Many people who are considering laser eye treatment ask themselves the same question: does the health insurance company pay for laser eye surgery – and if so, under what conditions? In Austria, there is no simple yes-or-no answer to this question, as the assumption of costs depends heavily on whether you have statutory or private insurance, whether there is a medical necessity and which individual contractual conditions apply.

In this blog, we explain when statutory health insurance pays, when private providers can step in and why supplementary insurance can be worthwhile. We also show how Smartlaser in Vienna supports patients with advice and cost clarification – so that you can start your treatment with a clear view and no surprises.

Do statutory health insurance companies cover the costs of laser eye surgery?

In Austria, the coverage of costs for laser eye surgery by statutory health insurance is strictly regulated. In principle, the following applies: only if the procedure is classified as medically necessary will the health insurance fund pay at least part of the costs. In most cases, however, laser eye surgery is seen as an aesthetic or comfortable procedure – similar to the correction of visual defects with glasses or contact lenses.

When is an intervention considered medically necessary?

An operation is recognized as medically necessary if there is a serious impairment of vision that cannot be adequately corrected with glasses or contact lenses. Examples are

• Extremely high visual impairment (often more than 10 diopters)
• Contact lens intolerance that is certified by a doctor
• Certain eye diseases or severe astigmatism that can no longer be adequately corrected with conventional visual aids

An important criterion is a medical certificate confirming the necessity.

Examples of when statutory health insurance pays – and when it doesn’t

Does the health insurance company pay?

• Yes: In the case of medically necessary surgery, e.g. due to severe myopia over 10 diopters or severe contact lens intolerance
• No: If the laser treatment is solely for the purpose of dispensing with glasses or contact lenses (aesthetic or practical wish)

In this case, it is worth consulting your ophthalmologist individually and clarifying the matter with your health insurance provider at an early stage to check whether the costs will be covered.

Why laser eye surgery is usually considered a private service

For statutory health insurance companies, laser eye surgery generally falls into the category of individual health services (IGeL) – i.e. treatments that are not medically necessary. The procedure is usually justified by the desire for a more comfortable life without glasses or contact lenses, not by medical necessity.

For this reason, the costs of laser eye surgery for vision defects such as short-sightedness, long-sightedness or astigmatism are not usually covered, even if the treatment corrects vision permanently.

Do private health insurance companies or supplementary insurances cover the costs?

Private health insurance companies and supplementary insurers have a much better chance of covering the costs of laser eye surgery than statutory health insurance companies. Many providers have tariffs that fully or at least partially cover laser eye treatments for vision defects such as short-sightedness, long-sightedness or astigmatism. Important: The exact conditions depend on the individual contract and not every insurance policy automatically includes this benefit.

What requirements must be met?

In the case of private health insurance or supplementary insurance, the assumption of costs does not usually depend solely on a strictly defined medical necessity – the individual contract also plays a decisive role here. Many tariffs explicitly provide benefits for laser eye treatment, even if the procedure is performed for purely aesthetic or practical reasons, e.g. to permanently avoid glasses or contact lenses.

Typical requirements are

• The defective vision (e.g. short-sightedness, long-sightedness, astigmatism) must be listed in the policy as eligible for reimbursement
• A medical report or expert opinion to document the initial situation
• A cost estimate from the clinic or practice (to be submitted in advance)
• Possibly a minimum value for the diopters (e.g. over 3 diopters), depending on the tariff

The big difference to statutory health insurance: Private providers also cover costs if laser eye surgery is not medically necessary but is planned as an optional service to improve quality of life. This makes it all the more important to check the terms of the contract carefully – Smartlaser is happy to help with individual advice.

Why supplementary insurance can be worthwhile:

Supplementary insurance can be particularly attractive for people who:

• Have moderate to severe defective vision
• want to avoid glasses or contact lenses permanently
• value modern treatment methods such as laser eye surgery

Some tariffs offer additional benefits such as cost coverage for the entire treatment or at least part of the costs. Depending on the contract, follow-up treatment may also be covered.

Cost coverage in Vienna and other federal states: Are there regional differences?

In principle, the same legal framework conditions apply in Austria for the assumption of costs for laser eye surgery – regardless of whether you are in Vienna, Salzburg, Graz or Innsbruck. The statutory health insurance funds are based on the general medical criteria, so there are no systematic differences between the federal states.

What can differ, however, are:

• The experience of individual doctors or clinics in dealing with health insurance companies
• The willingness of certain health insurance funds to assess individual applications more generously
• Regional cooperation with laser eye centers that support patients in submitting the documents

Especially in a metropolis like Vienna, there is usually a larger selection of specialized providers such as Smartlaser, who know exactly which documents are required for cost coverage and accompany patients in their contact with the health insurance company.

How SmartLaser helps with advice and cost clarification:

Smartlaser supports patients not only medically, but also organizationally – especially when it comes to the question of whether health insurance will cover the costs of laser eye surgery. During the first consultation in Vienna, the individual requirements are clarified and whether the costs can realistically be covered by statutory or private health insurance.

The team helps with:

• The preparation of a medical report or report of findings
• The compilation of important documents such as cost estimates or surgical plans
• The submission to the health insurance company – including tips on what to look out for
• Clarification of whether supplementary insurance covers part of the treatment costs

Thanks to its experience with statutory and private insurance companies, Smartlaser can provide targeted advice on which options are worthwhile and how to prepare the application. This way, patients are optimally prepared and know what costs to expect – and in some cases, at least part of the costs for laser eye treatment can be financed.