Abroad, German statutory health insurance does not pay a flat amount. What it covers depends on whether you are inside the EU or outside it, whether you receive treatment in kind or pay yourself, and how long you stay. Students studying abroad should know these differences before a bill arrives. This guide sets out the rules, with date and source.
Short answer: Within the EU, the EEA and Switzerland, your statutory insurer covers necessary treatment with the European Health Insurance Card (EHIC) under the same conditions as for local residents. Outside that area it pays only in narrow cases under section 18 SGB V, usually up to domestic cost levels and, for temporary stays, for at most six weeks per calendar year. Last updated: October 2026.
The most important points at a glance
- Inside the EU, your insurer covers necessary treatment with the EHIC under the conditions of the host country.
- Benefits in kind and reimbursement are two different routes. With reimbursement you pay first and claim back later.
- Outside the EU and the EEA, section 18 SGB V applies. The insurer may pay, but usually only within limits.
- The EHIC does not cover return transport or private treatment, and the statutory insurer usually does not pay for these either.
- Collect all receipts, diagnoses and payment proofs from the start, or reimbursement becomes difficult.
How does treatment in another EU country work with the EHIC?
The EHIC entitles you to use necessary services in the host country under the same conditions and at the same cost as local residents. The European Commission describes this as protection for acute illness, accidents and necessary treatment that cannot wait. You show the card at treatment, and the doctor or hospital settles the bill through the local system where benefits in kind are available.
If you pay yourself, for example because a practice only accepts cash or invoices, you can apply to your German insurer for reimbursement. The amount follows the rules of the insurer and of the host country. Part of the cost can remain with you, so check the scope of benefits. The German liaison body for cross-border cases is the DVKA (Deutsche Verbindungsstelle Krankenversicherung Ausland, the German health insurance liaison office abroad).
What does the insurer pay outside the EU and the EEA?
Outside the EU and the EEA the position is narrower. Under section 18(1) SGB V, the insurer can cover costs in whole or in part if treatment meeting the medical standard is available only outside the EU and the EEA. For temporary stays, section 18(3) SGB V says that urgently needed treatment is covered only if it could also be provided in Germany. Costs are limited to domestic levels and to six weeks per calendar year. According to the statute, these rules apply accordingly to study-related stays abroad.
| Benefit | Inside EU and EEA with EHIC | Outside with section 18 SGB V |
|---|---|---|
| Necessary treatment | yes, under the conditions of the host country | only in exceptional cases, domestic cost level as the cap |
| Time limit | no fixed limit named in the statute | at most six weeks per calendar year for urgently needed treatment |
| Return transport | not covered by the EHIC | as a rule not covered by the insurer |
| Private treatment | not covered by the EHIC | not provided for |
Which documents do you need for a reimbursement?
Reimbursement often fails because documents are missing. The insurer usually needs the original invoice, proof of payment, a diagnosis or medical report and details of the treatment. If documents are not in German, a translation helps. Put the file together so that date, treatment and amount are clear.
- Keep the original invoice and the proof of payment, ideally showing date and description of service.
- Request the medical report or discharge letter, if one exists.
- Fill in your insurer’s form and submit it with all documents.
- Keep copies for yourself and ask for confirmation of receipt.
Why travel health insurance can still be necessary
Statutory insurance is not all-round cover abroad. Return transport, treatment in a private clinic or a stay outside the EU can create costs that the insurer does not pay or pays only in part. For the comparison, look at our guide Travel health insurance for Erasmus, USA and work and travel (in German).
What matters is that your cover fits the country and the length of stay. For a short stay inside the EU, the EHIC often suffices, with extra protection for return transport. For a long stay outside the EU, check the cover in writing before you leave.
Which mistakes cost you most in a reimbursement?
In practice, reimbursements rarely fail over the amount. They fail over formalities: incomplete documents, missing translations and deadlines that pass because post abroad is delayed. A few habits prevent most of this.
- Never keep only a photo of an invoice. Keep the original or a complete copy.
- Write down the diagnosis and the type of treatment, even if the practice explained it only briefly.
- Note the deadlines for applications in your calendar as soon as you receive a decision.
- Answer any questions from your insurer within the set deadline, so the file does not stall.
Frequently asked questions
Does the EHIC pay for everything abroad in the EU?
No. The EHIC covers necessary treatment under the conditions of the host country. Return transport, private services and treatment you travel for specifically are excluded. It is also no replacement for travel insurance.
Do I always have to pay in advance abroad?
Not necessarily. With the EHIC, treatment can be provided in kind, and the provider then settles the bill. If the practice demands payment up front or does not accept the card, you pay first and apply for reimbursement.
Who is responsible for the reimbursement?
Your German health insurer is responsible. For cross-border questions, the DVKA supports the process, because as the German liaison body it coordinates with foreign bodies.
What do I do if the insurer refuses a reimbursement?
Ask for the refusal in writing with reasons, and check whether all requirements were proven. A refusal can usually be challenged through an objection procedure. Note the deadlines as soon as you receive the decision.
So proceed like this
- Before departure, check whether the EHIC is in hand and whether your student insurance continues.
- When you need treatment, show the EHIC where possible and secure the receipts at once.
- Apply for reimbursement promptly with complete documents.
- If refused, ask in writing and note the deadline for an objection.
Related reading
- Semester abroad: Do you need travel health insurance? (in German)
- Health insurance during study abroad (in German)
- Health insurance during a semester abroad (in German)
- Travel health insurance for Erasmus, USA and work and travel (in German)
- Health insurance for students in the EU: EHIC and more
Sources: European Commission, European Health Insurance Card (published 5 December 2023); Section 18 SGB V, benefits during stays abroad (version without date, checked October 2026); DVKA, German health insurance liaison office abroad (responsible body, date not checked)
Last updated: October 2026. This guide is general information, not individual advice.
