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Social health insurance
The coverage provided by statutory health insurance extends not only to be insured himself but to members of his family such as children sand spouses or partners, provided they do not pay health insurance contributions in their own names. About two thirds of those with health insurance pay contributions, while the remainder receive free coverage as family members (e.g. children) and/or, since 2001, if they are co-insured by an additional contribution in cases regulated by law. As a result, 98 percent of the population is covered by statutory health insurance.
Statutory health insurance is organised according to vocational groups and regional aspects, with some very wide variations in arrangements.
Health insurance provides the following benefits:
Medical aid
In case of illness, the insured person can visit any contracting doctor of his insurance carrier. In this case the fee is paid by the insurance provider; an annual co-payment of EUR 10 is charged to cover the costs of the E-card. The patient also has the option of consulting a doctor who is not in possession of a contract (“aid by doctors of choice”). In such cases, the health insurance fund will reimburse 80 percent of the amount which would have been paid by the insurance provider to a contracting doctor if he had been visited. The individual providers of health insurance may, however, lay down in their conditions that - unless total geographic coverage with doctors is provided -100 percent of the usual contracting doctor’s fee will be repaid.
Medications
Medications prescribed by the doctor in observance of the Guidelines on Economic Prescribing of Medications and Medical Equipment, as well as the Code of Reimbursement, can be obtained at every pharmacy at the expense of the health board. The patient must pay a deductible of EUR 4, 70 per packet.
Hospital care
In case of need, every insured person has the right to hospital care without any time limitations as long as the illness requires it. There are two classes of fees in Austrian hospitals, a general and a special one. The insured person must pay a small contribution towards the general fee class per day, which differs for each insurance carrier and in each province and currently (2005) amount to between EUR 8 and EUR 15. This cost contribution only has to be paid for a maximum of 28 days per year and it need not to be paid at all in special cases, such as childbirth. In the special class the health board will pay a nursing fee compensation, which amount differs for each hospital. All other services must be paid for by the patient himself or by his private supplementary insurance, if he has one.
Home nursing services and midwives
Since 1922 certain medical and nursing services in the household sphere of the insured person which are ordered by a doctor have been covered by health insurance. The services are provided by trained nursing staff and relate in most cases to administering injections, dressing of wounds and special diets.
Since 1997 the services of self-employed midwives have also been re-included in a general contract and are therefore paid for by the health insurance funds.
Psychotherapy and clinical-psychological diagnosis
Since 1992 psychotherapy and clinical psychological diagnosis have been obligatory benefits provided by social health insurance. Evidence that a doctor has been consulted must be produced at the second psychotherapy session or before.
Services of the medical-technical professions
Since treatments performed by the medical-technical professions are equal to those performed by medical doctors, physiotherapeutic, logopedic and occupational therapy services are also covered by health insurance as long as they are performed according to a doctor’s prescription.
Mother-Child Medical Card examinations
Since 1974 the examination programmes for pregnant women and infants have been among the services provided by health insurance. The standardised programme provides examinations of pregnant women and children up to 62nd month of life. The service is offered free of charge.
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