Cost coverage by the WGKK
The WGKK pays about a third of the contributions made by insured persons into the Regional Health Fund that finances public hospitals. Insured persons and their dependants can thus get the treatment required in a hospital’s general price category.
This covers fully the cost of accommodation, food and care, the cost of medical examinations and treatment, as well as the provision of all required medicine and aids.
Contribution towards costs
However, insured persons have to – independent from the WGKK – pay a daily contribution (contribution to the cost of food) to the hospital for a maximum of 28 days per calendar year.
For persons exempt from prescription charges, there is no contribution (except when only exempt from prescription charges on reaching the upper limit).
For the hospital care of dependants, a daily contribution according to the General Social Security Act has to be made in all hospitals financed by the Vienna Regional Health Funds:
Per day and a maximum of 28 days per calendar year EUR 21.90 (as of January 2018).
There is no contribution for organ donors and in the case of maternity (giving birth) as well as for children up to the age of 18.
Special price category
The additional costs for the special price category (e.g. costs of operations, specialists’ invoices, special care fees) have to be paid privately and will not be reimbursed by the WGKK.
Cost coverage for hospitals not financed via the Regional Health Fund and hospitals abroad
(does not apply to private hospitals under contract)
If insured persons (dependants) receive necessary hospital care in a hospital not financed via the Regional Health Fund, and which has no contractual relationship, the WGKK, after the Medical Service has checked the situation, makes a maximum contribution towards care costs of a fixed daily amount.
From 1 January 2019 this amount is:
- for the hospital care of insured persons per day EUR 251,37
- for the hospital care of dependants per day EUR 211.69
- yet no more than the actual costs
This also applies to cost coverage for hospital care in a hospital abroad, unless the WGKK has promised in advance to bear the full costs as there is no appropriate treatment available in Austria. For treatments and operations abroad that in Austria cannot be provided or not within a medically acceptable time, and for which the Medical Service has given approval beforehand, the costs will be borne either under a
- cross-national agreement with the respective EU/EEA or contractual state or
- by directly assuming the costs abroad based on a case-by-case decision
For the application for cost reimbursement, the following documents are required
- Original invoice with proof of payment
- Proof of stay
- Detailed doctor’s report with daily course (temperature chart), in non-EU countries and countries with which there is no agreement on social security, in German or English language
- Signed application ( form available at the WGKK)
- Bank details
Hospital care in private hospitals under contract
The WGKK pays contributions to the private hospital financing fund (privater Krankenanstaltenfinanzierungsfonds - PRIKRAF). WGKK customers can thus also stay in the general price category of these hospitals without additional payment.
Attention: In private hospitals under contract there might be additional charges for services going beyond the general price category and which cannot be covered by the WGKK. It is therefore advisable to ask hospital staff about this at the beginning of the stay.
Private hospitals under contract in Vienna
- Sanatorium Hera
- Wiener Privatklinik
- Confraternität – Privatklinik Josefstadt
- Privatklinik Döbling
- Goldenes Kreuz
Attention: through the fixed payment of the social insurance institutions to the PRIKRAF the costs
- of accommodation
- of food
- of care
- of medical examination and treatment
- as well as of the provision of all required aids and medicines are covered.
The WGKK cannot assume any further costs or make reimbursements beyond this.
More information on hospital care:
Telephone: +43 1 601 22-2840