Irrespective of whether you are self-employed or an employee, if you work in Austria you will automatically receive social insurance coverage (compulsory insurance). As a result you are:
Insured against accidents
Insured for your retirement pension
From the first day of employment, you enjoy complete insurance cover whenever you make use of the benefits of the health care system.
Consulting a physician
Should you (or your relations – spouse, children who are also insured) wish to consult a physician, you will need an e-card. Using the e-card, the physician providing the treatment can ascertain the insurance fund from which you receive cover and will automatically clear the costs with this organization. Apart from a yearly service fee (€ 11,70), as a person with insurance fund coverage from a locally authorized health insurer (Gebietskrankenkasse) you are not subject to any costs for the medical treatment. People insured by other health insurance funds, such as those for the self-employed, are obliged to pay a percentage of the costs for various services. As an insured person, you will receive the e-card automatically by post.
Forgotten your e-card?
Should you fail to produce an e-card when visiting a physician, the doctor is entitled to demand a deposit, in order to ensure that card is presented reliably at a later date. In particular, such a deposit will be requested when you are not a regular patient at the respective practice. Once you have presented the e-card, the deposit will be returned.
Entitlement to services
Should you so require, you are entitled to use the services of one physician from each of the specialist groups (general practitioners, gynaecologists, opticians, dental surgeons, etc.) per quarter. You may receive as many treatments and consultations from this physician as medically required. However, you may only change from one physician to another within the same specialist group under exceptional circumstances. For example, this means that in the period between January and March (1st quarter) you may not visit two different opticians. Should your physician be absent, there will be a stand-in, who you may contact.
Free choice of physician
As a patient you are basically free to choose your physician. Physicians that have a contract with your health insurance fund, e.g. the Upper Austrian Gebietskrankenkasse are entitled to treat you and then clear the treatment fee with your insurer directly. This means that as a patient you do not have to pay the physician anything. In order to avoid excessive surgery waiting times, it is frequently necessary to agree an appointment in advance. Please keep this appointment and come on time. Nonetheless, it may be the case that emergencies are allocated priority. Should you be unable to keep the appointment, please do not forget to cancel.
You also have the possibility of going to a private physician, but this means that you will have to bear the costs. After the presentation of an invoice, you will receive the compensation, which is provided for by the health insurer (for example by the Gebietskrankenkasse). As a rule, this amount only covers part of the expense. Therefore, it is absolutely essential that you ascertain how much the treatment will cost before you receive it.
European insurance card – stays in other countries
The reverse side of the e-card constitutes an official European Health Insurance Card. This is used when treatment by a physician is required during temporary stays in other countries and is valid in EU member states, EEC countries and Switzerland. For Bosnia-Herzegovina, Macedonia, Serbia, Montenegro and Turkey you should obtain a foreign treatment certificate from your employee or health insurance fund in advance. All other countries:
Basically, an insured person enjoys insurance cover. However, cost compensation in line with Austrian directives and rates is only granted following the treatment in the other country and a related application for repayment after the patient’s return to Austria. This means that a patient must pre-finance any treatment in a foreign country. As a rule, every insured person, who has uninterrupted insurance cover for at least a year receives the European Health Insurance Card (reverse side of the e-card is completed in full). All other people (reverse side of the European Health Insurance Card is filled with ***) can apply for a provisional replacement certificate from their employer or health insurance fund. They will thus receive the same services.
Physicians with foreign language skills
The Upper Austrian Medical Association provides information regarding the location of physicians who speak foreign languages (site is only available in German): https://arztsuche.aekooe.at/finder/search/land/OO,SA
When your physician prescribes medication for your health, he/she writes a prescription. When you present a (completely filled out) prescription at a pharmacy, you will receive the necessary medicine. You do not have to pay the real cost of the medication (which can be very high), but merely the € 6.30 prescription fee, which is presented directly to the pharmacist. https://www.gesundheitskasse.at/cdscontent/?contentid=10007.813892&portal=oegkportal
Prescription fee exemptions: Should your monthly net income not exceed the following sum, you may apply to the health care insurance fund
for a prescription fee exemption:
€ 872,31 for single people
€ 1,307,89 for married couples
Pharmacies in Upper Austria
You can find the addresses of the pharmacies that are open at night, on weekends or on public holidays in a current edition of a local daily newspaper. They are also posted on signs on the pharmacies in the area where you live. If you go to a pharmacy at night, at the weekend or during a public holiday, you must pay an additional fee of € 1.30 (during the daytime) or € 3.80 (at night, from 8 pm to 8 am).
Stay in a hospital
When you are admitted to a hospital please take along your green social insurance card/e-card, as well as a letter of referral should you have one. The health insurance covers almost all of the costs of your hospital stay, with the exception of a small fee.
There are various specialist departments in hospitals (e.g. accident; ear, nose and throat and dental outpatients departments) that will allow you to return home once the treatment has been completed. In addition, following a stay in hospital it is generally the case that you have to attend an outpatients department. Your physician may also send you to the outpatients department of a hospital for further examinations. The outpatients departments of admitting hospitals are also open at weekends and on public holidays. Please have your e-card ready for admission.
Notification of sickness for employed persons
If you are unwell and unable to work, you must inform your employer and then go to see a physician. A retroactive notification for more than one working day is only possible in exceptional cases and therefore you should always consult a physician immediately! You will then receive a certificate stating that you are unable to work as a result of illness. The obligatory notification of illness is sent directly to the health insurance fund. Once you are better, the health insurer will require notification of your recovery. The physician treating you is responsible for providing it. However, you can also give notice that you are in good health (for example in case of the Gebietskrankenkasse, you can provide this notification online via the Internet using the „Gesundmeldung“ form (notification of medical discharge) under the address www.ooegkk.at.
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