Travel costs: when do health insurance providers cover the costs of traveling for medical treatment?

Under certain conditions, health insurance providers cover the costs of travel for medical treatment for people with statutory health insurance. However, cost assumption is very tightly regulated.

It is essential that:

• the travel is required in relation to specific services from the health insurance provider, for example inpatient treatment in a hospital. Travel costs for outpatient treatment are only covered on exceptions.
  The cost of travel for therapeutic treatment such as physiotherapy or massages must generally be borne by the patient as a home visit from the therapist will otherwise be prescribed.
• the travel is necessary for compelling medical reasons, for example due to treatment. Travel to a place of treatment to arrange consultations, find out results or collect prescriptions is not classed as having occurred for compelling medical reasons.

Travel costs are also only covered

• for travel to the nearest treatment location
• if the means of transport selected is medically necessary
• if the cheapest means of transport is used

The “nearest” location is the medical practice located at the shortest distance from the usual place of residence. If multiple medical practices are equidistant away, the insured person can choose between them. In the case of hospital treatment, insured persons can choose between the two hospitals indicated on the medical prescription. 

If treatment is required in a medical practice or hospital that is located further away, evidence of this must be provided. 

The type of vehicle that can be used depends on the person’s health condition and ability to walk. The cheapest option also has to be chosen. Taxis or rental cars can only be used if patients are unable to travel by public transport or in their own car.

Private health insurance

Whether and to what extent a private health insurance provider covers travel costs for treatment not only depends on the medical reasons for the travel but also whether your level of cover includes travel cost coverage. You can find information in your contract or obtain it from your health insurance provider.

Health insurance providers will cover the travel costs for all of the following:

• travel for inpatient treatment in a hospital – in the case of transfer to another hospital, only if this occurs for compelling medical reasons or if it is authorized by the health insurance provider in advance
• travel for pre- and post-inpatient treatment if this can shorten or avoid inpatient or day patient treatment in a hospital
• travel for outpatient operations where this avoids inpatient or day patient treatment in a hospital or where these are not possible
• travel involving medical care or a specially equipped vehicle if the patient depends on this or has a serious, contagious disease (patient transportation)
• travel to a hospital in an emergency vehicle

Health insurance providers differentiate between

• patient travel (Krankenfahrten)
• patient transportation (Krankentransporte)
• travel in emergency vehicles (Rettungsfahrten)

Patient travel (Krankenfahrten)

This means all travel where no professional medical care is provided. The following modes of transport can be used:

• public transport
• private cars
• taxis
• rental cars
• rental cars suitable for wheelchair users
• patient transport service (PTS) rental vehicles or taxis

Patient transportation (Krankentransporte)

This means travel in a specially equipped patient transport vehicle in which medical care is provided by non-medical personnel.  

Travel in emergency vehicles (Rettungsfahrten)

This means all travel in an emergency vehicle that is required due to the condition of the patient’s health. Such vehicles include:

• ambulances
• emergency doctor ambulances
• rescue helicopters

Whether you need a medical prescription for your travel costs to be covered depends on the type of treatment and mode of transport. In some cases, the health insurance provider’s approval is also required.

Patient travel (Krankenfahrten)

No prior approval from the health insurance provider is required for the following types of patient travel:

• travel for inpatient treatment
• travel for pre- or post-inpatient treatment if this can shorten or avoid day patient or inpatient treatment in a hospital
• travel for outpatient operations in a hospital or medical practice where this avoids day patient or inpatient treatment in a hospital or where these are not possible

If you use your own car or public transport, no medical prescription is required. One is, however, required if you travel by taxi or rental car. You can obtain a certificate of attendance at the place of treatment and apply to the health insurance provider for a refund of the travel costs. 

A medical prescription is always required for patient travel for outpatient treatment. This applies regardless of the mode of transport. The health insurance provider’s prior approval is generally also required. 

No approval is required in the case of insured persons: 

• with a disabled ID card marked “AG” (exceptionally physically disabled), “BI” (blind) or “H” (helpless)
• with care level 3 (permanently reduced mobility)
• with care level 4 or 5
• who were classed at care level 2 until December 31, 2016 and have been classed at care level 3 or above since January 2017

Patient transportation (Krankentransporte)

For health insurance providers to cover the cost of patient transportation, this must be prescribed by a doctor. 

For patient transportation for outpatient treatment, you also need prior authorization from the health insurance provider.  

No authorization from the health insurance provider is required for patient transportation for inpatient treatment, pre- or post-inpatient treatment or an outpatient operation.

Travel in emergency vehicles (Rettungsfahrten)

Statutory health insurance providers cover the cost of travel to a hospital in an emergency vehicle. This applies even if no inpatient treatment is required. The costs are settled via the electronic medical data card.

Medical rehabilitation

Whether or not the costs for travel to and from outpatient or inpatient rehabilitation measures are covered must be checked with health insurance providers in advance.

Health insurance providers only cover the travel costs for patient travel or patient transportation for outpatient treatment on exceptions.

For the travel costs for outpatient treatment to be covered, a medical prescription is always required. This applies in the case of both patient travel and patient transportation.

Patient transportation within the scope of outpatient treatment must always be approved by the health insurance provider in advance.

Health insurance providers will cover patient travel for outpatient treatment without prior approval for insurance holders 

• with a disabled ID card marked “AG” (exceptionally physically disabled), “BI” (blind) or “H” (helpless)
• with care level 3 (permanently reduced mobility)
• with care level 4 or 5
• who were classed at care level 2 until December 31, 2016 and have been classed at care level 3 or above since January 2017

Subject to prior approval, health insurance providers will cover the cost of patient transportation for insurance holders

• with an underlying condition that is treated using a treatment plan involving frequent treatment over a prolonged period
• and who are so severely impacted by the treatment or the medical condition that transportation is essential to prevent damage to life and limb.

These conditions are generally present in the case of dialysis treatments, oncological radiation therapy, chemotherapy or certain drug therapies.

All travel within the scope of such treatment can be applied for at the same time.

Transport companies often bill the health insurance providers directly.

If you pay the travel costs, you must apply for them to be refunded retrospectively. To do this, ask your health insurance provider for a travel costs form. Attach documents like medical prescriptions, attendance certificates and proof of costs (taxi receipt, tickets, proof of mileage).

If the health insurance provider reimburses you for the travel costs, you usually have to cover 10 percent of the costs yourself. You must pay a minimum of 5 euros and maximum of 10 euros per journey, but never more than the costs actually incurred. This obligation also applies to children and adolescents.

Return journeys are regarded as two separate journeys. This means you have to make a contribution for each direction. 

In the case of multiple journeys for dialysis, radiation therapy or chemotherapy for cancer, some health insurance providers only require a contribution for the first and last journeys. 

Health insurance providers may reject a claim for the reimbursement of travel costs.

Rejection reasons can include:

• A lack of authorization: The travel costs for outpatient treatments were not applied for in advance. Retrospectively submitted applications for the reimbursement of the costs are rejected.
• Expensive modes of transport (taxis or rental cars): Insured people who require regular outpatient treatment and meet the criteria to be classed as an exception must use public transport or their own car to travel for treatment – unless medically unable to do so. This also applies in rural areas with no or few public transport connections.
• Nearest treatment location: When insurance holders attend a place of treatment that is further away, for example due to the need for a specialist, they must provide evidence of this need.