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Medically advisable or necessary: when is repatriation covered?

In short

German statutory health insurance never pays for repatriation. It is covered by travel health insurance when it is medically advisable or necessary, depending on the clause. Necessary means you cannot be treated adequately abroad. Advisable is enough when, say, more than 14 days in hospital are expected. A doctor for the insurer decides. An intensive care flight costs EUR 24,000 to 400,000.

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Medically advisable or necessary: when is repatriation covered?

What it costs

Published costs of medical repatriation to Germany and premiums for annual policies.

Example	Typical range
Ground transport with doctor, St. Moritz to Munich	about EUR 2,450
Intensive care air ambulance from Mallorca, Crete or Antalya	about EUR 24,000 to 31,000
Intensive care transport from the Canary Islands	about EUR 75,000
Intensive care transport from North or South America	about EUR 200,000
Intensive care transport from Australia or New Zealand	up to EUR 400,000
Travel health insurance, annual policy, one person	about EUR 10 to 20 a year
Travel health insurance, annual policy, family	about EUR 25 to 35 a year

Costs from publications of a German motoring club, as of 2022 and 2025;

premiums checked October 2026.

The cases in the clause table are guide values from our quoting practice,

your terms and the insurer's doctor decide.

We obtain the exact quote for you.

Worked example

Broken hip after a fall on Gran Canaria, age 71, three weeks in hospital expected

The local hospital can operate and provide care. After surgery the patient wants to go home, his wife travelled with him. A stretcher transport in an air ambulance with escort is needed.

Statutory health insurance payout for repatriation	EUR 0
Policy with the necessary clause	no repatriation, local treatment is adequate
Policy with the advisable and justifiable clause	repatriation, because more than 14 days in hospital are expected
Cost of an intensive care transport from the Canary Islands	up to about EUR 75,000

With the strict clause he stays on the island for three weeks or pays for the flight himself. With the advisable and justifiable clause the insurer brings him home after surgery. Worked example with guide values.

Two words, one big difference

If your terms say repatriation is paid when it is medically necessary (medizinisch notwendig), the insurer only pays if you cannot be treated adequately abroad. As long as the local hospital can handle your broken leg or pneumonia, you stay there, even for weeks. In Europe, with good hospitals, a necessary repatriation is therefore rare.

If the terms say medically advisable and justifiable (medizinisch sinnvoll und vertretbar), it is enough that going home makes medical sense and you are fit to travel. You can then get home earlier, to your family and to a hospital where staff speak your language. German consumer advocates have recommended only policies with this wording for years.

How insurers define advisable

Many terms list fixed cases in which repatriation counts as medically advisable. One published example from a German health insurer for civil servants names three: life threatening cases where specialist treatment is needed or local treatment is inadequate; an expected hospital stay abroad of more than 14 days; or hospital costs abroad that would exceed the cost of transport plus further treatment in Germany.

Wanting to recover from a minor illness at home is not covered. If you spend two days in your hotel with a stomach bug, you get no repatriation, you fly home on your booked return flight.

Case	Clause necessary	Clause advisable and justifiable
Broken thigh in Spain, good local hospital, three weeks as inpatient	usually no repatriation	repatriation, because of more than 14 days in hospital
Stroke in Thailand, specialist care on site patchy	repatriation	repatriation
Appendicitis in Italy, five days in hospital	no repatriation	usually no repatriation
Heart attack in the USA, hospital costs higher than flight plus treatment at home	depends on local hospital	repatriation
Minor illness, wish to go home	no repatriation	no repatriation

Who decides and how repatriation works

Call your insurer's emergency number straight away, it is on your card or policy schedule. A doctor for the insurer talks to the treating doctor abroad. Together they decide whether and when repatriation is medically advisable or necessary and which means of transport fits.

Options range from a scheduled flight with a medical escort to a stretcher transport and an air ambulance with intensive care. Do not arrange transport yourself: many policies only pay for what the insurer organised or approved in advance. Cover usually runs to your home address or the nearest suitable hospital.

What repatriation costs

Without travel health insurance you pay for repatriation yourself, because section 60 (4) of Book V of the German Social Code (SGB V) expressly excludes it from statutory cover. That also applies within the EU and with the European Health Insurance Card.

The range is huge. A ground transport with a doctor from Switzerland costs a few thousand euros, an intensive care flight from the Canary Islands about EUR 75,000, from the Americas about EUR 200,000 and from Australia up to EUR 400,000. Travel health insurance including repatriation costs about EUR 10 to 20 a year.

Route and transport	Cost
St. Moritz to Munich, ambulance with doctor	about EUR 2,450
Mallorca, intensive care air ambulance	about EUR 24,000
Crete, intensive care air ambulance	about EUR 28,000
Antalya, intensive care air ambulance	about EUR 31,000
Canary Islands, intensive care transport	about EUR 75,000
North and South America, intensive care transport	about EUR 200,000
Australia or New Zealand, intensive care transport	up to EUR 400,000

When you want to go home and the insurer says no

Disputes almost always arise under the necessary clause: you want to go home, the insurer points to the good local hospital. Ask for the refusal in writing and request the treating doctor's report. With the advisable and justifiable clause, you are in a much stronger position after a long hospital stay.

For private health insurers, the ombudsman for private health insurance handles complaints free of charge, for other insurers the general insurance ombudsman. You are free to fly home at your own expense, but the bill may then stay entirely with you.

When you do not need extra repatriation cover

Repatriation is part of almost every travel health policy, so you do not need it twice. Do check whether your existing policy says necessary or advisable. Motoring club cover and some credit cards also include repatriation, often with the stricter wording or with caps.

If you have full private health insurance in Germany, you often have worldwide cover for treatment, but not always for repatriation. Check your terms to see whether a cheap travel health policy needs to close that gap.

Step by step

Search your travel health terms for the word repatriation (Rücktransport) and check whether it says necessary or advisable.
Save the insurer's emergency number in your phone and carry it on paper.
In an emergency call immediately, before any transport is arranged.
Keep medical reports and the local hospital's prognosis.
Ask for any refusal in writing and contact the ombudsman if needed.

Checklist

Repatriation when medically advisable and justifiable, not only when necessary
Costs covered without a cap
Transport to your home address or the nearest suitable hospital
Travel companion or escort included
Emergency line available around the clock
Applies to children and travellers over 70

Common mistakes

Relying on statutory health insurance or the European Health Insurance Card
Choosing a cheap policy with the necessary clause
Arranging repatriation yourself without asking the insurer
Travelling without the emergency number

Questions and answers

Frequently asked

Does German statutory health insurance pay for repatriation?

No.

The law expressly excludes the cost of transport back to Germany, even within the EU.

What does medically advisable and justifiable mean?

Going home must make medical sense and you must be fit to travel.

Typical cases are life threatening situations,

more than 14 days in hospital or higher costs abroad.

When is repatriation medically necessary?

When you cannot be treated adequately on site.

In Europe, with good hospitals, that is rare.

Who decides whether I am flown home?

A doctor for the insurer together with the treating doctor abroad.

You do not decide alone.

Will I always be flown in an air ambulance?

No.

Depending on your condition,

also on a scheduled flight with escort, on a stretcher or by road ambulance.

Can my partner fly with me?

Many policies pay the return journey of one companion.

If the terms do not say so, your partner pays their own flight.

What does travel health insurance with repatriation cost?

An annual policy for one person costs about EUR 10 to 20, for a family about EUR 25 to 35.

Sources

NAMMERT insurance broker

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