Yes, German private health insurance (PKV) does pay for IVF if the infertility has an organic cause in the insured person. Under the cause principle it then usually covers the whole treatment, including treatment of the healthy partner. There is no fixed age limit, but each cycle needs a success chance of about 15 percent. One cycle costs around EUR 3,700 to 10,000.
Cost per treatment cycle from published figures, without grants from the federal states.
Example
Typical range
IVF, privately insured, per cycle
about EUR 3,700
ICSI, privately insured, per cycle
about EUR 5,000 to 10,000
Own share for publicly insured couples per cycle
about EUR 1,500 for IVF, EUR 1,800 for ICSI
Four cycles in the 2019 BGH case
around EUR 17,500
Freezing fertilised eggs
about EUR 800, storage around EUR 25 a month
The cost per cycle comes from an overview dated 2021 and varies by clinic and medication.
The worked example below is a guide value from our quoting practice.
Worked example
Couple, man privately insured and infertile, woman 36 and publicly insured
The cause lies with the man, so his private insurer covers the whole treatment, provided the tariff reimburses in full.
Three ICSI cycles at about EUR 5,000
about EUR 15,000
PKV reimbursement with full cover
about EUR 15,000
Deductible in the tariff, example
EUR 500
Lost premium refund
depends on the tariff
The couple mainly pays the deductible. If the woman had the cause and were publicly insured, the fund would pay only half and the couple would pay around EUR 7,500 themselves.
Why private insurance pays at all
Childlessness itself is not an illness, but its organic cause is, for example blocked fallopian tubes or severely reduced sperm quality. Germany's Federal Court of Justice (BGH) classified IVF for organic infertility as medically necessary treatment as early as 17 December 1986 (IVa ZR 78/85).
Only the couple's own eggs and sperm are covered. Egg donation is banned in Germany, and private insurance does not have to pay for it even where it is legal abroad (BGH, 14 June 2017, IV ZR 141/16).
The cause principle
What matters is who has the cause. If a privately insured man is infertile, his insurer also pays the treatment of the woman: hormones, egg retrieval and embryo transfer. The treatment cannot be split into separate parts (BGH, 3 March 2004, IV ZR 25/03).
If the cause lies with a publicly insured female partner, the public rules apply to her, with age limits and a 50 percent subsidy. In mixed cases, ask both insurers in advance who covers which part.
Cause lies with
Insurance
Who pays what
Man
man private
his PKV, usually the whole treatment
Woman
woman private
her PKV, usually the whole treatment
Woman
woman public
public fund under its rules, 50 percent
Both
mixed
each side under its rules, agree in advance
Success chance, age and number of cycles
Private insurance pays only while the treatment has a sufficient chance of pregnancy. According to case law the threshold is about 15 percent per cycle. Many unsuccessful cycles can lower the chance. In 2005 the BGH also ruled that the insurer must pay for a second child (21 September 2005, IV ZR 113/04).
The woman's age alone is no reason to refuse. On 4 December 2019 the BGH ordered an insurer to cover most of about EUR 17,500 for four cycles of a 44 year old woman (IV ZR 323/18). The test is the chance of pregnancy, not of birth.
What your tariff says
Many tariffs reimburse the doctors' fee schedule (GOÄ) in full, others only a percentage. An agreed deductible applies here too, and in many tariffs a claim costs you that year's premium refund.
Before the first cycle, get a written confirmation of cover based on the treatment plan. Then you know which steps are paid and do not argue only after the invoice arrives.
When private insurance does not pay
Without an organic cause, with donated eggs or sperm and for methods banned in Germany. If the doctor rates the success chance below the threshold, the insurer usually refuses as well.
If you want to switch to private insurance only once you plan a child, you must disclose known findings in the health questions. That can lead to an exclusion or a surcharge.
Step by step
Have the cause diagnosed and documented by a doctor.
Check the tariff for reimbursement rate, deductible and premium refund.
Send the treatment plan with costs to the insurer.
Wait for written confirmation of cover, then start.
With mixed insurance, ask both insurers in advance.
Have the confirmation renewed before every further cycle.
Checklist
Organic cause in the insured person documented
Written confirmation of cover with treatment plan
Reimbursement rate and deductible known
Own eggs and sperm, no donation
With mixed insurance, agreement with both insurers
Common mistakes
Starting without confirmation of cover and then disputing parts of the bill
Assuming the public age limit also applies in private insurance
Asking only one insurer when the couple is insured differently
Planning treatment abroad with methods banned in Germany
Questions and answers
Frequently asked
Does private insurance pay for unmarried couples?
Many insurers do, unlike public insurance.
Your tariff conditions decide, so ask in advance.
Is there an age limit in private insurance?
Not a fixed one.
According to the BGH age alone is not enough to refuse; what counts is the chance of pregnancy.
How many cycles does private insurance pay?
Usually there is no fixed number.
Each cycle must still have a success chance of about 15 percent.
Does private insurance pay for a second child?
Yes, the illness continues after the first child is born.
The BGH ruled so in 2005.
Does my private insurer pay for my publicly insured wife's treatment?
Yes, if the cause lies with you.
Her treatment is then part of the treatment of your illness.
Does private insurance pay for egg donation abroad?
No.
It does not have to pay for methods banned in Germany, even abroad.
Is egg freezing covered?
Usually only if medically necessary, for example before cancer treatment.
