Almost the entire resident population of Austria (99.9 percent) is covered by statutory health insurance. Statutory health insurance offers the insured and their co-insured family members comprehensive protection in the case of illness.
In accordance with the law, the provision of medical treatment has to be sufficient and appropriate, but may not exceed that which is necessary.
The legal right to services includes – independently of the amount of health insurance contributions paid – a right to benefits in kind for the medical services required in the specific case. These can be provided by contracted doctors in the facilities of the social insurance institutions or in contracted facilities (hospitals). All of the insured and those entitled to services have the same level of entitlement.
Services are mostly provided without additional costs for the insured, although for some groups of insured persons contributions to costs (co-payments) have to be made.
Membership of occupational groups
Austrian social insurance is organised according to membership of occupational groups. This means that people belong to a certain social insurance institution because of the work they do.
Since 1 January 2020 (structural reform of the social insurance system), the following applies:
- Those employees who were previously insured with the regional health insurance funds are now insured with the Austrian Health Insurance Fund (ÖGK). Pensioners who were previously insured with the regional health insurance funds as well as all those persons who were insured with a company health insurance fund are now also with the ÖGK.
- Those persons who were previously insured with the Insurance Institution for Railways and Mining as well as those civil servants and contracted public-sector employees whose employment relationships began after 31 December 2000 (unless they belong to a special health insurance scheme at a provincial level) now belong to the new Social Insurance Institution for Public-Sector Employees, Railways and Mining (BVAEB).
- Those businesspeople and freelancers previously insured with the Social Insurance Institution for Businesses (SVA) are now in the Social Insurance Institution for the Self-Employed.
Co-insurance and self-insurance
Statutory health insurance also protects the family members of the insured, either without additional contributions or for a reduced contribution.
Non-insured persons have the opportunity to apply to insure themselves on a voluntary basis.
What does health insurance offer?
The benefits and services of statutory health insurance include the following:
- check-ups for young people and preventive screening for adults to recognise diseases early on;
- medical treatment (the services of doctors, medicines and therapeutic aids), inpatient treatment and if necessary also medical care at home;
- dental treatment and dentures;
- sickness benefit to provide financial security in the case of inability to work as a result of illness, plus rehabilitation benefit in the case of reduced ability to work,
- reintegration benefit for persons returning to working life after a long period of illness, and
- benefits in kind and cash benefits for new mothers (maternity allowance).
For competent advice, contact the relevant health insurance institution.