Statutory health insurance abroad in the EU: your comprehensive guide to seamless cover
25.05.25
7
Minutes
Katrin Straub
Managing Director at nextsure
A medical emergency while on holiday in the EU or during a longer stay can quickly become expensive. Your German statutory health insurance does provide basic cover, but there are important details to bear in mind. This article explains which benefits you are entitled to and how to protect yourself as well as possible.
The topic in brief and concise terms
Your German statutory health insurance is valid with the EHIC in other EU countries for medically necessary treatment in the public system, but benefits and cost coverage are determined by the rules of the host country.
Medical repatriation to Germany is generally not covered by statutory health insurance and can cost tens of thousands of euros; private overseas health insurance is essential here.
Private international health insurance closes important gaps in cover, covers the costs of private treatment and repatriation, and often costs just a few euros per year.
Quick Facts: Statutory health insurance coverage in the EU
Your German statutory health insurance generally also applies in other EU countries. The European Health Insurance Card (EHIC) on the back of your health card is your proof. You receive medically necessary treatment under the conditions of the respective EU country. This means you are treated as if you were insured there. It is important to note that this only applies to the public healthcare system. Private doctors or clinics are often not covered. Repatriation to Germany for medical reasons is usually not covered by statutory health insurance. For longer stays, you should inform your health insurer and, if necessary, apply for form S1. These initial points already show that, despite EU-wide protection, gaps can remain.
The European Health Insurance Card (EHIC) in practice
The EHIC simplifies access to medical care in 27 EU countries, as well as Iceland, Liechtenstein, Norway and Switzerland. It covers medically necessary treatment that cannot be postponed until your return to Germany. This includes doctor visits, hospital stays and medicines. Billing is handled directly between the foreign health insurer and your German health insurer. However, co-payments may apply that are customary in the host country. You often have to pay these yourself on site. For example: if you have to pay ten per cent of the doctor’s costs yourself in France, that also applies to you. The EHIC is not a free pass for free treatment and does not cover planned treatment abroad if the sole purpose of the trip is medical treatment. It is advisable to find out in advance about the healthcare system of the country you are travelling to. The EHIC is an important building block, but not always sufficient, as the next section will show.
Limits of statutory protection: When does it become expensive?
Despite the EHIC, there are situations in which significant costs can arise for you. Statutory health insurance in other EU countries only covers services that are also part of the benefits catalogue of the local statutory insurance scheme in that country. The level of cover can be lower than in Germany. Particularly critical are the costs of medically necessary repatriation. These are almost never covered by the statutory insurer and, depending on the distance and the patient's condition, can amount to several tens of thousands of euros. Treatment in private clinics or by private doctors, which is often available more quickly in other EU countries, is also usually not reimbursed, or only reimbursed in part. For example: a complicated leg fracture while skiing in Austria can quickly cost more than ten thousand euros in a private clinic, of which the statutory health insurer may only cover a fraction. Here is an overview of possible cost traps:
Costs for medically sensible or necessary repatriation (often over EUR 10,000).
Treatment in private clinics or by private doctors (additional costs often several thousand euros).
Higher co-payments for medicines and treatments than in Germany (can quickly add up to hundreds of euros).
Dental treatment that goes beyond simple pain relief.
Services that are not standard in the host country (e.g. certain therapies).
These examples show that a additional cover is often essential. But what options are there?
Additional cover: The essential overseas health insurance
A private overseas health insurance policy fills the gaps in statutory health insurance abroad in the EU. It usually covers the costs of medically sensible repatriation, treatment in private clinics and higher doctors' fees. Many policies cost only a few euros a year, yet provide comprehensive cover. Make sure that the policy covers medically sensible repatriation, not just medically necessary repatriation. For example: even if treatment abroad were possible, repatriation may still make sense so that you can receive care in a familiar environment and language. A good annual travel health insurance policy covers all trips within a year, often for up to six or eight weeks per trip. For longer stays, there are special policies. Our expert tip: always take out the insurance before you travel. The exact terms and benefits can vary, so it is worth taking a close look at the policy details.
Expert knowledge: legal foundations and special cases
The legal basis for health insurance cover in other EU countries is EU Regulation 883/2004. It coordinates social security systems. For hospital treatment in other EU countries, prior approval from your health insurer is often required, except in acute emergencies. If you take up employment in another EU country, you are generally subject to the social security rules of the country of employment. Form S1 (formerly E106) certifies your entitlement to benefits in your country of residence if you work and are insured in another EU country. Pensioners who move their place of residence to another EU country usually remain insured in Germany, but receive benefits in kind in their country of residence via Form S1. Our expert tip: if treatment is planned or you are staying for an extended period, always clarify the details with your health insurer in advance. The German Liaison Office for Health Insurance – Abroad (DVKA) can also help with complex questions. These rules are complex, but good preparation helps you avoid surprises.
Recommendations for your next EU trip
To be optimally prepared for medical emergencies abroad in the EU, we recommend the following steps. Check the validity of your European Health Insurance Card (EHIC). This is usually on the back of your health card. Find out about the healthcare system in your destination country. The standard is not the same as in Germany everywhere. Be sure to take out private travel health insurance. This should include at least medically necessary repatriation and cover the costs of private treatment. Carry important emergency numbers and the contact details of your travel health insurance with you. Here is a checklist for preparing your trip:
Check EHIC: Is it up to date and undamaged?
Take out travel health insurance: Pay attention to the scope of cover (repatriation, private clinic).
Assemble a travel medicine kit: basic medicines for minor ailments.
Save emergency contacts: insurance provider, embassy, local emergency number.
Make copies of important documents: passport, insurance card, insurance policy.
If you have pre-existing conditions: carry a medical certificate (if necessary in English) for essential medication.
Our expert tip: Save the emergency number of your travel health insurance directly in your mobile phone. That way, you can act quickly in an emergency. With these precautions, you can set off on your trip with greater peace of mind.
The statutory health insurance scheme provides basic cover in the EU abroad, but in practice gaps keep emerging. Co-payments, costs for private treatment and, above all, repatriation that is not covered can quickly lead to a financial burden amounting to several thousand euros. Private travel health insurance is therefore an important addition for every EU traveller, even for short trips. It protects you against unforeseen costs and ensures you receive the best possible care in an emergency. At nextsure, you will find tailor-made solutions designed precisely around your needs. We will help you find the right cover for your trips. Get in touch with us now.
Request an individual risk assessment now: Have your insurance situation reviewed free of charge and receive concrete recommendations for optimisation.
More useful links
German Liaison Office for Health Insurance – Abroad (DVKA) provides an information sheet on health insurance abroad specifically for pensioners.
Federal Ministry of Health provides comprehensive information on health insurance abroad.
The National Association of Statutory Health Insurance Funds provides detailed information on the European Health Insurance Card (EHIC).
European Commission provides information on the European Health Insurance Card (EHIC) in the context of EU social security coordination.
Europa.eu explains your rights to healthcare in another EU country.
Federal Statistical Office (Destatis) provides a publication on health insurance based on the microcensus.
European Commission provides an overview of cross-border healthcare in the EU.
German Pension Insurance provides information on receiving a pension and health insurance abroad.
Consumer Advice Centre provides information on health insurance for long stays abroad.
FAQ
Which services exactly are covered by my statutory health insurance in the EU abroad?
Your statutory health insurance covers medically necessary treatment via the EHIC from doctors, dentists and in hospitals that are affiliated with the public system of the respective EU country. The scope of benefits is determined by the regulations of the country you are visiting. This means that you receive the same benefits as someone insured there, but you must also make the co-payments that are customary there.
What happens if I forgot my EHIC while in another EU country?
If you have forgotten your EHIC, contact your health insurance provider in Germany immediately. They can issue you with a Provisional Replacement Certificate (PEB) and often also send it directly by fax or email to the foreign healthcare provider or to you.
Does statutory health insurance also cover planned treatments in other EU countries?
Special rules apply to planned treatment in other EU countries. Outpatient treatment is often possible without prior authorisation, provided the service is also included in the range of benefits in Germany. However, for planned hospital treatment you will almost always need prior authorisation from your health insurer. Be sure to clarify this with your insurer in advance.
What happens to health insurance cover if you stay in or move to another EU country for a longer period?
For longer stays (e.g. sabbatical, study), German health insurance cover often remains in place as long as your main residence remains in Germany. In the event of a permanent move or starting employment in another EU country, the social security rules of the new country of residence or employment usually apply. Inform your health insurance provider in good time and clarify your status (if applicable, form S1).
What is the difference between a medically necessary and a medically advisable repatriation?
A medically necessary repatriation transport applies when adequate treatment is not possible abroad. A medically advisable repatriation transport can also take place if treatment on site would in fact be possible, but a transfer back home is preferable for various reasons (e.g. better chances of recovery, social reasons, language). The statutory health insurance scheme usually does not pay for either, and many private overseas health insurance policies cover medically advisable repatriation transport.
Does the overseas health insurance also cover costs in the event of a pandemic travel warning?
It depends on the specific tariff and the insurance terms and conditions. Some overseas health insurance policies also provide cover if you fall ill (e.g. with COVID-19) abroad despite an existing travel warning, while others exclude this. Check the terms carefully or ask your insurer. In general: a travel warning from the Foreign Office is not a travel ban, but it can have implications for insurance cover.
