Living with a chronic illness while studying often means ongoing costs for medication, aids or therapy. Statutory health insurance in Germany limits this burden through copayments (Zuzahlungen) and an annual cap (Belastungsgrenze). This guide explains the 2026 rules, works through an example and shows where the compensation for disadvantages (Nachteilsausgleich) fits in.
Short answer: With statutory health insurance you generally pay 10 percent of the pharmacy price for medicines, at least 5 and at most 10 euros per item (section 61 SGB V). In a calendar year you pay only up to the annual cap: 2 percent of your gross income for living costs, or 1 percent for chronically ill people in continuous treatment for the same serious illness (section 62 SGB V). Last updated: October 2026.
Key points at a glance
- For medicines, the copayment is 10 percent of the pharmacy price, at least 5 and at most 10 euros (section 61 SGB V).
- The annual cap is 2 percent of gross income for living costs, and 1 percent for chronically ill people in continuous treatment (section 62 SGB V).
- Once the cap is reached, your fund issues a certificate of exemption from further copayments.
- The 1 percent cap requires that you document the prescribed health check-ups or take part in a structured treatment programme.
- Compensation for disadvantages during your degree is handled by your university, not by your health insurance fund.
How high are copayments during a degree?
The copayment depends on the type of service. The table lists the most common cases as of October 2026. The rules come from the German Social Code Book V (SGB V), not from individual pharmacies or providers.
| Service | Copayment | Legal basis |
|---|---|---|
| Medicines | 10 percent of the pharmacy price, at least 5 and at most 10 euros per item, never more than the cost of the medicine | Section 61 sentence 1 SGB V |
| Therapeutic services, for example physiotherapy | 10 percent of the costs plus 10 euros per prescription | Section 61 sentence 3 SGB V |
| Aids and appliances | Copayment under section 61 sentence 1; for consumable aids 10 percent of the fund share, up to 15 euros per monthly need | Section 33 (8) SGB V |
| Inpatient treatment | 10 euros per calendar day | Section 61 sentence 2 SGB V |
The rules apply to all statutory members in the same way, regardless of student status. For medicines, the copayment also depends on the pharmacy price. If a medicine costs less than the 5 euro minimum, you never pay more than its cost, because section 61 sentence 1 SGB V caps the copayment at the cost of the medicine.
Exemptions and special cases are clarified with your fund on an individual basis. If you need several services in one year, the amounts add up quickly. That is exactly what the annual cap is for.
When is the annual cap reached?
The annual cap is the amount above which you pay no further copayments in a calendar year (section 62 (1) SGB V). It is 2 percent of your gross income for living costs. For chronically ill people in continuous treatment for the same serious illness, the figure is 1 percent.
Assumption: your gross income for living costs is 12,000 euros a year, you are chronically ill and in continuous treatment, and you pay 10 euros per pack. The cap is then 120 euros. After 12 packs the annual limit is reached, and from the 13th pack no copayment applies in that year.
Without the prescribed health check-ups, the cap for chronically ill people born after 1 April 1972 is 2 percent. In this example that would be 240 euros, or 24 packs. The difference shows why the check-ups are worth taking.
Once you reach the cap, your statutory fund issues a certificate of exemption from copayments (section 62 (1) sentence 1 SGB V). Show it at the pharmacy or practice so that no further copayments are charged.
What counts as a chronic illness for the annual cap?
What matters is that you are in continuous treatment for the same serious illness. The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) defines which serious chronic conditions qualify (section 62 (1) sentence 8 SGB V). Your fund decides whether your condition falls under this definition.
You must prove the duration of treatment every year. The fund can waive this if there is no indication that the treatment has ended (section 62 (1) sentence 6 SGB V). Funds notify members at the start of each year about the check-ups required (section 62 (1) sentence 7 SGB V).
What does compensation for disadvantages do at university?
Compensation for disadvantages (Nachteilsausgleich) is not a service of your health insurance fund. It can cover forms of examination, deadlines and attendance requirements, and it is governed by your university. The usual contacts are the examination office and the student advisory service. The evidence required is set out in your university’s examination regulations.
Our German guide on accessible studies, compensation for disadvantages and support (in German) describes the steps in more detail.
Frequently asked questions
Does the annual cap also apply to aids?
Yes. Copayments from the different service areas count towards the annual cap until it is reached (section 62 (1) SGB V). Keep every receipt and prescription with its date and amount. This makes settling with your fund much easier.
Do copayments for hospital stays count as well?
Yes. Inpatient treatment costs 10 euros per calendar day (section 61 sentence 2 SGB V). These amounts belong to the copayments of the calendar year and count towards the annual cap once you submit the proof to your fund. Keep your discharge documents as well.
What happens if I cannot show the check-ups?
Then the 2 percent cap applies to chronically ill people born after 1 April 1972, instead of 1 percent (section 62 (1) sentence 3 SGB V). Ask your fund which check-ups count. People who take part in a structured treatment programme also qualify for 1 percent (section 62 (1) sentence 4 SGB V).
How does this work in private health insurance?
The copayment rules of the SGB V apply only within statutory health insurance. Private tariffs can include their own deductibles (Selbstbeteiligung), which are set out in the contract. If you are considering a switch, check the deductible carefully, for example with our German guide on private deductibles (in German).
How do you document copayments properly?
Clean documentation saves time and disputes during the year. The annual cap is calculated from the total of your copayments, so you should be able to prove that total. The fund does not automatically record everything, which is why your own overview is worth the effort.
- Keep a list for each calendar year with date, service, amount and copayment. A simple spreadsheet is enough.
- Keep receipts, prescriptions and statements at least until the fund has confirmed the year’s settlement.
- Halfway through the year, ask your fund how much has already been counted.
- Request the certificate of exemption once the cap is reached, and present it for further prescriptions.
If you have several chronic conditions, the link between them matters. The 1 percent cap applies to continuous treatment for the same serious illness. With different conditions, clarify with the fund which treatment counts.
What should you do now?
- Gather all prescriptions, receipts and copayment statements for the current calendar year.
- Ask your fund for the current status of your copayments and whether a certificate is already in place.
- Check whether you have the required health check-ups documented, otherwise the cap remains at 2 percent.
- Contact your university before examinations are due and clarify compensation for disadvantages early.
- If you consider switching, compare statutory and private cover based on your actual yearly need for medicines and therapy. Our approach to personal advice is on our working method page.
Related reading
- Copayment Exemption and Out-of-Pocket Limit for Students
- Health insurance for students: glossary from A to Z
- Gaps in statutory cover: what the fund does not pay (in German)
Sources: Section 61 SGB V, copayments (retrieved October 2026, in German), Section 62 SGB V, annual cap (retrieved October 2026, in German), Section 33 SGB V, aids (retrieved October 2026, in German), Section 27 SGB V, statutory treatment (retrieved October 2026, in German).
Last updated: October 2026. This guide is general information, not individual advice.
