Service Finder
Apply for cost coverage for measures to induce pregnancy or for cryopreservation measures for people with statutory health insurance
Service Description
Before starting treatment, you must submit a treatment plan drawn up by a doctor to the health insurance company for approval. The statutory health insurance companies will cover 50 percent of the costs of the measures approved in 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.
The main requirements are
- You cannot become pregnant naturally.
- From a medical point of view, artificial insemination measures are suitable for bringing about a pregnancy
- You are married and use your own egg and sperm cells.
- Women must be between 25 and 39 years old; men between 25 and 49 years old.
Your doctor can advise you on 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 a reasonable chance that the chosen treatment method will result in pregnancy. The Federal Joint Committee stipulates further details in its guidelines on artificial insemination. According to these guidelines, there is no longer a reasonable chance of success for the respective treatment measures if
- up to eight times in the case of insemination in a spontaneous cycle,
- up to three times in the case of insemination following hormonal stimulation,
- up to three times in the case of in vitro fertilization,
- up to twice for intratubal gamete transfer,
- up to three times in the case of intracytoplasmic sperm injection
without a clinically proven pregnancy having occurred.
You are entitled to have the costs of cryopreservation measures covered if this appears necessary due to an illness 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 health insurance provider.
Process flow
Normally, the procedure is as follows:
- If your fertility treatment has a chance of success, your gynaecologist 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 post or - in the case of many statutory health insurance companies - in person at the office.
- Send the completed sample form of the treatment plan with both copies and any other necessary documents by post to the woman's and the man's health insurance company (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 forms and hard copies.
- You should give the cost coverage certificate to your doctor.
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Your doctor will bill your health insurance fund directly via your electronic health card. You will receive an invoice for your own contribution.
Requirements
- Your doctor has diagnosed you with a fertility disorder. This means that you are unable to conceive 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 with sperm or egg donation from a third party.
- If you are a woman, you must be at least 25 years old and no older than 39.
- If you are a man, you must be at least 25 and no older than 49.
The costs of cryopreservation are only covered by statutory health insurance if there is a risk that you will become infertile due to an illness and its treatment. The following conditions also apply:
- There is a desire to have children.
- Women must not be older than 39 years of age.
- Men must not be older than 49 years of age.
- Subsequent artificial insemination measures must be possible in principle.
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 duration
Processing normally takes around 3 to 14 working days.
In order to process and decide quickly, your health insurance fund must have the necessary information and any required documents in a complete and meaningful form.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent to you or your health insurance fund by post.
The Medical Service may need to be involved. It may take up to an additional 5 weeks to process your request.
Legal basis
Applications / forms
- Contradiction
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Action before the social court
Appeal
- Forms: yes
- Online procedure possible: Many statutory health insurance companies offer an online procedure.
- Written form required: yes
- Personal appearance necessary: no
What else should I know?
Under certain conditions, you can receive further grants from the federal government and some federal states, for example if you are in a same-sex relationship or are unmarried. Information on this can be found on the "Information portal on the desire to have children" of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.
In addition to the statutory subsidy of 50 percent of the costs of approved artificial insemination measures, health insurance companies can regulate higher subsidies in their statutes. Simply contact your health insurance provider for advice.
Further Information
Author
The text was automatically translated based on the German content.
- Measures to induce pregnancy Authorization
Remark: Display of performance in the source portal
Technically approved by
Federal Ministry of Health
Professionally released on
25.10.2021
Source: Zuständigkeitsfinder Thüringen (Linie6PLus)