Co-insurance of family members

Social insurance services are rendered to the persons insured and some of their family members. This includes, as a rule, all persons not insured but living in the same household as the insured.

Co-insurance does not depend on an expression of intention on the part of the insured or a member of their family but on statutory prerequisites only. The insured cannot refuse family membership if all prerequisites are fulfilled. The insured is obliged to notify their health insurance institution of any family members they have. Any changes to family membership, such as divorce or family members taking out own insurance must also be reported to the health insurance institution.

Prerequisites for claim to insurance on the grounds of family membership

• The family member concerned must have their main residence in Austria. Exceptions are children and grandchildren residing abroad for educational or vocational training purposes.
• The family member must not be insured under the ASVG (act governing social insurance) or any relevant other law and has no claim to medical treatment or care from any institution established by an employer under public law providing such treatment or care.

Family members are

• spouses (male or female),
• children born in wedlock, legitimised children and adopted children,
• children of the female insured born out of wedlock,
• children of the male insured born out of wedlock, provided paternity has been recognized or established by judgement,
• stepchildren and grandchildren permanently living in the same household with the insured,
• foster children taken care of by the insured without remuneration or where fostering has been officially assigned; children taken care of and raised by the insured who are related to the insured to the third degree or by marriage and permanently living in the same household,
• housekeeping family member, either parent, adopted, foster or stepparent, child, adopted, foster or stepchild, grandchild or sibling, provided they have been living in the same household for a minimum of ten months, are fulfilling housekeeping duties without remuneration and no fit-for-work spouse of the insured is living in the same household or
• life companion provided they have been living in the same household with the insured for a minimum of ten months, are doing housekeeping duties without remuneration and there is no fit-for-work spouse of the insured still alive.
• Individuals who use the main share of their working capacity to provide domiciliary care on a non-commercial basis for an insured person entitled to long-term care benefit ("Pflegegeld") that corresponds to dependency level ("Pflegestufe") 3 or above according to Article 5 of the Austrian Federal Act Governing Long-Term Care Benefits ("Bundespflegegeldgesetz") or the relevant provisions of the provincial laws on long-term care benefits ("Landespflegegeldgesetze").
  The term "family members" ("Angehörige") applies to the spouse and other individuals related to the person requiring care in the direct line or within the fourth degree by blood or marriage, as well as to the person's children, adopted children, step children, foster children, parents, adoptive parents, step parents or foster parents, grandchildren or siblings, and the partner who manages the joint household.