Austrian Health Insurance: Glasses Coverage Explained

Health insurance in Austria is mandatory for all residents, and there are three public insurance institutions: ÖGK, BVAEB, and SVS. The type of insurance and the benefits covered depend on employment status and income. While basic treatments and hospital care are included, it is unclear whether glasses are covered by Austrian health insurance. However, it is likely that glasses would be considered an out-of-pocket expense, as dental bridges and orthodontic treatments are not covered.

What is covered by mandatory health insurance?

In Austria, mandatory health insurance covers a broad spectrum of treatments and services. This includes basic care, hospital care, specialist and emergency care, X-ray examinations, maternity services, psychotherapy, prescription drugs, and rehabilitation. The system also covers spouses and children of those who work in Austria and are covered by the worker's medical insurance.

The public healthcare system in Austria is comprehensive, covering virtually all health care needs, regardless of age or background. There are four main pathways of coverage: precautionary, maternity, therapeutic aids, and illness.

Precautionary Coverage

Precautionary coverage includes vaccinations, remedies and treatment, lifestyle advice, health checks, health at work, and recovery.

Maternity Coverage

Maternity coverage includes childbirth, parental leave benefits, child allowance, and maternity allowance.

Illness Coverage

Illness coverage includes work-related illness, doctor visits, mental illness treatments, and support for serious health problems.

Therapeutic Aids Coverage

Therapeutic aids coverage is for incapacity for work, accidents at work, treatment after accidents, and occupational diseases.

In addition to the above, mandatory health insurance also covers prescription drugs, rehabilitation, and psychotherapy.

It is worth noting that while mandatory health insurance covers a wide range of services, there are some things that are not covered. For example, patients may have to pay a portion of the cost for treatment by private doctors, in private hospitals, orthodontic treatments, and dental bridges.

Who is covered by mandatory health insurance?

In Austria, health insurance is mandatory for certain parts of the population. This includes:

• (Salaried and self-employed) workers and their dependent family members, who are legally required to register for a "Pflicht­versicherung".
• Seniors with an Austrian pension.
• Employees, apprentices, trainees, and people collecting unemployment benefits, childcare allowance, social assistance, or rehabilitation allowance.
• Anyone who falls outside of the above scope (e.g. students) can register voluntarily.

Additionally, Austria allows co-insurance in the case of dependent children, partners, direct family members, and relatives who require nursing care.

There are three public health insurance funds in Austria:

• Austrian Health Insurance (Österreichischen Gesundheitskasse, ÖGK), which covers most of the population.
• Social Insurance Fund for freelancers (Sozialversicherungsanstalt für Selbständige, SVS).
• Insurance Company for public employees, railways, and mining (Versicherungsanstalt öffentlich Bediensteter, Eisenbahnen und Bergbau, BVAEB).

The type of health insurance fund an individual is assigned to depends on their profession. For example, public employees, such as teachers and university staff, are insured through the BVAEB, while the self-employed are insured through the SVS.

For those who do not fall under mandatory health insurance, taking out health insurance is optional but highly recommended as medical treatments in Austria can be expensive.

What is the cost of mandatory health insurance?

In Austria, health insurance is mandatory for everyone. The public healthcare system is financed through monthly contributions from the insured, with the amount depending on the individual's gross income. If you are an employee, your employer will generally handle your healthcare provision.

For employees, the monthly contribution towards statutory health insurance is 7.65% of your gross income: the employee covers 3.87%, while the employer covers 3.78%. For the self-employed, the amount paid towards public health insurance is set by the SVS on a quarterly basis. Farmers running agricultural enterprises are also covered by the SVS.

If you don't have an income, statutory health insurance in Austria costs €495.58 a month, as of 2024, and is known as "self-insurance". Students can opt for self-insurance at a much lower rate of €69.13 per month.

What is the process for claiming reimbursement?

The process for claiming reimbursement for glasses from Austrian health insurance can be done by following these steps:

Firstly, it is important to understand the type of Austrian health insurance coverage you have. There are three public insurance institutions in Austria: ÖGK, BVAEB, and SVS. Each of these institutions may have different processes for reimbursement, so knowing which one you are covered by is essential. You can identify your insurance provider by checking your e-card (social insurance card). This card is provided to all insured persons in Austria and serves as proof of your insurance status.

Once you have identified your insurance provider, you can follow these general steps for claiming reimbursement for glasses:

• Contact your insurance provider: Reach out to your insurance company to clarify the details of your coverage and understand the specific process for claiming reimbursement. Ask about any requirements or restrictions, such as in-network providers or specific claim forms.
• Verify your coverage: Review your insurance policy to confirm that it includes vision care or eye care services. Look for keywords related to eye exam coverage, health insurance benefits, and vision care sections in your policy document.
• Choose an in-network eye care provider: To maximize your benefits and save costs, verify that your chosen eye care provider is included within your insurance network. This step is crucial to avoid unexpected expenses.
• Obtain an itemized receipt: After receiving your prescription glasses, obtain an itemized receipt from the provider. This receipt should include all the necessary details of your purchase, including the cost of frames and lenses.
• Complete a claim form: Download and print the relevant claim form from your insurance company's website or request it from your insurance provider. Fill out the form with the required details.
• Submit the claim form and receipt: Gather and submit the completed claim form along with the itemized receipt to your insurance company. Submit these documents to the specified address provided on the form.
• Receive reimbursement: After submitting your claim, you can expect to receive reimbursement within a few weeks. The time frame may vary depending on your insurance provider.

It is important to note that the reimbursement process may differ slightly between insurance providers, so always refer to your specific insurance company's guidelines for the most accurate information. Additionally, the amount of reimbursement will depend on your insurance policy, level of cover, waiting periods, and prior claims.

By following these steps, you can effectively claim reimbursement for your prescription glasses and make the most of your Austrian health insurance coverage.

What is the difference between statutory and private health insurance?

In Austria, almost the entire resident population (99.9%) is covered by statutory health insurance. This is because health insurance is mandatory in Austria, even for expats. However, the distinction between statutory and private health insurance does not exist in Austria as it does in some other countries, such as Germany.

In Austria, there are three public insurance institutions:

• ÖGK (Austrian Health Insurance Fund) covers salaried employees, apprentices, pensioners, and other groups.
• BVAEB (Versicherungsanstalt öffentlich Bediensteter, Eisenbahn und Bergbau) is responsible for public employees, including civil servants, teachers, and workers in the railroad and mining industries.
• SVS (Sozialversicherungsanstalt der Selbstständigen) insures the self-employed, businesspeople, freelancers, and farmers.

The three institutions differ in the way they provide benefits and the amount of contributions or co-payments required from the insured person, but overall, they are quite similar. The prerequisite for claiming benefits is the presentation of an e-card, which serves as proof of insurance status and provides access to the public system of hospitals, doctors, and treatment centers throughout the country.

While everyone in Austria is covered by statutory health insurance, individuals have the option of taking out supplementary insurance policies on a private basis. These include insurance for the doctor of your choice, hospital insurance, and additional packages for travel or children. These private insurance policies can only be taken out in conjunction with statutory health insurance and simply supplement the basic provision. Private insurance schemes charge premiums based on personal health risk, taking into account age, medical condition, and occupation.

Frequently asked questions