One of the most important characteristics of Austrian healthcare is the variety of health insurance funds, and respectively, the difference in the coverage they provide for the people insured with them. One does not choose a health insurance fund themselves but rather gets assigned one depending on area of work and/or employer.
The Austrian Health Fund (ÖGK) is the fund that covers most employed persons and their dependents in Austria. It is possible that some funds may require self-participation: for example, the fund may cover a maximum of 90% of a doctor’s fee and the patient has to pay the other 10% of the invoice. When choosing a practitioner, it is important to consider which fund he or she has a contract with and what is covered by this contract.
Types of Doctors in Austria
There are three types of doctors in Austria:
- Public doctors (Kassaarzt) – These have contracts with one or more of the public health insurance funds and patients use their e-card as a form of payment. Only one doctor per medical specialty (for example, general practitioner, gynecologist, ophthalmologist, dentist, etc.) can be consulted per quarter. You can visit these physicians as often as necessary for treatments and consultations but you cannot, for example, go to two different gynecologists within the same quarter without the prior agreement of your insurance provider. A referral from a GP is not required in order to consult a specialist, however, the scope of the insurance coverage depends on the particular fund.
- Doctors of choice (Wahlarzt) – Doctors who do not have a contract with any of the funds and are free to determine their own fees. After visiting a Wahlarzt you can submit their bill to your health insurance provider. You will be refunded a portion of the fee equal to 80% of the amount they would have paid for a doctor they have a contract with.
- Private doctors (Privatarzt) – Тhe patient is not entitled to reimbursement of any part of the fee and covers the full cost of his or her treatment. These are usually doctors who have a contract with one of the health funds but also offer private services.
All doctors have to display signs in their offices stating whether they work with any of the public insurance funds or are solely private.
To find a doctor, you can use Docfinder or Praxisplan. Both allow you to search by specialty (choose “Kinder- und Jugendheilkunde” for pediatricians) and geographic area, as well as filtering the results by insurance coverage, reviews and even language(s) spoken.
Health Insurance for Dependents
Another important bonus of the Austrian healthcare system is that children are insured with their parents. No additional contribution is required for a child’s insurance (but it must be remembered that if your health insurance becomes invalid, so does your child’s). If parents are insured with different funds, the child can be co-insured by both.
Stay-at-home mothers and fathers are also covered, free of charge, by their partner’s insurance until the child’s eighteenth birthday.
Unemployed spouses/partners can be co-insured with their working spouse/partner if they do not have another source of insurance. The cost of the insurance is 3.4% of the gross salary.