town hall
Procedure descriptions

Statutory health insurance - apply for exemption from co-payment

For many services, such as medication, physiotherapy or hospital treatment, you have to make a co-payment. There is a limit so that you are not overburdened financially. If you have reached the limit that applies to , you can apply to your health insurance company for an exemption from co-payment.

Tip: You can find a detailed list of services subject to co-payment on the websites of many statutory health insurance companies. You do not have to make co-payments for many medicines.

Amount of the co-payment limit:

  • Per family 2% of the gross income for living expenses.

This family income includes all financial income of the insured person and the co-insured family members living in the same household. Income from letting and leasing or capital income is also included in the calculation.

  • Seriously chronically ill persons undergoing long-term treatment: 1 % of gross income for living expenses. This limit also applies to your family members with family insurance. An illness is considered to seriously chronic if it has been medically treated at least once per quarter for at least one year and fulfils additional criteria.

As a chronically ill person, you will only receive the reduced contribution limit of one per cent if you submit a chronic illness certificate issued by a doctor to the health insurance company.

  • Children under the age of 18: no co-payments. Exception: travelling expenses.

Tip: Many health insurance companies offer a co-payment calculator on their websites, which you can use to determine your maximum co-payment.

Responsible department

Your health insurance company



You have reached your limit in the current calendar year.


You must apply in writing to your health insurance company for exemption from co-payments; some health insurance companies already offer digital exemption applications. Provide receipts to prove that you have reached your personal limit.

Please note: You will receive a receipt containing your personal details for each co-payment,which you keep. This also applies to the receipts of your co-insured family members.

Your health insurance company will check whether you can be exempted from further co-payments for the rest of the year. If you have reached your limit, you will a notice of exemption from the health insurance company.

Please note: If you have already made too many co-payments in the current calendar year, you will be reimbursed the excess amount by the health insurance company. You can also apply for a refund in the following year.


Please contact your health insurance company.

Required documents

  • Proof of income
  • for exemption from co-payments for the rest of the year: receipts for co-payments made
  • for chronic illness: medical certificate or "chronic illness certificate"


The application and the notice of free of charge.


There is a special feature for dentures: if you have a low income, your health insurance company can grant an additional amount on presentation of the treatment and cost plan. The health insurance company's share of the costs is limited to twice the fixed allowance.

Please note that you must submit the application for cost coverage before the dental treatment begins. You will also receive the treatment and cost plan from your dentist before treatment begins.

Legal basis

Sozialgesetzbuch Fünftes Buch (SGB V)

  • § 61 Zuzahlungen
  • § 62 Belastungsgrenze

Release note

machine generated, based on the German release by: 13.05.2024 Sozialministerium Baden-Württemberg


Bürger- und Standesamt (Bürgeramt)
Grabenstraße 15
89522 Heidenheim an der Brenz
Fax (0 73 21) 3 23-33 32