Travel expense reimbursement is an important issue for many patients. This is because trips to the doctor, hospital, or specialist treatment can quickly incur high costs. Under certain conditions, health insurance companies will cover these travel costs in full or in part. This magazin provides magazin comprehensive overview of the applicable regulations, legal basis, and practical steps for reimbursement.
What does travel expense reimbursement mean in healthcare?
Travel expense reimbursement refers to the coverage or reimbursement of costs for travel that is necessary for medical reasons. This includes travel to doctors, medical facilities, hospitals, or outpatient or inpatient treatment.
A distinction is made between:
- Patient transport: Journeys that do not require medical care or special medical equipment in the vehicle (e.g., taxi, private car, public transport).
- Patient transport: Journeys requiring professional care or the special equipment of an ambulance for medical reasons.
- Emergency transport: Transport in acute emergencies where life-saving emergency care is required.
Why is travel expense reimbursement important?
Regular travel represents a considerable financial and logistical burden, especially for chronically ill, mobility-impaired insured persons or people with severe disabilities. Think of weekly dialysis, daily radiation therapy or trips to specialized centers that are further away. Health insurance provides social compensation here and ensures that necessary treatments are not prevented by transportation costs.
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Legal basis for travel expense reimbursement
Section 60 SGB V – Central legal basis
The most important basis is Section 60 of SGB V. It regulates when and to what extent the health insurance fund covers the costs of travel.
Key principle: Travel costs are covered if they are related to a service provided or approved by the health insurance fund and the trip is necessary for compelling medical reasons.
Section 115a SGB V – Pre- and post-hospital treatment
According to Section 115a of the German Social Code, Book V (SGB V), pre- and post-hospitalization treatment is also eligible for reimbursement. In this case, travel costs are covered if these treatments replace or prepare for full hospitalization, as they are directly related to the hospital stay.
Guideline of the Federal Joint Committee (G-BA)
In addition to the laws, the guideline on the prescription of patient transport, ambulance transport, and emergency transport (KTW guideline) issued by the Joint Federal Committee (G-BA) specifies the details regarding prescription and approval. It defines the exact exceptions for trips to outpatient treatment that go beyond the legal requirements.
Which trips are eligible for reimbursement?
Patient transport refers to the transportation of patients to medical treatment without the need for professional care during the journey. It is usually carried out by public transport, private car, taxi, or rental car.
Typical examples:
- Trips for outpatient treatment
- Ways to see a doctor for specialized examinations
- Trips to chemotherapy or radiation treatment
- Trips to dialysis
- Trips to rehabilitation or preventive care
- Trips to inpatient treatment in a hospital or inpatient rehabilitation facility.
patient transport
Medical care or the use of a specially equipped ambulance is necessary for patient transport, for example because the patient:
- must lie,
- must be supervised while driving,
- or is unable to walk and cannot be transported by other means (e.g., wheelchair taxi).
emergency transport
Emergency transport is provided in acute, life-threatening emergencies using an ambulance (RTW) or emergency doctor vehicle (NEF) and is always covered by health insurance without prior approval.
Costs for travel to outpatient treatment – exceptions
Trips for outpatient treatment (e.g., to a general practitioner, specialist, or dentist) are generally not covered. They are only reimbursable in certain exceptional cases if they represent a considerable burden and the trip is medically necessary.
When are trips to outpatient treatment eligible for reimbursement? (G-BA guideline)
- Long-term treatments:
- Trips to chemotherapy
- Trips to radiation therapy
- Trips to dialysis treatment
- Equality with long-term treatment:
- Trips to outpatient treatment for insured persons with a severely disabled person's pass marked aG (exceptional walking disability), Bl (blind), or H (helpless).
- Trips for insured persons who have care level 3, care level 4, or care level 5 and require transportation due to their permanent mobility impairment or mental condition.
- Other rare exceptions: trips that avoid or shorten inpatient treatment (e.g., serial treatment that would normally require hospitalization).
Requirements for cost coverage
- Medical necessity
The trip must be necessary for compelling medical reasons. Medical necessity is the key criterion. A longer journey alone or a desire for greater comfort are not sufficient reasons.
- Medical prescription – Sample 4
A doctor's prescription is almost always required. The attending physician issues the prescription for patient transport on the official Form 4. This form is essential and serves as proof of medical necessity.
Important: The doctor must indicate the necessary means of transportation (e.g., public transportation, private car, taxi/rental car, ambulance) and the medical reason on the form.
- Application for reimbursement of travel expenses
In addition to the doctor's prescription, the insured person usually has to submit an application for reimbursement of travel expenses to their health insurance company. This is particularly necessary in the case of journeys that require approval (e.g., taxi to outpatient treatment).
Pre-approval: When is it necessary?
The approval requirement is the most critical point in reimbursement.
Trips requiring authorization
Many medical trips must be approved in advance.
This applies to:
- Taxi or rental car: If they are to be used for outpatient treatment (except for the above-mentioned long-term treatments, if the requirements are met).
- Recurring outpatient treatments: Even if the medical necessity is obvious (e.g., for long-term treatments such as dialysis, chemotherapy, or radiation), it is often necessary to apply for a permanent or collective permit for a certain number of trips.
- Trips without inpatient stay: Basically all trips for outpatient treatment that do not fall under the emergency or inpatient exception.
Exceptions to travel expense reimbursement without approval
No prior authorization is required for:
- Emergency transport: Acute emergencies.
- Travel to and from inpatient treatment: Travel to and from the hospital if an inpatient stay follows/precedes. In this case, it is sufficient to submit the doctor's prescription retrospectively.
- Emergencies: When immediate treatment cannot be postponed and transportation can only be prescribed retrospectively.
Practical tip: Always obtain approval before traveling! If approval is not obtained, the health insurance company may refuse to cover the costs retrospectively, even if the trip was medically necessary.
Reimbursement of actual costs: Special provisions for persons with severe disabilities
People with a severely disabled person's pass benefit from simplified regulations and are treated in the same way as insured persons undergoing long-term treatment. This applies in particular to the following categories:
- Marking aG (exceptional walking disability)
- Bl (blind) symbol
- Mark H (helpless)
Benefits for those affected:
With a severely disabled person's pass bearing one of the above-mentioned marks, there is generally no need for an individual, time-consuming assessment of the medical necessity of travel for outpatient treatment. This equal treatment means that such travel is considered reimbursable. A doctor's prescription (Form 4) is still required, as is often approval for the travel.
Which modes of transportation are reimbursed?
The health insurance company will generally only reimburse the costs for the most medically necessary and economical means of transport.
| means of transportation | Requirements for reimbursement | Note |
| Public transportation | Whenever they are reasonable. | Standard case. Reimbursement of tickets in the cheapest class. |
| Passenger car (private) | When public transportation is unacceptable or unavailable. | Reimbursement is usually made on the basis of a mileage allowance. |
| Taxi or rental car | Only permissible if medically necessary and other means of transport are unreasonable (e.g., due to severe mobility restrictions). | Subject to approval. The physician must check the "Taxi/rental car" box on Form 4. |
| Ambulance | If lying down during transport or care by medical professionals is necessary. | Doctor checks "Ambulance" on Form 4. |
| Ambulance | In acute emergencies and life-threatening situations. | Always accepted. |
Costs, co-payments, and reimbursement
Amount of reimbursement for travel
Reimbursement will be made for the necessary costs, but only up to the most economical solution (e.g., cheapest available taxi, public transport fare).
Additional payment obligation for patient transport
Insured persons pay a statutory co-payment for travel costs, unless they are exempt.
- 10% of the cost per trip
- Minimum €5, maximum €10 per trip
The co-payment is due for each individual trip (round trips count as one trip for outpatient treatment) and for each patient transport. For inpatient treatment, the co-payment is limited to the first and last trip.
Exemption from co-payment
Exemption from co-payments is possible for:
- Children and adolescents: those under the age of 18 are generally exempt.
- Persons with an exemption card: Anyone who has reached their individual co-payment limit (2% of their annual gross income, 1% for chronically ill persons) receives an exemption card from their health insurance fund.
Typical reasons for rejecting a claim for travel expense reimbursement
- Lack of authorization: The most common reason for rejection. The trip was undertaken without the necessary prior authorization.
- No medical necessity: Although the journey was comfortable, the MDK (Medical Service of the Health Insurance Funds) considered that a cheaper means of transport would have been reasonable.
- Wrong vehicle selected: An ambulance was ordered when a taxi would have been sufficient, or a taxi when public transportation would have been possible.
- Routine outpatient trip: A trip to a specialist for a routine check-up that does not fall under any of the exceptions.
Important terms explained briefly
- Patient transport: umbrella term for patient transport, ambulance transport, and emergency transport.
- Health insurance benefits: The reimbursement of travel costs is a statutory benefit provided by statutory health insurance under clear conditions (Section 60 of the German Social Code, Book V).
- Sample 4: Official form for the medical prescription of patient transport.
- Principle of cost-effectiveness: The health insurance company will only cover the costs of the cheapest, yet medically necessary, mode of transport.
Frequently asked questions about travel expense reimbursement
Does the health insurance company always cover the costs?
No. Health insurance will only cover the costs if there is a legal entitlement, i.e., the trip must be medically necessary, prescribed, and, as a rule, approved in advance.
Do I always have to approve the trip in advance?
No, not in emergencies or for trips to and from inpatient hospital treatment or inpatient rehabilitation. For all other trips requiring approval, in particular taxi rides for outpatient treatment, approval is mandatory.
What should I do if my application is rejected?
You have the right to appeal against the health insurance fund's decision within the period specified in the rejection notice. This should be well-founded and accompanied by additional medical evidence (e.g., a detailed explanation from the doctor as to why the chosen means of transport is necessary).
Conclusion: Well informed about travel expense reimbursement
Travel expense reimbursement is an important form of support for many insured persons. Those who are familiar with the regulations, submit an application in good time, and provide the necessary documentation can have a large portion of their travel expenses reimbursed. Especially in cases of chronic illness, severe disability, need for care, or complex therapies, it is worthwhile to consult with your health insurance provider at an early stage.
Talk to your doctor and your health insurance provider to ensure that you have completed all the necessary formalities before you set off. This will help you avoid unnecessary financial burdens and allow you to concentrate fully on your recovery.
