In principle, the Austrian health insurance system provides, to a large extent, free access to medical care (visits to the doctor) and hospital treatment.
(Part of) the costs incurred for measures of prevention and rehabilitation (“rehab”) as well as curative stays are also borne by the social insurance institutions. A fee has to be paid for all prescriptions. With some social insurance institutions (Social Insurance Institution for Commerce and Trade, SVA, and Insurance Institution for Public-Sector Employees, BVA) the insured has to pay a deductible of 20% on all medical services. There are differences in the scope of benefits provided by the insurance institutions – for instance regarding the meeting of the costs of dentures. Not all doctors are accredited for all insurance institutions. Services provided by some non-panel physicians (“Wahlarzt”) have to be paid for, but part of the costs will then be reimbursed by the social insurance institution. Services by other private consultants (“Privatarzt”) have to be borne exclusively the insured persons (unless they have additional private insurance).
Hospital patients are charged a certain amount for every day of their stay. The amount of this contribution is determined and levied by the legal entity operating the hospital (e.g. provincial or municipal authority) and varies according from land to land.
The following persons are subject to compulsory health insurance:
- Employees whose income exceeds the marginal earnings threshold
- Self-employed persons whose income exceeds the marginal earnings threshold
- Recipients of unemployment benefits
- Recipients of an old-age pension
- Family members of the above groups
Voluntary self-insurance is available for everybody – and highly recommended for marginally employed persons!
Dependent coverage of family members
In Austria, insured persons and their family members are entitled to benefits.
- spouses, civil partners and, under certain conditions, cohabiting partners
- children up to the age of 18
- children up to the age of 21 if they are not engaged in any professional activity
- children up to the age of 26 if they are engaged in education or training
Dependent coverage of children is free of charge. The same applies to spouses, civil partners and cohabiting partners in families with children.
Special rules apply for childless couples. For them, dependent coverage is not free of charge.
The insured persons and their family members are entitled to medical care by general practitioners, consulting physicians and dentists who have a contract with a social insurance provider. A list of these panel doctors is available from the respective health insurance institution.
Drugs and medicines are prescribed by doctors and sold at pharmacies. The prescription fee is EUR 6 (2018) per item. Insured persons are eligible for exemption from prescription fees if their income falls short of a certain threshold.
The e-card (social health insurance card/EHIC) is also subject to a service fee.
Continued payment of wages/salaries
In the event of sickness or accident, employees are entitled to continued payment of their wages or salaries for a period of six weeks provided that they have not caused the sickness or accident by intent or gross negligence.
The duration of continued payment increases depending on the employee’s length of employment, up to a maximum of twelve weeks. Thereafter, employees are entitled to half of their pay for another four weeks.
In the event of another sick leave within the same working year, different rules apply for wage earners and salaried employees.
If they fall sick again within the same working year, wage earners are only entitled to continued payment of their wages if their overall entitlement has not yet been used up for previous sick leaves. If a salaried employee falls sick again within half a year from returning to work after the first sickness, at first the basic entitlement not yet used up will be paid out. After that, the employee will receive half of the sick pay he/she was originally entitled to. Six months after returning to work after the first sick leave, the employee will be entitled to continued payment of the full salary again.
After the period of continued payment of wages or salaries, employees are entitled to sickness benefits (Krankengeld) under the social insurance scheme.
Persons who need permanent nursing care due to sickness or disability are entitled to long-term care benefits (Pflegegeld). Applications for long-term care benefits have to be made to the competent health insurance provider. There are seven different levels of care (Pflegestufen) depending on the care needs to be met.
Since 2013, self-employed persons have also been entitled to financial support in case of long periods of sickness.
Entitlement starts on the 43rd day of incapacity for work as determined by a physician.
Good News: From 01.07.2018 the financial support for self-employed persons having less than 25 employees after an illnes of 43 days will start already with the fourth day of illness. It will be paid retrospectively.
Benefits for one and the same episode of sickness are paid for a maximum of 20 weeks. If the same sickness reappears within half a year (26 weeks), the insured may claim financial support for the remaining time – provided that the maximum period of 20 weeks has not yet been exceeded. In principle, the payment of benefits will be stopped as soon as the insured person is no longer unfit for work. After having received sickness benefits for a period of 20 weeks, the insured must maintain a valid insurance contract with a statutory health insurance institution for at least half a year (26 weeks) before being entitled to such benefits again.
Maternity allowance (Wochengeld)
The following applies to employees: Pursuant to the provisions of the Maternity Act (Mutterschutzgesetz) expecting mothers must not be employed starting from the beginning of the eighth week prior to the estimated day of childbirth. To make sure that they do not suffer any financial disadvantage during this time period, they receive maternity allowance from their social insurance institution which, in principle, replaces their full net income. Self-insured persons in marginal employment receive a fixed amount of maternity allowance.
Other state benefits for persons with children
Childcare allowance (Kinderbetreuungsgeld)
In Austria, parents are entitled to benefits after a child is born. They may choose between income-related childcare allowance and non-income-related childcare allowance. Childcare allowance is a state benefit that is granted upon application. According to the Childcare Allowance Act (Kinderbetreuungsgeldgesetz, KBGG) which entered into force on January 1, 2010, parents may choose from two systems with a total of five different options for receiving childcare allowance. Since March 1, 2017 new provisions have been in force for all children born after that date.
The earliest date for applications for childcare allowance under any of the options applicable until 1 March 2017 is the day the child is born. Once you have chosen an option and applied for childcare allowance, you are entitled to change to another option only within 14 days from the date of the first application, and the option you have chosen will also apply to the other parent. There are no exceptions to this statutory rule!
Family allowance (Familienbeihilfe) – also referred to as: child allowance (Kinderbeihilfe)
In Austria, family allowance is paid to parents as a monthly benefit for their child or children regardless of whether or not the parents are employed and regardless of the type of their employment. Following the revision of the applicable law, parents receive family allowance until their child turns 24. In exceptional cases, family allowance is paid until the child’s 25th birthday, for instance if the child is still engaged in community service in lieu of military service (Zivildienst). Parents of children with disabilities receive higher family allowances and are entitled to such benefits for a longer time period.
In 2018, the following monthly family allowances were paid per child
|Child's age||Monthly amount|
|From birth||EUR 114|
|from 3 years||EUR 121.90|
|from 10 years||EUR 141.50|
|from 19 years||EUR 165.10|
If more than one child is entitled to family allowance, the total monthly allowance for each eligible child is increased by the following increments:
- for two children by EUR 7.10 per child
- for three children by EUR 17.40 per child
- for four children by EUR 26.50 per child
- for five children by EUR 32 per child
- for six children by EUR 35,70 per child
- for seven or more children by EUR 52 per child
Health insurance in Europe
When you visit a doctor or have to stay at a hospital in a European country, you will usually be asked to complete certain forms. The same applies in case of short-term or long-term employment in European countries.
In many European countries, doctors’ fees or other medical services first have to be paid on the spot. In some cases, they can then be submitted to the respective health insurance institution at home for reimbursement. The costs incurred are not always borne in full. The difference in the scope of benefits paid in the individual EU countries may also limit the reimbursement of costs. It is recommended to take out international travel health insurance for all stays in foreign countries outside the EU.
European Union e-forms