How does the state health insurance system work?
Health insurance in Austria is a two-tier system, with state-funded insurance (Krankenkasse) covering a wide range of basic medical services, and private treatment adding optional top-ups. Around 99% of Austrian residents are covered by the state health insurance (SHI), which is decentralized and organized into regional authorities (Gebietskrankenkassen).
The World Health Organisation says that around 60% of healthcare is funded from insurance premiums, with the remainder being drawn from taxes. However, the 2010 recession hit Austria hard, and since a percentage of healthcare was funded out of national debt, this has caused problems, resulting in a perceived need to overhaul the system.
Residents pay ‘social insurance,’ comprised of health, pension and accident insurance, which is governed by over 20 statuary bodies, all members of a single professional association: the Main Association of Austrian Social Security Institutions (Hauptverband der österreichischen Sozialversicherungsträger). This decentralization is part of risk pooling, and generally you are not allowed to choose which body you are signed up to.
Health records are digitised and once you sign up, you will be issued with an e-card, proving that you are covered and allowing any claims to be processed quickly and efficiently.
The private sector also has extensive contracts with social services, so even if you do need to make an appointment with a private doctor or hospital, the Austrian state will often make a substantial contribution. Approximately 50% of private doctors and 75% of private dentists are contracted to social services and the e-card system, allowing up to 80% reimbursement of costs.
If you go to a ‘panel’ doctor — one who is employed by the state — your e-card will act as a voucher and you will not have to pay directly: it will already be covered by the state insurance. You will be free to choose your own doctor. Doctors and dentists usually display a sign saying "Kassenarzt" (contracted doctor) or "Alle Kassen", which means they fall under the state system.
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Who is eligible for state healthcare?
Everyone is eligible, with the exception of some international students. Medical insurance is mandatory in Austria.
How do you apply to join the state health insurance system?
If you are working in Austria, you will need to pay into the system in order to be eligible for cover for yourself and your family. The amount you will have to pay depends on your salary, but your employer might contribute to some of the costs.
Your workplace will automatically enroll you and deduct the premiums from your salary, but if you are self-employed, you can sign yourself up. If you are staying in Austria longer than six months, and are self employed, you will need to sign up with a local insurance institution (Sozialversicherungsträger) and they will then send you your e-card.
If you come from a country which has a reciprocal social insurance pact with Austria, make sure you bring the right documents with you: an A3 form for stays shorter than three months or an A4 (Hauptwohnsitz) if you are staying longer.
What is covered by the state health insurance system?
State coverage entitles you to a full package of services:
- doctors’ visits
- hospital visits
- maternity care
Austria places high importance on preventative treatment, so you will also be eligible for an annual free medical check.
You will be charged a small fee for prescriptions, around €6. Medication is available from the many apothekes (pharmacies) across the country. You will need to take your prescription and your e-card with you to pick up your medication.
You will have to pay a fee for in-patient hospital care; the amount varies according to region but is usually between €14 and €25.
If you are ill, your first 12 weeks off work will be covered by your employer, but after that your insurance cover will apply and you will be eligible for sickness benefits. However, the amount you are paid in benefits may not match your usual salary.
Are retirees covered by state medical insurance?
Under Austrian law, pensioners are covered by state insurance. As an expat you will need proof that you have health insurance when you arrive (for example, private cover from your home nation), and that you have sufficient funds to pay for health insurance in Austria.
Are students covered by state medical insurance?
Schoolchildren are covered under the state system and if your children are undertaking studies, they will be covered up to the age of 26. If you are an international student, it varies, but if you come from one of the following countries then your home nation will have a reciprocal arrangement with Austria:
You will need an A3 form from your own national insurance organization and you will need to take this with you in order to sign up with the Gebietskrankenkasse.
If you are not from one of these countries, then you can still apply for medical insurance under the Gebietskrankenkasse, but this usually only applies to students who will remain in the country for a maximum of one year. You should be eligible for a reduced premium (around €51 per month).
If your application is rejected, you will need to either seek private cover or sign up with the Gebietskrankenkasse at the premium rate of over €300 per month. Even then, you may not be eligible to receive treatment until you have paid up to six months of premiums.
You might be able to take out a different form of student insurance (Studierendenselbstversicherung) at a discounted rate. Your educational institution will be able to provide you with all the details and assess your eligibility.
Will your family be covered by your insurance?
Your spouse, registered partner and in certain cases, your life companion, as well as your children will be covered if they live in Austria. There are some exceptions for children and grandchildren who are in educational institutions outside the country.
The term ‘life companion’ refers to someone who has been living in your house for ten months or more and who undertakes unpaid household duties. This only applies if you do not have a registered living spouse.
Is dental treatment covered by state health insurance?
A limited range of dental treatment is covered under the national insurance scheme, but otherwise, you will have to pay upfront for your treatment. Basic treatments such as fillings are covered by the state system but more sophisticated dental care is not, such as:
- dental bridges
- orthodontic treatments
You will be able to access more extensive dental treatment in some parts of the country than in others, as healthcare is organized by region.
Many Austrians go to Hungary for dental treatment because it is cheaper.
What are the contribution rates for state health insurance?
Contributions from the self-employed are around €418 a month. Your e-card will require an annual service charge of around €11 per year, which is usually deducted by your employer if you are in paid employment. Co-insured spouses also need to pay the service charge; pensioners and children do not, and neither do some people in particular professions, such as those who work for the Austrian railways.
Why buy private health insurance?
Whether or not you take out private insurance could strongly depend on your approach to the speed of treatment. For surgeries deemed non-urgent, such as hip replacements, the queues can be very long, and paying for health insurance can decrease the waiting time.
Additionally, there can be a wait before you are fully signed up to the state system, and many people take out private cover for this period.
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What is covered by private health insurance?
Private health insurance in Austria offers additional choice, speed and comfort. It covers:
- hospital care
- more advanced forms of dental treatment
- free choice of doctors/clinics
Before buying private medical insurance in Austria, always check if pre-existing conditions are excluded and if so, for how long.
How much does private health insurance cost?
Numerous variables can have an impact on the cost of private health insurance in Austria.
The most important variables are:
- Age (the higher the more expensive)
- Area of cover (i.e. just Austria or other areas too? If those other areas include any of the US, the Caribbean, Singapore, China, Hong Kong or Dubai this can significantly increase the overall price)
- Product choice (higher end insurance products are more expensive)
Other variables include:
- Payment frequency
- Country of residence
As so many variables have an effect on the cost of private medical insurance in Austria it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.
Which companies offer private health insurance?
The big international insurance companies such as
- Aetna International
- Bupa Global
- Cigna Global
- Foyer Global Health
- Pacific Prime
all cover Austria, but you might want to check with your employer to see if they have an arrangement with a local provider as well.
Glossary of health insurance terms
Gebietskrankenkassen - regional authorities
krankenkasse - state-funded insurance
Ich habe eine EHIC-Karte - I have an EHIC card
privatärzte - private health insurance
sozialversicherungsträger - local insurance institution
studierendenselbstversicherung - insurance for students