Load limit for co-payments in the statutory health insurance

For medicines, remedies and applications that are prescribed, co-payments must be made. However, those with health insurance do not have to pay more than two percent of their annual gross income. For chronically ill people, the load limit is one percent of the annual gross income. Gross income includes all income with which insured persons finance their livelihood - for example: salary pensions or pensions, Principal interest rental income In calculating the load limit, the annual gross income of all members living in the household shall be taken into account. These can be spouses, civil partners under the Civil Partnership Act or children with family insurance. For families, the burden limit is reduced by the child allowances and, if necessary, the allowance for the spouse. In the case of recipients of social assistance, the standard rate of the head of the household is the basis for calculating the load limit, which is why the allowances cannot be estimated. Children and adolescents up to the age of 18 are generally exempt from co-payments. Exception: Additional payment for travel expenses.

Collect all additional payment receipts so that they can prove to the health insurance company that they have reached the load limit. Upon application, you will be exempted from further co-payments by your health insurance company for the current calendar year. Children and adolescents are always exempt from the additional payment.

Responsible for the content
Lower Saxony Ministry of Social Affairs, Health and Equality

Last update or date of publication
24.07.2020