💶 Co-payment exemption and burden limit (§ 62 SGB V)

The burden limit for co-payments is 2% of the household's annual gross income – 1% for those recognised as seriously chronically ill. Here is how to apply for the exemption.

Burden limit Co-payment Chronic illness rule Seriously chronically ill Exemption certificate § 62 SGB V Chroniker-Richtlinie

In brief

Co-payments for medicines, therapies, aids and appliances, hospital stays and travel costs are capped in statutory health insurance: the burden limit (Belastungsgrenze) is in principle 2% of your household's annual gross income for living expenses. If you count as "seriously chronically ill" under the Chroniker-Richtlinie, the limit for the illness concerned drops to 1%. Once you have reached your burden limit in the calendar year, the health insurer issues an exemption certificate (Befreiungsbescheinigung) – further co-payments then no longer apply for the rest of the year.

Step by step

Collect co-payment receiptsKeep all receipts for co-payments (pharmacy, therapies and aids, hospital, travel costs) throughout the calendar year – easiest in a receipts folder or digitally.
Work out the household's gross incomeThe burden limit is calculated from the annual gross income of all family members living in the shared household, minus statutory allowances for dependants.
Check whether the 1% limit appliesThe reduced limit of 1% applies only to an illness for which you are recognised as "seriously chronically ill" – if necessary, have your practice confirm this and have it recognised by the health insurer.
Submit receipts when you reach the limitAs soon as the total of your co-payments reaches the burden limit, submit the receipts to the health insurer and apply for the exemption certificate.
Use the exemption certificateWith the certificate you do not have to make any further co-payments for the rest of the calendar year; alternatively, some insurers may offer an advance payment with later settlement.

Deadlines

1 year of continuous treatment

The reduced 1% limit applies only from the calendar year in which continuous treatment for the same serious illness has already lasted one year§ 62 Abs. 1 SGB V

Calendar year

The burden limit is recalculated for each calendar year; co-payments not used up are not carried over to the following year§ 62 SGB V

Watch out – common mistakes

A special rule applies to insured people born after 1 April 1972: anyone who did not regularly attend the statutory health checks under § 25 Abs. 1 SGB V before the chronic illness began stays at the 2% limit, but can reach the 1% limit if they take part in a structured treatment programme (DMP) existing for the illness. Providing the exact proof is complex in individual cases – if in doubt, ask your health insurer directly.
Services free of co-payment (e.g. for children up to 18 years for most services) do not count towards the burden limit.
The exact allowances per dependant deducted from gross income, and how they are updated each year, could not be conclusively verified in this research with a current primary source for 2026 – have your health insurer calculate the specific amount for you (see Sources and methodology).

In depth · legal basis, figures and practice – for advisers and professionals

The two burden limits in detail

§ 62 Abs. 1 SGB V caps the co-payments of all members of a household (insured people and co-insured dependants together) at 2% of annual gross income for living expenses. For insured people in continuous treatment for the same serious illness, this value drops to 1%.

Conditions for "seriously chronically ill"

The Chroniker-Richtlinie of the Federal Joint Committee specifies the term: what is required is continuous medical care (medical or psychotherapeutic treatment, provision of therapies or aids and appliances, or drug therapy) for at least one year, without which, according to medical assessment, a life-threatening deterioration, a permanent impairment of quality of life caused by the illness itself or by secondary illnesses, or a reduction in life expectancy would be expected. Alternatively, a recognised care level 3, 4 or 5 suffices, or a degree of disability or reduction in earning capacity of at least 60, provided it is at least partly caused by the illness concerned.

Calculation in detail

Allowances for the spouse or registered partner and for each child living in the household are deducted from annual gross income; the current values of the social assistance standard rate levels are decisive. For recipients of Bürgergeld/Grundsicherungsgeld (basic income support), basic old-age security or social assistance, the standard rate generally counts as gross income.

Procedure with the insurer

The law does not prescribe a formal application form; however, most health insurers offer a form for simplicity. Anyone who can estimate in advance that they will certainly reach the burden limit in the current year can, with some insurers, also make a one-off advance payment equal to the burden limit and is then exempt from further co-payments for the rest of the year.

Who is responsible

Statutory health insurer (calculation of the burden limit, issuing the exemption certificate)

Quick questions

Worum geht es bei „Co-payment exemption and burden limit (§ 62 SGB V)“?

The burden limit for co-payments is 2% of the household's annual gross income – 1% for those recognised as seriously chronically ill. Here is how to apply for the exemption.

Which deadlines and figures matter?

1 year of continuous treatment: The reduced 1% limit applies only from the calendar year in which continuous treatment for the same serious illness has already lasted one year (§ 62 Abs. 1 SGB V)
Calendar year: The burden limit is recalculated for each calendar year; co-payments not used up are not carried over to the following year (§ 62 SGB V)

What should I do first?

Collect co-payment receipts: Keep all receipts for co-payments (pharmacy, therapies and aids, hospital, travel costs) throughout the calendar year – easiest in a receipts folder or digitally.
Work out the household's gross income: The burden limit is calculated from the annual gross income of all family members living in the shared household, minus statutory allowances for dependants.
Check whether the 1% limit applies: The reduced limit of 1% applies only to an illness for which you are recognised as "seriously chronically ill" – if necessary, have your practice confirm this and have it recognised by the health insurer.

What do I need to watch out for?

A special rule applies to insured people born after 1 April 1972: anyone who did not regularly attend the statutory health checks under § 25 Abs. 1 SGB V before the chronic illness began stays at the 2% limit, but can reach the 1% limit if they take part in a structured treatment programme (DMP) existing for the illness. Providing the exact proof is complex in individual cases – if in doubt, ask your health insurer directly.
Services free of co-payment (e.g. for children up to 18 years for most services) do not count towards the burden limit.
The exact allowances per dependant deducted from gross income, and how they are updated each year, could not be conclusively verified in this research with a current primary source for 2026 – have your health insurer calculate the specific amount for you (see Sources and methodology).

Evidence

§ 62 SGB V (gesetze-im-internet.de)
§ 61 SGB V – definition of co-payment (gesetze-im-internet.de)
Chroniker-Richtlinie of the Gemeinsamer Bundesausschuss (g-ba.de)
§ 25 Abs. 1 SGB V – health checks (gesetze-im-internet.de)

As of

As of: September 2026. · Sources and method

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