The exemption doesn't happen by itself
The burden limit under § 62 SGB V is a legal entitlement — but your health insurer does not automatically know how much you have paid. Pharmacies, practices and hospitals do not report your co-payments to the insurer. So you have to act yourself: collect receipts, prove your income and apply for the exemption.
Step 1: collect receipts
Under § 61 SGB V, every provider that collects a co-payment must give you a receipt. Ask for one if none is issued. Many pharmacies keep a receipt booklet or print an annual overview of all co-payments on request. Each receipt should show the name, date, type of service and the co-payment amount.
Think of all areas: pharmacy, physiotherapy, hospital, rehab, medical aids and travel costs. And collect the receipts of all household members, because the limit applies to the joint household.
Step 2: calculate your limit
Work out where your personal burden limit lies. The co-payment exemption calculator takes into account the 2026 allowances for partners (€7,119) and children (€9,756 each), the chronic illness rule and the special rule for basic income support. Enter the co-payments made so far and you will see how much is left before exemption.
Step 3: gather your documents
For the application you usually need:
- the application form of your insurer (usually available on its website or at a branch)
- all co-payment receipts for the calendar year, as originals or copies, depending on the insurer's requirements
- proof of income for all household members, such as payslips, pension notices, the tax assessment or evidence of rental income
- for basic income support, the current benefit notice
- for the 1% limit, the medical certificate of long-term treatment and, if applicable, the decision on care level, disability degree or reduced earning capacity
Step 4: receive and show the certificate
Once your household has reached the limit, the insurer issues an exemption certificate. It is valid until the end of the calendar year. Under § 62(3) SGB V it must not contain any information about your income — so you don't have to reveal anything about your finances at the pharmacy. Show the certificate for every service. If you paid more than the limit, the insurer refunds the excess.
Paying in advance: exemption from January
If you know you will definitely reach the limit — for example because of a chronic illness with regular medication — many insurers let you pay the expected limit in advance at the start of the year. You then receive the exemption straight away and no longer need to collect receipts during the year. Ask your insurer directly whether and how it offers this.
Applying retrospectively: deadlines
If you paid more than your limit last year, you can also claim the refund retrospectively. Under § 45 SGB I, claims to social benefits become time-barred four years after the end of the calendar year in which they arose. How your insurer applies this period to co-payment refunds is best clarified directly with it. Either way: keep your receipts for several years.
Checklist
- Get a receipt for every co-payment, including your partner's
- Compare the total with the burden limit regularly
- Apply as soon as the limit is reached
- Renew the chronic illness certificate annually if the insurer requires it
- Keep receipts for a possible retrospective refund
If you are reconsidering your health insurance in general, the public vs. private health insurance calculator compares contributions — the burden limit only exists in statutory health insurance.