Co-payment exemption
Under certain conditions, you may be exempt from co-payments
People with statutory health insurance pay part of the costs for some medical services themselves, for example, for physical therapy, medication, or hospital treatment. This portion is called a co-payment.
Co-payments are usually 10% of the cost of a service. For inpatient treatment, however, for example in hospital or during a spa treatment, insured persons pay an additional €10 per calendar day for the first 28 days.
You can find out which co-payment applies to which type of service and how much you have to pay on the
Co-payment limit
The co-payment limit is the maximum amount you have to pay for your co-payments. Co-payments are limited to 2% of a household's gross annual income. If a person in the household has a serious chronic illness, co-payments are limited to 1% of gross annual income.
The income and co-payments of all family members in the shared household are always taken into account for the calculation. In addition, allowances for spouses, partners, and each child are deducted.
The co-payment limit is always calculated jointly for all family members in a household. The household includes
The co-payment limit is always calculated for all family members in a household together. Once they have reached the two percent limit, the insured person and all of the above-mentioned family members living in the household are exempt from further co-payments for the remainder of the calendar year.
An exemption from co-payments always applies for one calendar year, i.e. from January 1 to December 31. The co-payment limit must therefore be recalculated each year, even if your income has not changed.
All personal income available to family members living in the household for living expenses is used to calculate the co-payment limit, regardless of whether it is taxed or not. This includes, among other things:
Please include appropriate proof of all income with your application. This includes:
Do your spouse and/or children live in your shared household? If so, allowances will be deducted from your total income when calculating your tax liability. These allowances are reviewed annually.
| Years | Allowance for spousal | Allowance per child |
|---|---|---|
| 2026 | €7,119.00 | €9,756.00 |
| 2025 | €6,741,00 | €9,600.00 |
| 2024 | €6,363.00 | €9,312.00 |
| 2023 | €6,111.00 | €8,952.00 |
| 2022 | €5,922.00 | €8,548.00 |
| 2021 | €5,922.00 | €8,388.00 |
| 2020 | €5,733.00 | €7,812.00 |
Certain types of income are not considered when calculating your co-payment limit. These are usually payments intended to cover additional expenses caused by disability, illness, or the need for care. Examples include:
Please still list all income on your application for exemption from co-payments to avoid unnecessary follow-up questions.
For some people, income is not calculated individually but based on a legally defined standard amount. This so-called standard needs rate is €6,756 for 2026 (€6,756 in 2025). This special rule applies to individuals who, for the year they are applying for exemption, meet one of the following conditions:
Please include the official approval notice of the respective benefit with your application for exemption from co-payments.
A summary of the standard needs rates and the corresponding co-payment limits can be found here:
| Year | Standard rate mothly | Standard rate annually | Burden limit (2%) |
|---|---|---|---|
| 2024 - 2026 | €563.00 | €6,756.00 | €135.12 |
| 2023 | €502.00 | €6,024.00 | €120.48 |
| 2022 | €449.00 | €5,388.00 | €107.76 |
Your co-payment limit is reduced to 1% if a member of your household suffers from a severe chronic illness. A condition is considered severe and chronic if it has required medical treatment for at least one year, at least once per quarter (ongoing treatment).
Additionally, at least one of the following must apply:
Mr. M. contacts SBK to request an exemption from co-payments. He receives a retirement pension of €800 per month before deductions (gross pension) and additional rental income of €150 per month.
| Income | monthly rate | annual rate |
|---|---|---|
| Old-age pension | €800 | €9,600 |
| Rental income | €150 | €1,800 |
| Total | €950 | €11,400 |
Mr. M.’s total annual gross income is therefore €11,400. This means he must pay up to €228 per year in co-payments himself. Any amount above this will be reimbursed by SBK.
This year, he has already contributed to his treatment costs several times, for example during a prolonged hospital stay:
| Service | Amount of co-payments |
|---|---|
| Hospital treatment | €200 |
| Medication | €20 |
| Physiotherapy | €20 |
| Total | €240 |
Mr. M.’s total annual gross income is therefore €11,400. This means he must pay up to €228 per year in co-payments himself. Any amount above this will be reimbursed by SBK.During the year, he has already made several co-payments, for example for a hospital stay, totaling €240. Since his personal co-payment limit is €228, SBK will reimburse him €12. He will also receive an exemption card, allowing him to avoid further co-payments for the rest of the year.
If Mr. M. were chronically ill, his personal co-payment limit would be €114, and he would be reimbursed €126.
You can skip collecting receipts: if you already know that you will spend 2% (or 1% if chronically ill) of your income on co-payments in the coming year, you can transfer this amount to us in advance. You will then receive your exemption card at the beginning of the year and won’t have to make any further co-payments during the year. Please contact your personal SBK consultant if you are interested.
Important: If your actual expenses stay below the co-payment limit, the advance payment cannot be refunded. Therefore, prepayment is mainly suitable for people with long-term chronic illnesses who can reliably estimate their annual co-payments.
How to apply for a co-payment exemption
1. You have already made co-payments this year?
Apply easily via Meine SBK. Alternatively, you can download the application form below, fill it out, and send it by post together with your payment receipts. You can find our address and a prepaid envelope
We will check whether your co-payments exceed your limit and reimburse any amount above it to your account. Please note that the statutory limitation period for claims is four years. You can use the SBK co-payment calculator in advance to estimate your individual limit.
2. You would like to be exempt in advance to avoid collecting receipts?
You can also apply for a co-payment exemption easily via Meine SBK.
You then transfer the amount corresponding to your expected co-payments. After that, you will receive your personal exemption card, which you can present at pharmacies and other service providers.
If you are already exempt from co-payments for the current calendar year, we will automatically send you an application form to participate in our prepayment program at the beginning of the fourth quarter.
