Cost reimbursement (Kostenerstattung) in the statutory health insurance (gesetzliche Krankenversicherung, GKV) is an optional tariff (Wahltarif). Instead of benefits in kind, where the fund pays the provider directly, you pay the bill first and then claim the amount back from your fund. For students this matters mainly if they have regular providers or prefer this process.
Short answer: Cost reimbursement in the GKV is an optional tariff under § 53 para. 4 SGB V. You pay treatments first and the fund reimburses them according to the tariff. The tariff binds you for at least one year (§ 53 para. 8 SGB V). The fund may charge a premium. Details are set by your fund’s statute and tariff. Last updated: October 2026.
The most important points at a glance
- Cost reimbursement means you pay first and the fund reimburses afterwards. Usually providers bill the fund directly.
- The fund may charge a premium for the tariff. The amount reimbursed can vary between tariffs.
- The minimum commitment is one year. You can end the membership in the tariff at the earliest when that period ends.
- You can limit cost reimbursement to outpatient medical, dental or inpatient care (§ 13 para. 2 sentence 4 SGB V).
- Details such as premium, deductible and special termination rights are set in the statute and tariff of your fund.
What is cost reimbursement in the GKV?
The GKV generally works on the principle of benefits in kind. You receive treatment without paying upfront, and the fund pays the provider directly. Cost reimbursement reverses this process. You pay the bill and the fund refunds the amount. Under the law this is only possible where a statute or the fund’s rules allow it (§ 13 para. 1 SGB V).
For students the relevant option is the tariff under § 53 para. 4 SGB V. It allows members to choose a cost reimbursement tariff for themselves and their family members who are insured with them. The reimbursement can vary by tariff, and the fund may charge special premiums.
What are the binding rules?
The binding period is the key point to check before you decide. Tariffs under paragraphs 2 and 4 have a minimum binding period of one year. Tariffs under paragraphs 1 and 6 have three years (§ 53 para. 8 SGB V). Membership in the tariff can only be ended at the end of that period. The statute must provide a special termination right in particular hardship cases.
| Tariff type | Minimum commitment | Note |
|---|---|---|
| Cost reimbursement (paragraph 4) | one year | Reimbursement instead of benefits in kind |
| Deductible tariff (paragraph 1) | three years | Co-payment for costs with a premium |
| Premium for not claiming benefits (paragraph 2) | one year | Premium if no benefits were used in the year |
Last updated: October 2026. The table shows the statutory periods. Your fund will tell you which tariffs it offers.
Is cost reimbursement worth it for students?
Whether a cost reimbursement tariff pays off depends on two things: the premium and how much treatment you need. A tariff with a premium must save or refund enough over the year to justify the cost. People who rarely see a doctor usually gain little. People with regular specialist appointments should check the numbers carefully.
With benefits in kind you normally pay only the statutory co-payment (Zuzahlung). With cost reimbursement you carry the bill first. Assumption: treatments cost you 400 euros in a year, the fund reimburses 300 euros under the tariff, and the tariff costs a 60 euro premium. You then bear 100 euros yourself plus the 60 euro premium. A tariff pays off only when reimbursement covers almost all costs. Calculate with your fund’s figures, not estimates.
- List last year’s treatments with amounts and billing method.
- Set the premium of the tariff against that list and calculate the difference.
- Check the one-year minimum commitment and the notice period.
- Compare the result with the treatment you expect next year.
How does a reimbursement claim work?
You pay the bill, submit it with proof of payment to the fund and wait for the decision. The fund decides on benefit applications promptly, at the latest after three weeks. If an expert opinion is needed, the period extends to five weeks (§ 13 para. 3a SGB V). If the fund cannot keep to the deadline, it must give reasons. Without a sufficient reason, the benefit is deemed approved after the deadline has passed.
Special rules apply to prior information under this tariff. Sentences 2 and 3 of § 13 para. 2 SGB V do not apply to this tariff. Still, inform the fund early and check the details in your tariff.
Common questions
Can I switch between benefits in kind and cost reimbursement?
A switch is possible, but it is tied to the binding period. While the period runs, you stay in the tariff. Ask the fund for the earliest possible termination date before you change.
Does cost reimbursement also cover dentists and hospitals?
The choice can be limited to outpatient medical, dental or inpatient care. Which areas apply depends on the tariff of your fund. Ask in advance before you book an appointment. Background on fund choice is in Student Health Insurance: Compulsory Cover, Options and Special Cases.
What if the fund refuses a benefit?
If the fund wrongly refuses an urgent benefit or does not provide it in time, it must reimburse the costs of a necessary benefit you obtained yourself, in the amount incurred (§ 13 para. 3 SGB V). In that case a written objection with all documents is worthwhile.
Can I leave the tariff before the period ends?
Only if the statute provides a special termination right in particular hardship cases. Otherwise the tariff is binding until the minimum period ends. Get the rule confirmed in writing before you sign. For the basics of statutory cover, see the glossary for students.
Watching your bills
Cost reimbursement moves the payment step from the fund to you. For larger treatments, agree the costs in advance and ask for a written cost plan. That shows which part can later be reimbursed and which part stays with you.
Keep all original bills, payment confirmations and letters from the fund. Without complete documents, reimbursement can be delayed or refused. A copy with a note of when and to whom you submitted it helps in a dispute.
What to do now
- Compare your fund’s tariffs and note premium, reimbursement scope and minimum period.
- Calculate with last year’s costs, not with an optimistic expectation.
- Ask for the conditions in writing, including the hardship rule.
- Decide only after that, and put the notice date in your calendar.
Related guides
- Health insurance for students: glossary from A to Z
- Student Health Insurance: Compulsory Cover, Options and Special Cases
- Unpaid Health Insurance Contributions: What Students Should Do
- Family Insurance for Students Under 25: Income Limit
Sources (in German): § 53 SGB V, optional tariffs (gesetze-im-internet.de, retrieved October 2026) | § 13 SGB V, cost reimbursement (gesetze-im-internet.de, retrieved October 2026)
Last updated: October 2026. This guide is general information, not individual advice.
