Cost approval (Kostengutsprache)

A cost approval (Kostengutsprache) is the health insurer's prior commitment to cover the costs of a specific treatment. Where basic insurance reimburses a medicine in an individual case under Art. 71a to 71d of the Health Insurance Ordinance (KVV), it pays only on such a special approval (Art. 71d para. 1 KVV).

How the insurer decides

• The cases in which basic insurance can cover a medicine outside its regular lists are set out in Art. 71a to 71c KVV.
• Before deciding, the insurer consults its medical adviser, in German Vertrauensarzt or Vertrauensärztin (Art. 71d para. 1 KVV).
• Once the application is complete, the insurer decides within two weeks (Art. 71d para. 3 KVV).
• A refusal must be justified to the treating physician and to the patient (Art. 71d para. 6 KVV).

Where patients meet it

According to the Federal Office of Public Health (BAG), the benefits catalogue of basic insurance currently contains no cannabis medicines, and basic insurance reimburses them only in exceptional cases. The BAG adds that case-by-case reimbursement always requires a cost approval (BAG FAQ of 4 March 2025).

We cannot promise an outcome: the decision lies with the insurer. Whether a supplementary insurance pays is a separate question that depends on the individual policy. Our article on insurance and cost approval explains the rules in more detail.