In case of sickness, the doctor may be chosen freely
On presentation of the e-card, insured persons and co-insured dependants are entitled to treatment by doctors at the WGKK’s expense. The e-card must be presented at each visit to the doctor.
Treatment is provided by:
- Doctors under contract
- Group practices under contract
- Facilities under contract (out-patient departments)
- Doctors at WGKK health facilities (addresses)
Please always note the “quarter rule”, also applying to group practices under contract!
Per quarter (January–March, April–June, July–September, October–December)
- only one general practitioner under contract
- up to three specialists in different fields under contract
- any number of dentists under contract
can be visited directly without a referral.
If in one quarter it should become necessary to consult more than three specialists, a general practitioner or specialist can make a referral for a further visit at a specialist.
Consulting a second specialist in the same field in one quarter at the WGKK’s expense is in general not possible. In special cases, and if there is good reason, approval for the additional visit may be given before the visit to the doctor at one of the WGKK’s branches.
Service fee for the e-card
The service fee for the e-card, due in November 2019, is EUR 11,95.
Examples of collection:
|Insured persons registered in the health insurance system by their employers on 15 November||Employer||EUR 11,95|
|Recipients of sickness, maternity or child care benefit who received that benefit on 15 November||Relevant health insurance institution||EUR 11,95|
|Recipients of unemployment benefit who received that benefit on 15 November||Employment service||EUR 11,95|
|Self-insured person voluntarily insured in health insurance on 15 November||Relevant health insurance institution||EUR 11,95|
Exempt from the service fee for the e-card are
- co-insured spouses
- co-insured registered partners
- co-insured civil-union partners
- co-insured children
- Persons exempt from prescription charges
The following services are deemed equivalent to treatment by doctor
- Physiotherapeutic treatment
- Speech-therapy treatment
- Ergotherapeutic treatment
- Psychotherapeutic treatment
- Diagnostic services by clinical psychologists
- Treatment by massage therapists
Approval by the head physician
For certain services, a head physician’s approval is required beforehand. Generally, this can be done at any WGKK branch (addresses).
The following services require a head physician’s approval:
- Speech-therapy treatment from the 2nd session onward
- Ergotherapy from the 2nd session onward
- Physiotherapy by freelance physiotherapists in the form of home visits and treatment by freelance massage therapists from the 1st session onward
- Prescriptions for physiotherapy treatment at institutes and specialists under contract have to be presented to the WGKK prior to or at the beginning of the treatment at the lates
- Psychotherapy from the 11th session onward
- Home medical care from the 28th day onward
- Scheduled treatment and examinations abroa
- Computed tomography, magnetic resonance imaging
- Cosmetic treatment, cosmetic surgery
- Sterilisation, sex change
- HELP therapy
- surgical weight reduction measures
- Air transport
- Ambulance transport for serial treatment from the 11th transport onwards (except for transports to and from dialysis, chemo-nuclear therapy and follow-up examinations in casualty departments)
- Dialysis at home
More information on special prescriptions:
Telephone: +43 1 601 22-2162 or 2165