The flu epidemic still has a firm grip on Germany and is presenting doctors and health authorities with an almost insurmountable challenge. The hospitals have not only been overcrowded for weeks, the nursing staff themselves have also been infected with the virus – and there is still no ebb in sight. This is not least due to the fact that the health insurance companies do not cover the quadruple vaccine, which is effective against the influenza B viruses. Here you can find out everything you need to know about the reimbursement of flu vaccines by health insurers.
First of all, the question arises for whom a flu vaccination is useful and necessary at all. The risk groups include all those whose immune system is already weakened, such as the elderly and people with chronic diseases. A vaccination is also useful for anyone who has a lot of contact with other people at work, e.g. employees of medical facilities. Consultation with the family doctor is advisable in the individual case.
Are the vaccination costs covered by the statutory health insurance?
But even those who belong to the risk group get stuck when it comes to the cost factor for the vaccination, because not all health insurances pay this. Although the flu vaccination is now covered by many statutory health insurance companies, it is still worth checking with the health insurance company in advance whether and under what conditions the costs will be covered. The vaccine is sometimes taken over, but the doctor’s service is not. A medical recommendation from the doctor is often the decisive factor so that the vaccination costs are covered by the health insurance fund. In the worst case, those who do not belong to the risk group will be prescribed the vaccine as a private prescription and have to pay for it out of pocket.
Triple vaccinations only included
But be careful: The vaccines that are covered by health insurances are only the so-called triple vaccines. These were the flu vaccines that were widely used up to now, but do not provide adequate protection against the so-called influenza B viruses of the Yamagata line, which are responsible for the majority of illnesses this flu season.
Effective protection from the quadruple vaccine
The quadruple vaccine offers more effective protection against precisely these influenza B viruses. However, this is considerably more expensive and has so far only been covered by health insurers for high-risk patients. Recently, the Standing Vaccination Commission (STIKO) has even recommended him. But the statutory health insurance companies are not bound by this. In addition, they have concluded exclusive discount agreements that only include the triple vaccines. General practitioners therefore usually still give the triple vaccination.
Of course, everyone can get the quadruple vaccine at their express request, but then first has to pay for it themselves and then hope for the goodwill of their health insurance company.
Urgency request for reimbursement made
Based on the recommendation of the Standing Vaccination Commission for the quadruple vaccine, the Federal Joint Committee has already drawn up a draft resolution. This committee decides which vaccinations must be covered by the statutory health insurance. However, until the decision is binding, the Ministry of Health has to agree, so that this will take at least until June – clearly too late for this year’s flu season. Critics therefore demand the introduction of an urgent procedure for such hazardous situations.