If couples want a child and it doesn’t work out, it’s a big burden. In Germany, every sixth couple depends on medical help to have a baby. In addition to psychological and physical challenges, artificial insemination also poses a financial burden for couples. Stiftung Warentest has looked at the subsidies paid by statutory health insurance companies.
Anyone who has been trying unsuccessfully to become pregnant for a year should seek advice from a doctor. If fertility treatment is necessary, Stiftung Warentest points out that couples must first have the treatment plan approved by the health insurance company before the start of treatment – otherwise no costs will be covered by the health insurance companies. Such a treatment plan determines which treatment is suitable for a couple wishing to have children, which medication and examinations are necessary and what the treatment costs.
In order for those with statutory health insurance to have part of the fertility treatment paid for by the health insurance company, they must meet certain conditions. Married couples are reimbursed half of the approved treatment costs for artificial insemination by all statutory health insurance companies. Women and men must not be younger than 25 years. In addition, women must not be older than 39 and men must not be older than 49. A treatment may only be carried out with egg and sperm cells of the spouses. However, this regulation only applies to opposite-sex couples. Health insurance does not pay for the treatment for same-sex couples. Lesbian couples receive grants from the state in Bremen, Berlin, Rhineland-Palatinate, Saarland and Thuringia. Even unmarried couples do not receive a subsidy from the health insurance company. If spouses are insured with different health insurance companies, each health insurance company covers the costs for its insured person proportionately. For people who are privately insured, the assumption of costs depends on the respective tariff.
There are various options for artificial insemination. During insemination, processed semen is injected into the uterus. Depending on the case, the woman may be hormonally stimulated before conception to promote egg maturation. In in-vitro fertilization (IVF), the woman undergoes hormonal treatment. Egg cells are removed from her and fertilized in the laboratory with the man’s sperm. If embryos grow in the egg cells, they are placed in the uterus.
If the sperm quality is not sufficient, the procedure of intracytoplasmic sperm injection (ICSI) is used. A single sperm is injected directly into the egg cell and the embryos obtained are placed in the uterus. With TESA/MESA, sperm are obtained from the testicles or epididymis during an operation and ICSI is then used. This procedure is used when there are not enough intact sperm in the semen.
The costs of artificial insemination can represent an enormous financial burden for couples, despite the subsidy from health insurance. This personal contribution applies to legally insured, married couples:
Insured spouses receive the same statutory subsidy from all statutory health insurance companies for a maximum of eight inseminations without hormonal stimulation of the woman, a maximum of three attempts at in vitro fertilization or three attempts at intracytoplasmic sperm injection. 39 of the 71 statutory health insurance companies in the study by Stiftung Warentest grant an extra subsidy. With the BKK, for example, the costs of the treatment plan are covered 100 percent if both spouses are insured with the health insurance company for the time of the fertility treatment.
In all federal states apart from Brandenburg, Baden-Württemberg, Hamburg and Schleswig-Holstein, couples (married and mostly unmarried) of a certain age are entitled to a cost sharing for the first four IVF and ICSI treatments by the state in cooperation with the Federation. For couples who have to pay for the fertility treatment themselves, the tax return is an option – there it can be claimed as an “extraordinary burden”.
The complete (fee-based) examination is available from Stiftung Warentest!
