If you pay a lot in copayments (Zuzahlungen) for medicines, therapies or medical aids in a calendar year, you can apply for a copayment exemption. This checklist explains the copayment cap (Belastungsgrenze), which documents you should prepare and how the application works at your statutory health insurer (gesetzliche Krankenkasse).
Short answer: You apply for the copayment exemption at your statutory health insurer. Once your copayments in the calendar year reach the cap, the insurer issues you a certificate. Under § 62 SGB V the cap is two percent of your annual gross income for living expenses, or one percent for chronically ill people in continuous treatment (Last updated: November 2026).
The most important points
- The cap applies to one calendar year. Counting starts again after the turn of the year.
- The cap is two percent of gross income for living expenses, or one percent for chronically ill people in continuous treatment.
- Income of spouses, registered partners and children living in the same household can be added together under certain conditions.
- The certificate is issued by the health insurer, not by your doctor or pharmacy.
- Each insurer uses its own forms and document lists. What it requests in its application form is decisive.
How high is the copayment cap?
The cap is the upper limit up to which you pay copayments in a calendar year. The relevant figure is your annual gross income for living expenses, meaning what you have available over the year before taxes and contributions are deducted. The insurer applies the rules set out in § 62 SGB V.
| Group of insured persons | Cap | Example at 12,000 euros income (assumption) |
|---|---|---|
| Standard case | 2 percent | 240 euros |
| Chronically ill, in continuous treatment for the same serious illness | 1 percent | 120 euros |
| Chronically ill, born after 1972, without regular health check-ups | 2 percent | 240 euros |
| Chronically ill, takes part in a structured treatment programme | 1 percent | 120 euros |
The example assumes gross income of 12,000 euros per year (assumption). At 24,000 euros of income the standard cap would be 480 euros. The figures follow § 62 para. 1 SGB V as published on gesetze-im-internet.de (accessed November 2026).
Checklist: documents to prepare
- Proof of your gross income in the calendar year, for example payslips, pension notices or notices of social benefits.
- A list or receipts of your copayments in the current calendar year.
- Details of people who live with you in the same household, and their income.
- For a chronic illness, proof of continuous treatment and, where requested, information on health check-ups.
- The application form of your health insurer, usually available for download on its website.
Which documents are sufficient in each case is for the insurer to decide. Ask in advance whether there is a form or an online procedure and which receipts are accepted. Clarifying this before you submit the application means you will rarely need to send supplementary documents.
How the process works at the health insurer
The insurer checks the application against your details and the enclosed documents. Under § 62 para. 1 SGB V it issues a certificate of exemption from copayments once the cap has been reached. No further copayments are due for the rest of the calendar year. The insurer also reminds its members at the start of the year of the health check-ups that can affect the level of the cap.
For a chronic illness you must prove the duration of the treatment every year. The insurer may waive this if there are no signs that the continuous treatment has ended. This saves effort if your treatment has not changed.
Household and shared income
Under § 62 para. 2 SGB V, copayments and gross income of insured persons, spouses or registered partners, children and certain other relatives are added together, provided they live in the same household. Before this happens, the income is reduced: by 15 percent of the annual reference income (Bezugsgröße) for the first relative in the household and by 10 percent for each further relative. For each child, the child allowances under § 32 para. 6 of the Income Tax Act apply, after which the reduction for that child no longer applies.
Students are subject to the same cap. The insurer decides, based on the documents, which income must be included. The specifics for students are explained in Zuzahlungsbefreiung und Belastungsgrenze im Studium (in German).
Which income does not count?
Certain compensation payments and pensions do not count as income for living expenses under § 62 para. 2 SGB V. For recipients of basic income support (Grundsicherung), subsistence assistance (Hilfe zum Lebensunterhalt) or benefits under SGB II, only the standard requirement (Regelbedarf) applies. If one of these situations applies to you, do not calculate it yourself. Ask your insurer or an advice centre for support.
Frequently asked questions
Is the exemption granted automatically?
No. The insurer issues the certificate of copayment exemption once the cap has been reached. You therefore need a document that you can show at the pharmacy or your practice. When you receive it depends on your copayments and on how the insurer processes the case.
Do I have to keep every receipt?
Keep receipts for copayments for as long as the calendar year runs and documents are still outstanding. The insurer’s application form states which receipts it requires. A personal list with date, amount and type of copayment makes the application easier and helps you keep track.
Does the count start again every year?
Yes. The cap applies to each calendar year. Counting starts again on 1 January, even if you reached the cap in the previous year. You may then have to apply again for the new year.
What if the insurer rejects the application?
You can object to a rejecting notice. The deadline and the office to which you must send the objection are stated in the notice of legal remedies (Rechtsbehelfsbelehrung). If you are unsure, a social advice centre can help before the deadline expires.
Are medical aids included?
Yes, to the extent that copayments are due for medical aids. Because § 62 SGB V caps copayments as a whole, they are taken into account for the cap. Which copayment applies to each aid depends on the rules for that service.
What to do now
- Note your copayments for the current year with date, amount and type.
- Collect the income documents for yourself and for relatives who live in your household.
- Download your insurer’s application form or request it, and ask which documents it accepts.
- Submit the application with complete documents and keep a copy for your records.
Related articles
- Krankenkasse 2027: What changes for insured persons and students (in German)
- Copayment exemption and cap for students (in German)
- Copayments 2027: what the GKV contribution stabilisation act changes (in German)
- Copayments for medical aids: what students pay (in German)
- Changing health insurer as a student (in German)
Sources: § 62 SGB V, cap and certificate (gesetze-im-internet.de, as accessed November 2026)
Last updated: November 2026. This guide is general information, not individual advice.
