Leistungen bei Schwangerschaftsabbruch Gewährung

If you want to have an abortion, you can apply to the statutory health insurance fund to have the costs covered under certain conditions.

If the abortion is performed for criminological or medical reasons, the costs will be covered by the health insurance company and billed by your doctor via the electronic health card (eGK). A prior application for cost coverage is not required. This is the case in the following two constellations:

• If the termination of the pregnancy is necessary from a medical point of view in order to avert a danger to your life or the risk of serious impairment to your physical or mental state of health, the health insurance company will cover the costs of the abortion. In this case, it is not necessary to apply to the health insurance company for the costs to be covered, as the doctor will make the necessary determination.
• If the pregnancy is to be terminated because it is the result of an offense against sexual self-determination, for example in the case of rape, the health insurance company will cover the costs of the abortion if no more than 12 weeks have passed since conception. In this case, it is not necessary to apply to the health insurance company for the costs to be covered, as the doctor will make the appropriate findings.

If the abortion is performed for other reasons, it is illegal but not punishable if the following conditions are met in full:

• You prove to the doctor by means of a certificate from a recognized conflict counselling centre that you have sought advice from a pregnancy conflict counselling centre at least three days before the procedure.
• A doctor will perform the abortion.
• A maximum of 12 weeks have passed since conception.

In this case, the health insurance fund will cover the costs of

• medical advice on the preservation and termination of the pregnancy,
• medical treatment with the exception of the abortion and follow-up treatment if there are no complications,
• the provision of medicines, dressings and remedies and
• hospital treatment

The costs for the medical procedure of the abortion itself and for medical aftercare if there are no complications are not covered by health insurance.

However, if you have little or no income, in certain cases you can apply to your statutory health insurance fund to have the costs of these services covered. This is the case, for example, if you are considered to be in social need.

If additional cost coverage is requested in cases where there is no medical or criminological indication:

• Proof of your personal income and financial circumstances, e.g. current salary statement or bank statement

Please contact your health insurance company to find out which additional documents are required in addition to proof of your personal income and financial circumstances.

If there is no medical or criminological indication, you are entitled to full coverage of the costs of an abortion by the statutory health insurance fund if

• you have your place of residence or habitual abode in Germany and
• after examination by the health insurance company, you cannot reasonably be expected to bear the costs of the abortion for financial reasons. You can find out the exact requirements and income limits for this from your health insurance company.

An unreasonable cost burden exists for you in particular if you

• receive assistance with living expenses ("social assistance") or
• receive income support;
• have a disability and receive training support (training support within the framework of the Federal Employment Agency's order on individual support for vocational training or on employment and vocational support for people with disabilities) or
• a training grant under the Federal Training Assistance Act (BAföG) or
• receive benefits under the Asylum Seekers Benefits Act;
• are accommodated in a home or similar facility and the costs for this are borne by social welfare or youth welfare.

You do not have to pay anything for the application.

You can submit the application for cost coverage for abortion by post and - with many statutory health insurance companies - online or in person at the office. It is usually possible to obtain advice over the phone or at the office on the best way to submit the application. Normally, the procedure is as follows:

• Fill out the application for cost coverage from your statutory health insurance provider.
• Submit the application together with the required documents to your health insurance company.
• With most health insurance companies, you can also submit the application directly to the office. The application is usually processed immediately.
• The health insurance company will check your application and issue you with a cost coverage certificate if the requirements are met.
• You should give the cost coverage certificate to your doctor together with the certificate confirming that you have received counseling at a conflict counseling center.
• Your doctor will bill the responsible office for the abortion. You do not have to pay anything.

• Note (for more information on the deadline): You must submit the application for cost coverage before the abortion.
• Abortion is only possible up to the end of the 12th week (in the case of a criminological indication as well as in the case of an illegal but non-punishable abortion).
• Counseling at a pregnancy conflict counseling center must have taken place at least 3 days before the unlawful but non-punishable abortion.

If you do not have statutory health insurance, you can apply for reimbursement of abortion costs to a statutory health insurance fund in your place of residence or habitual abode.

• Objection
• Action before the social court
  

• Statutory health insurance companies cover the costs of an abortion:
  • in exceptional medical cases
  • if the pregnancy is the result of an offense against sexual self-determination (e.g. rape)
• If the abortion is to be performed for other reasons, the statutory health insurance funds have a limited obligation to provide benefits in the case of unlawful but non-punishable abortions (in these cases, the scope of benefits provided by the statutory health insurance fund excludes the performance of the abortion itself as well as medical aftercare in the event of no complications and the entitlement to sickness benefit).
• Application for full assumption of costs for an unlawful but non-punishable abortion; an application for assumption of costs can be made in the case of low income or social need.
• Application must be made before the abortion
• After examination, the health insurance company issues a cost coverage certificate for the treating doctor
• The doctor settles the abortion with the responsible body
• Information from: statutory health insurance companies