Measures to induce pregnancy under statutory health insurance; applying for cost coverage

If you have been diagnosed by a doctor as being unable to conceive naturally and artificial insemination is suitable, the statutory health insurance funds will cover part of the costs under certain conditions.

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You can apply for benefits on the portals of the statutory health insurance funds via the Kassen-Navigator of the GKV-Spitzenverband.

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 sufficient chance of success for the respective treatment measures if

in the case of insemination in a spontaneous cycle up to eight times,
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.

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.

Required Documents
- 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.

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 and - with many statutory health insurance companies - online or in person at the office.
Send the completed sample form of the treatment plan with both copies as well as any other required documents by post 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 forms and hard copies.
You give the cost coverage certificate to your doctor.
Your doctor will bill your health insurance company directly via your electronic health card. You will receive an invoice for your own contribution.

You do not have to pay anything for the application.

You must submit the application before artificial insemination or cryopreservation of your sperm or eggs.

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 company by post.

The Medical Service may need to be involved. This can then lead to a processing time of up to 5 weeks.

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 ask your health insurance provider for advice on this.