which others require.
The cost of a Cryopreservation, so for freezing egg cells are generally not reimbursed because it is not a treatment. But there are few exceptions to this principle.
Treatment costs one heterologous treatment with donor sperm have not yet been reimbursed by statutory health insurance or private health insurance. A heterologous treatment with egg donation prohibits the ESchG.
The health insurances cannot get into that medical planning of treatment intervention. This lies in the hands of the couple together with the doctors and results from the specific medical findings.
This presentation should be a first general introduction to the topic. A Case-by-case examination is recommended.
Text: Attorney Andreas Maria Wucherpfennig, info © ra-wucherpfennig.de, Mobile: 0151 24071888, www.ra-wucherpfennig.de
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