Private Health Insurance Patients

Private health insurance patients are not required to apply for a confirmation of cost coverage from their insurance provider before beginning treatment. However, this is recommended before beginning cost-intensive treatments such as IVF and ICSI.
In accordance with the legal requirements, the invoice process for private patients uses the GOÄ fee scale (German physician fees scale). Invoicing is based on what is known as the individual service principle. Generally, a threshold value is applied to private patients to ensure appropriate remuneration of the partial provision of services. The threshold value for general medical services is set at a factor of 2.3, and 1.8 for laboratory services, but this can be exceeded if justified. A factor below 1.0 is prohibited as are fixed fees and the gifting of services.
In contrast to statutory health insurance providers, couples with private health insurance do not have to be married and the women does not have to be under 40 for the insurance provider to agree to cover the costs. However, there must be a medical necessity and an appropriate chance of success.

The requirements for cost coverage are:

  • The privately insured partner must be the “originator” of the sterility.
  • The so-called “originator principle” is applied.
  • If a woman is 40 or older, information must be presented demonstrating that the sterility treatment of this woman is “reasonable and with a chance of success”.
  • Information relating to the menstrual cycle, levels, including AMH (Anti-Müllerian hormone) will be requested. In general, private health insurance providers will not agree to reimbursement for (female) patients older than 43-45 years old.

Additional services which are generally not covered:

  • HALO sperm test (approx. €253)
  • Cryopreservation of fertilised egg cells (approx. €450)
  • Storage costs for 6 months (€150)
  • Extended culture phase (maximum €300)
  • Laser assisted hatching (approx. €200)
  • Acupuncture (approx. €93)
  • Cryo-cycle with the aim of transferring previously frozen fertilised egg cells (approx. €800 to €1,100 Euro) plus costs for medication of approx. €100 to €500 Euro.
  • The treatment with donor sperm is always a self-paying service (for costs, see self-payer plus sperm bank).

Costs

  • Insemination cycle
    approx. €400,
    plus additional medication costs (€50 to €500)
  • IVF (conventional IVF)
    approx. €2,000 to €3,000,
    plus additional medication costs (€1,000 to €2,500),
    plus additional cryopreservation costs if necessary.
  • MINI IVF/ Soft-IVF
    approx.  €1,500 to €2,500,
    plus additional medication costs (€300 to €400)
  • ICSI (conventional ICSI)
    approx. €3,500 to €5,500
    (Calculation of ICSI on 6 egg cells),
    plus additional medication costs (€700 to €2,500),
    plus additional cryopreservation costs if necessary.
  • Mini-ICSI/ Soft-ICSI
    Approx. €2,500 to €4,000
    plus additional medication costs (€300 to €400)

“In accordance with current tax case law, fertility treatment for single women and same-sex couples WITHOUT medical indications is not considered a necessary medical treatment and the full VAT will be applied.”