A Question Many Couples Face
Roughly one in ten couples in Germany seeks medical help to conceive. Fertility treatment — from hormone therapy to IVF and ICSI — is expensive, often €4,000–€8,000 per IVF cycle including medication. How much of that lands on you depends heavily on whether the relevant partner is privately or statutorily insured.
The headline difference: GKV typically pays 50% of costs for a limited number of cycles under strict conditions. PKV, by contrast, generally reimburses 100% of medically necessary treatment — but only for the partner whose body is the cause of the infertility (the causation principle, Verursacherprinzip).
The Causation Principle
Private insurance covers treatment of the insured person's own illness. In fertility medicine, courts have long applied this by cause: if the man's limited fertility necessitates ICSI, his insurer pays the treatment — including the procedures performed on his partner as part of it. If the cause lies with the woman, her insurer is responsible.
| Constellation | Typical outcome |
|---|---|
| PKV partner is the cause | PKV usually reimburses 100% of medically necessary cycles |
| GKV partner is the cause | GKV rules: ~50%, limited cycles, age and marriage conditions |
| Mixed / both contribute | Apportionment — get both insurers' positions in writing first |
| Unexplained infertility | Case-by-case; pre-approval is essential |
What PKV Typically Requires
- Medical necessity: a diagnosed fertility problem — purely elective treatment (e.g. social freezing) is not covered
- Reasonable prospect of success: insurers may decline where success probability per cycle falls below thresholds shaped by case law (often an issue at higher ages)
- Tariff conditions: some tariffs limit the number of attempts or contain specific fertility clauses — read them before treatment
- Pre-approval: always obtain a written benefits confirmation with the clinic's treatment and cost plan
Practical Steps for Couples
Get the diagnostic workup for both partners first — it determines which insurer is responsible. Then submit the treatment plan to that insurer and wait for written confirmation before starting a cycle. If your PKV declines, ask for the legal basis; causation-principle disputes are common and often resolve in the insured's favour when the medical facts are clear. Note that unmarried couples generally fare better under PKV than GKV, which requires marriage.
The Bottom Line
For couples where the privately insured partner is the medical cause, PKV usually pays fertility treatment in full — a substantial advantage over the statutory 50%. Clarify causation, check your tariff's fertility clause and never start a cycle without written pre-approval.
Frequently Asked Questions
Compare PKV Tariffs for Your Situation
Our independent advisors help expats and professionals find the right private health insurance — personalised to your age, health, and budget.
Get My Free Quote