Medical Ride: Getting Approval from the Health Insurer

At a glance

Prescription

Form 4 from the practice, ideally before the ride.

Approval

Depending on the reason: required, not required or deemed granted.

Co-payment

Generally 10 percent, at least 5 and at most 10 euros per ride.

The key points

The health insurer does not always pay for rides to the doctor. Whether it has to approve a ride beforehand depends on where you are going and how well you can move. This page explains it in plain words. It is based on the patient transport directive of the Federal Joint Committee (G-BA). In each case your doctor and your insurer decide.

These rides need no approval from the insurer

Here too, the practice writes a prescription on Form 4. But the insurer does not have to approve the ride in advance. This applies if:

• You stay in hospital (inpatient treatment). This applies to taxi and rental car with driver, and also to patient transport ambulance rides.
• You go to hospital for treatment before or after a hospital stay, and this makes a stay shorter or avoids it.
• An outpatient operation replaces a hospital stay that would otherwise be needed. This happens only very rarely. If you are unsure, send the prescription to your insurer first.
• You are treated in hospital during the day (day-patient treatment) and one of the groups below applies to you.
• You travel to outpatient treatment by taxi or rental car, and one of the groups below applies to you.

The groups: Your severe disability card shows the mark aG, Bl or H. Or you have care level 4 or 5. Or you have care level 3 and a permanent mobility impairment. Show the card or the notice when the ride is prescribed. For a patient transport ambulance, these groups also need approval.

For other outpatient treatment the insurer pays only in a few exceptions. They are listed in the next section and need approval.

These rides need approval beforehand

• Rides to dialysis, to radiotherapy for cancer or to chemotherapy for cancer. These treatments are frequent and last a long time. Techniker Krankenkasse asks you to send the prescription before treatment starts. According to the KBV, the insurer can also approve similar treatments on request.
• Rides if you move with a similar level of difficulty, but have neither the card nor care level 3 to 5, and you are treated over a long time.
• Rides to check-ups (early detection of diseases and cancer), if the exception applies to you.
• Rides by patient transport ambulance to outpatient treatment. This does not apply to the cases before and after a hospital stay and to the rare outpatient operation above.

Submit the prescription to the insurer early. The insurer decides how long the approval lasts and which vehicle is allowed.

Other cases

The practice does not write rides to rehabilitation or to a preventive cure on Form 4. Ask your insurer. The insurer can pay for rides by bus, train or your own car on request. You do not need a prescription for that.

Step by step

1. Ask the practice. A taxi or rental-car ride is prescribed only if you cannot use public transport or a private car for medical reasons.
2. Have the prescription issued. It is on Form 4, often called the transport prescription. It should be issued before the ride. More: transport prescription and Muster 4.
3. Hand it to your insurer if approval is needed. Do this early. At Techniker Krankenkasse you can send the original by post or use “Meine TK”.
4. Wait for the answer. The insurer decides how long the approval lasts and whether the outbound and return trips are included.
5. Request the ride from us. Tell us whether a prescription or approval exists. Whether we can bill a ride directly to your insurer depends on the individual case and the documents.

What you pay yourself

You pay 10 percent of the ride cost, at least 5 euros and at most 10 euros per ride. You never pay more than the ride costs. If you have already paid a lot in one year (annual burden limit), your insurer can exempt you for the rest of the year. You need a certificate for that. More in the guide on cost coverage and co-payments.

What insurers write themselves

Barmer writes for transport providers: rides to outpatient treatment generally have to be approved before the ride. For people with permanent mobility impairment they are deemed approved by law. Techniker Krankenkasse explains its procedure on its pages about approving travel costs. If in doubt, ask your own insurer before the rides start.

No reimbursement guarantee

PrimaFahrten does not guarantee reimbursement. The practice and the insurer decide case by case whether a ride is prescribed and whether the insurer pays. This page does not replace advice. The information is based on the directive as in force since 6 August 2025 and was checked on 21 October 2026. Where it is written: directive sections 6 to 10.

See also: care levels and disability marks and comparing types of transport.

By Tobias A. Kreuzig, co-founder of PrimaFahrten GmbH
Published: 21 October 2026 · Last substantive update: 21 October 2026

Sources and further information

G-BA: Patient transport directive (version in force since 6 August 2025, German) · KBV: Patient transport practice information (German) · Techniker Krankenkasse: approval of travel costs (German) · Techniker Krankenkasse: dialysis and chemotherapy (German) · Barmer: when travel costs are approved (German)