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Most employees in Austria are insured with the ÖGK (Österreichische Gesundheitskasse, the Austrian health insurance fund). Care from its contracted doctors, dentists and hospitals costs them little or nothing at the point of use, and the money leaks out at the edges instead: doctors without an ÖGK contract, dentures, private hospital rooms, a charge on every prescription pack.
The edge that surprises newcomers most is the Wahlarzt refund. It’s 80 % of the ÖGK’s own tariff for the visit, not of the doctor’s bill, and it usually comes to well under half of what the doctor actually charged.
ARTICLE SUMMARY
Employees, apprentices, most people on unemployment benefit and people drawing a general-scheme pension are insured with the ÖGK. The self-employed are insured with the SVS, and civil servants and railway staff with the BVAEB.
Contracted doctors bill the ÖGK directly through your e-card (social insurance card). A Wahlarzt (a doctor without an ÖGK contract) is paid by you up front, and the ÖGK refunds 80 % of its own tariff, never more than you paid.
A general-ward hospital stay costs a daily contribution, set by each state, for at most 28 days a year. Prescriptions cost EUR 7.55 a pack until a yearly cap linked to your net income kicks in.
Children are co-insured free. A co-insured spouse or partner usually costs the insured person a supplementary contribution of 3.40% of their pay.
Who the ÖGK covers, and who it doesn’t
The ÖGK insures everyone in Austria’s general social insurance scheme. That means employees, apprentices, most people receiving unemployment benefit from the AMS (Arbeitsmarktservice, the public employment service) and people drawing a pension from the general scheme.
It’s one federal carrier, and its benefits are the same in all nine states. It was formed on 1 January 2020 by merging the nine regional health insurance funds (Gebietskrankenkassen), according to the ÖGK’s own page about itself (in German), so older letters and forms may still carry a regional fund’s name.
Two large groups are insured elsewhere. The self-employed, whether trading on a Gewerbeschein (trade licence) or registered as Neue Selbstständige (new self-employed), are with the SVS (Sozialversicherung der Selbständigen), whose contributions and cost-sharing rules differ. Civil servants, many other public-sector employees and railway and mining staff are with the BVAEB (the insurer for public servants, railways and mining), and this article covers neither group.
CONTESTED.
If you work for one of the international organisations based in Vienna (the UN bodies, the IAEA and OPEC among them), your health cover is often set by your organisation’s headquarters agreement with Austria rather than by the general rules in this article. Which regime applies depends on the organisation and your staff category, so check with your organisation’s HR or legal office before relying on anything below.
Family members can be co-insured on your cover, which the section on family co-insurance below walks through.
The e-card and its yearly service fee
The e-card is how contracted doctors, hospitals and pharmacies check your cover and bill the ÖGK. For most employees it carries a yearly Service-Entgelt (service fee) of EUR 25, according to the ÖGK’s notice to employers on collecting the Service-Entgelt (in German).
Your employer deducts it from your November pay if you’re employed on 15 November, and it covers the following calendar year. People in marginal part-time jobs don’t pay it, and nor do employees who receive no pay on 15 November (during parental leave, say).
TIP.
If you’re exempt from the prescription charge (see the medicines section below), your employer still deducts the fee in November. The ÖGK refunds it on application, so the deduction on your payslip isn’t the end of the story.
Doctor visits: contracted doctors and Wahlärzte
Doctors who treat ÖGK patients come in two kinds, and which kind you see decides most of what a visit costs.
| Question | Vertragsarzt (contracted doctor) | Wahlarzt (non-contracted doctor) |
|---|---|---|
| Contract with the ÖGK | Yes | No, sets their own fees |
| What you pay at the practice | Nothing for a covered service | The full invoice |
| What the ÖGK pays | The doctor, directly | 80 % of its own tariff, refunded to you |
| Paperwork | None | A refund claim, filed by you or the practice |
A Vertragsarzt (often called a Kassenarzt) has a contract with the ÖGK. You show your e-card, the practice bills the ÖGK, and a covered service costs you nothing.
A Wahlarzt has no contract and treats you as a private patient. According to the ÖGK’s page on Wahlärzte (in German), the refund is 80 % of the Kassentarif, the fee the ÖGK would have paid a contracted doctor for the same service, and never more than you actually paid.
The ÖGK’s own page admits patients rarely get that share of the invoice back, because Wahlarzt fees usually run well above the tariff. The ÖGK publishes a list of its flat refund amounts for common services (PDF, in German), which is the quickest way to estimate a refund before booking.
Two further rules on the same ÖGK page cost people money:
- The same-quarter rule. See a contracted doctor and a Wahlarzt in the same specialty in the same calendar quarter, and the ÖGK won’t refund the Wahlarzt. See two Wahlärzte in one specialty in a quarter, and only the first invoice submitted gets a refund.
- Services outside the ÖGK’s remit. Sports medicals, pre-employment check-ups, purely cosmetic treatment and vaccinations that aren’t part of treating an illness get no refund at all.
Since 1 July 2024, Wahlärzte who see at least 300 patients a year have had to file the refund claim for you, through the ÖGK’s WAHonline system (you still pay the invoice first, and give the practice your bank details). Smaller practices, dentists and therapists can offer the same service voluntarily.
Otherwise you file the claim yourself, through Meine ÖGK (the ÖGK’s online service, which needs ID Austria) or by post, with the paid invoice and proof of payment. You have 42 months from the date of treatment.
ILLUSTRATION
Illustration: a hypothetical person employed full-time in Vienna, insured with the ÖGK, paid 14 times a year, in the 2026 tax year, not a US person and not on international organisation staff.
They see a Wahlarzt dermatologist and are billed EUR 90. The Kassentarif for the same consultation from a contracted dermatologist is EUR 40 (a hypothetical figure; real tariffs vary by specialty and service).
The ÖGK refunds 80 % of EUR 40, which is EUR 32, so the visit costs the person EUR 58. Reading the refund as 80 % of the invoice would have put the cost at EUR 18.
Had they already seen a contracted dermatologist earlier in the same calendar quarter, the refund would be nil, and the visit would cost the full EUR 90.
Hospital stays: covered treatment, a daily contribution
Treatment in the allgemeine Gebührenklasse (the general ward) of a publicly funded or ÖGK-contracted hospital is paid by the ÖGK in full, for as long as your illness requires it, according to the ÖGK’s page on hospital stays (in German).
What you pay is a daily Kostenbeitrag (cost contribution), set and collected by the hospital’s operator, for at most 28 days per calendar year. The cap counts every stay in the year together, whichever hospitals they were in, and after that the social insurance carries the full cost.
Children under 18, stays for childbirth (up to 10 days) and admissions for organ donation are exempt. Co-insured adult family members pay a separate daily contribution in place of this one, under different rules, and a prescription-charge exemption doesn’t remove theirs.
STATE NOTE.
The daily contribution is set state by state. Federal hospital law sets the framework and a ceiling, and each state government fixes the actual rate by regulation. The Gesundheitsportal’s page on what a hospital stay costs (in German) puts it at roughly EUR 12 to EUR 16 a day depending on the state, and the hospital’s website or billing office has the current rate for yours.
The Sonderklasse (private class: a private room, free choice of doctor, better catering) is never covered. Those charges are billed privately or paid by a private supplementary policy.
Treatment in a private hospital with no ÖGK contract gets only a fixed daily subsidy, capped at what you actually paid.
ILLUSTRATION
a hypothetical person employed full-time in a state where the daily contribution is EUR 15 (a hypothetical rate within the published range), insured with the ÖGK, paid 14 times a year, in the 2026 tax year, not a US person and not on international organisation staff.
They spend 20 days in hospital in March and another 15 days in October, 35 days in all. The daily contribution applies to only 28 of them across both stays.
The year’s total is 28 × EUR 15 = EUR 420. Charging every day of both stays would have produced EUR 525.
Medicines and aids: the Rezeptgebühr and its yearly cap
Each pack of prescribed medicine costs a fixed Rezeptgebühr (prescription charge) of EUR 7.55, paid at the pharmacy, according to the ÖGK’s page on the Rezeptgebühr (in German). If the medicine costs less than the charge, you pay the lower price, and the ÖGK pays the rest.
There’s a yearly ceiling, the Rezeptgebührenobergrenze (prescription charge cap, REGO for short). Once your spending in a calendar year passes 2 % of your annual net income, and at least EUR 314.01, you pay no further charges that year.
The e-card system tracks this automatically, so there’s nothing to apply for. It resets on 1 January.
Some people are exempt from the charge altogether. That happens automatically for groups such as people receiving the Ausgleichszulage (the minimum-pension top-up), or on application where monthly net household income is below limits the ÖGK publishes each year.
A full exemption reaches further than the cap. It also removes the e-card fee, the cost share on aids, the insured person’s own hospital contribution and the supplementary contribution for a co-insured partner, and it covers co-insured family members’ prescriptions too.
Prescribed aids and appliances (Heilbehelfe and Hilfsmittel: bandages, orthopaedic insoles, hearing aids, wheelchairs) come from ÖGK contract suppliers. According to the ÖGK’s page on Heilbehelfe and Hilfsmittel (in German), you pay 10 % of the cost, with a minimum of EUR 46.20, so an item cheaper than the minimum ends up paid in full by you.
The prescription for an aid has to be redeemed within 30 days. Children under 15 and people fully exempt from the prescription charge pay no share, but reaching the yearly prescription cap doesn’t remove it.
Glasses and contact lenses carry a higher minimum. Austrian social insurance law’s rule on aids (in German) sets your share at 10 % or at least EUR 138.60, whichever is more, and varifocal and trifocal lenses aren’t covered at all (co-insured children pay the ordinary aids minimum instead).
ILLUSTRATION
a hypothetical person employed full-time, insured with the ÖGK, paid 14 times a year, in 2026 (this example is pinned to 2026 values), with annual net income of EUR 24,000 excluding the 13th and 14th salary (which the ÖGK’s own worked example also leaves out), not a US person and not on international organisation staff.
Their prescription cap is 2 % of EUR 24,000, or EUR 480. That’s above the EUR 314.01 minimum, so EUR 480 applies, which at EUR 7.55 a pack is roughly 64 prescription charges before the rest of the year is free.
The same year, they’re prescribed orthopaedic insoles with a tariff cost of EUR 120. Their 10 % share would be EUR 12, so the EUR 46.20 minimum applies instead, and it still applies after they’ve reached the prescription cap.
Dental care: treatment, dentures and implants
From a contracted dentist, the ÖGK pays the tariff in full for its listed contract services. According to the ÖGK’s page on dental treatment (in German), those include composite fillings in the front teeth, root canal treatment, tartar removal by the dentist, oral surgery and extractions.
Dentures are where the costs start. The ÖGK’s page on dentures (in German) sets out three different regimes:
- Removable dentures need the ÖGK’s approval before they’re made, usually applied for by the contracted dentist. Since 1 May 2026 you pay 30 % of the tariff cost, or 20 % if you’re exempt from the prescription charge, and a replacement is covered only after 4 years (partial acrylic plates) or 6 years (metal-framed and full acrylic ones).
- Fixed dentures (crowns and bridges) are a private service as a rule. The ÖGK contributes only in special medical cases, approved in advance with medical documentation.
- Implants are paid only in narrowly defined medical cases, such as cleft lip and palate, rebuilding after tumour surgery or multiple jaw fractures, and some congenitally missing teeth. Mini implants aren’t paid at all.
A Wahlzahnarzt (a dentist without an ÖGK contract) is refunded like a Wahlarzt, at 80 % of the tariff. For dentures, that refund is worked out on the tariff after your cost share has been taken off, so the two rules stack.
ILLUSTRATION
a hypothetical person employed full-time, insured with the ÖGK, paid 14 times a year, in the 2026 tax year, not exempt from the prescription charge, not a US person and not on international organisation staff. They need a removable partial denture with a tariff cost of EUR 600 (a hypothetical figure).
From a contracted dentist, with the ÖGK’s approval, they pay 30 % of EUR 600, which is EUR 180.
A Wahlzahnarzt bills them EUR 1,000 for the same denture. The ÖGK refunds 80 % of EUR 420 (the tariff after the EUR 180 cost share), which is EUR 336, so the denture costs them EUR 664.
At a glance: what you pay
| Care | ÖGK pays | You pay |
|---|---|---|
| Contracted doctor | The full cost of a covered service | Nothing at the practice |
| Wahlarzt or Wahlzahnarzt | 80 % of its own tariff, refunded | The invoice up front, then the gap |
| Hospital, general ward | The treatment and stay | A daily contribution for up to 28 days a year |
| Prescription medicine | The rest of the price | EUR 7.55 a pack, until the yearly cap |
| Aids and appliances | The rest of the cost | 10 %, at least EUR 46.20 |
| Contracted dentist, treatment | The tariff, in full | Nothing for listed contract services |
| Removable dentures | The rest of the tariff, after approval | 30 % of the tariff |
Family co-insurance (Mitversicherung)
Children are co-insured with both parents from birth, free of charge, until the day before their 18th birthday, according to the ÖGK’s page on co-insuring children (in German).
Free cover can continue to 27 while the child is in recognised school or vocational training of at least 20 hours a week, or in a university degree with the required progress. It also runs for up to 24 months of job-seeking after education (to 29 at most), and without an age limit for a child unable to work because of illness or disability that began before 18 or before their education ended.
Adults are different. A spouse, registered partner, cohabiting partner or a relative who runs your household can be co-insured, but the insured person usually pays a Zusatzbeitrag (supplementary contribution) of 3.40% of their own contribution base, according to the ÖGK’s page on the supplementary contribution (in German).
For an employee, that base is pay subject to social insurance, including Sonderzahlungen (the 13th and 14th salary), and anyone with two insured jobs pays it on each. A cohabiting partner qualifies only after living with you for at least 10 months and running the household unpaid, and only if no spouse able to work lives in the same household.
No supplementary contribution is due where:
- the co-insured person is raising a child in your shared household now, or did so for at least 4 years in the past;
- the co-insured person receives long-term care allowance at level 3 or above;
- you’re receiving sickness benefit, maternity benefit, childcare allowance, unemployment benefit, emergency assistance or means-tested minimum income;
- your household is in social need, mainly where your monthly net income is below the couples’ reference rate the ÖGK publishes each year.
The social-need test is decided by the ÖGK on application, which is the point to contact them with your own figures.
ILLUSTRATION
Illustration: a hypothetical person employed full-time in Vienna, insured with the ÖGK, paid 14 times a year at EUR 3,000 gross per payment (below the contribution ceiling), in the 2026 tax year, not a US person and not on international organisation staff. Their spouse doesn’t work, has no insurance of their own, and has never raised children in the household.
The supplementary contribution is 3.40% of EUR 3,000, or EUR 102, on each of the 14 payments. Over the year that’s EUR 1,428, deducted with the employee’s other social insurance contributions.
If the same couple were raising a child together at home, the contribution would be nil.
What the ÖGK doesn’t cover
- The gap between a Wahlarzt’s or Wahlzahnarzt’s invoice and the refund.
- Sonderklasse charges in hospital: a private room, choice of doctor, comfort extras.
- Anything that isn’t treatment of an illness, such as cosmetic procedures, sports medicals and pre-employment check-ups.
- Crowns, bridges and implants, except in the special medical cases approved in advance.
- Your cost share on aids, dentures, glasses and contact lenses, and varifocal or trifocal lenses entirely.
- Private hospitals without an ÖGK contract, beyond a fixed daily subsidy.
The list covers the common gaps. For a specific treatment, your contracted doctor or the ÖGK’s customer service can confirm cover before you commit.
KEY TAKEAWAY
Inside the contract network, ÖGK cover is close to free: contracted doctors and dentists, general-ward hospital care, and prescriptions up to a yearly cap. The costs sit at the edges, mainly the Wahlarzt gap, dentures, the daily hospital contribution and the supplementary contribution for a co-insured spouse or partner.
For a hypothetical employee who stays in the network and co-insures only children, the yearly out-of-pocket bill is mostly the e-card fee and a handful of prescription charges.
Where the answer turns on your own facts (whether a partner qualifies for co-insurance, whether your household meets the income limit for a prescription-charge exemption, whether a denture or implant will be approved), the ÖGK decides. You can ask it directly at a Kundenservicestelle (customer service centre) or through Meine ÖGK.
If a claim goes badly, the ÖGK runs its own Ombudsstelle (ombuds office) (in German), which mediates complaints but can’t set the law aside. Staff of international organisations should start with their organisation’s HR or legal office instead.
Official sources
- ÖGK: Wahlärztinnen und Wahlärzte (Wahlarzt refunds) (in German)
- ÖGK: Aufenthalt im Krankenhaus (hospital stays) (in German)
- ÖGK: Rezeptgebühr und Rezeptgebührenbefreiung (prescription charge and exemptions) (in German)
- ÖGK: Heilbehelfe und Hilfsmittel (aids and appliances) (in German)
- ÖGK: Zahnersatz (dentures) (in German)
- ÖGK: Mitversicherung, Zusatzbeitrag für Angehörige (supplementary contribution) (in German)
