Wahlarzt ÖGK Reimbursement 2026: How Much You Get Back

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Why your refund is smaller than you think

In Austria you often book a Wahlarzt (private doctor) appointment faster than a slot at a public GP. The invoice arrives, you send it to ÖGK and wait for the refund. What lands on your account is almost always well below the bill total. That is not a clerical slip. It is how the statute works.

This guide explains how private doctor reimbursement through the Austrian Gesundheitskasse actually functions: the 80 % rule on the correct reference value, the deadlines, the electronic submission via WAHonline since 1 July 2024 and the realistic refund rates. Heavy private doctor users will find a sober view at the end on when an outpatient supplementary insurance genuinely closes the gap.

The 80 % rule: 80 % of what exactly?

The legal basis is § 131 Abs. 1 ASVG, specified by § 23 of the ÖGK statute. ÖGK reimburses 80 percent of the amount a contracted doctor would have received for the same service. That reference is called the Kassentarif. It is not your private doctor's fee.

The difference catches many patients off guard. A Wahlarzt sets fees freely. ÖGK calculates internally on tariffs negotiated with each regional medical chamber (Landesärztekammer). The gap between those two worlds stays with you.

A worked example that matches reality

Item	Amount
Wahlarzt fee (freely set)	€150.00
Kassentarif per Gesamtvertrag (example)	€50.00
ÖGK refund (80 % of the Kassentarif)	€40.00
Your out-of-pocket	€110.00 (around 73 %)

Short version: The further a Wahlarzt fee sits above the Kassentarif, the smaller the share ÖGK returns on your actual bill. In practice, only 10 to 30 percent of the amount you paid tends to come back.

Kassentarife: why we do not print a price list

This is where many articles run into a problem by printing concrete euro amounts for a doctor visit. We do not. Austrian Kassentarife consist of a base consultation fee plus individual-service items. They differ across the nine federal states, between general practice (Appendix A) and specialists (Appendix B) and by consultation context. Any fixed list would be outdated quickly or simply wrong for another state.

What is public knowledge: the Vienna Medical Chamber publishes reference values for sick-slip fees in the contracted system. For 2025 these include €6.00 for the first or second visit in a quarter, €5.36 for a third general-practitioner consultation and €2.99 for a third specialist consultation (source: aekwien.at). These are not complete Kassentarife. They do illustrate the scale gap.

As a market-price orientation from current observations at Wahlärzt*innen: general practitioners typically charge around €80 to €130 for a first consultation, specialists €120 to €220, and an MRI scan in a private institute is often above €300. These numbers are indicative and do not replace a binding quote from the practice. For MRI costs and refund specifically, see the MRI costs guide Austria 2026.

Submitting a Wahlarzt bill to ÖGK

What changed on 1 July 2024

Since 1 July 2024, Wahlärzt*innen have to submit the reimbursement application electronically to the statutory health insurer, provided they have at least 300 patient contacts per year. The technical backbone is WAHonline (for therapists: WAZAonline). The legal basis is the Vereinbarungsumsetzungsgesetz (VUG). For patients in the covered group: you pay the bill, the submission itself is taken over by the practice, and the refund arrives on your account automatically (source: gesundheitskasse.at, WAHonline information page).

What changes on 1 January 2026

From 1 January 2026, all Wahlärzt*innen must be connected to the e-card infrastructure and to ELGA, Austria's electronic health record. Findings are transmitted in a standardised format, the electronic vaccination record also runs inside private practices, and submissions digitalise further. Paper volume for patients drops noticeably.

If you still submit the bill yourself

Smaller practices below the 300-patient threshold are not obliged to submit through WAHonline. Three routes then lead to a refund:

1. Online via Meine ÖGK / meineSV. Log in with ID Austria, upload the invoice and proof of payment as a scan.
2. By post to your regional ÖGK office. Enclose the original invoice and payment receipt.
3. In person at an ÖGK customer service point during opening hours.

What ÖGK needs to see

The 42-month deadline, read correctly

The submission deadline is 42 months from the date of treatment, the day the service took place. The invoice date does not count, nor does the issue date of the Honorarnote. If you find an older bill, you usually have more time than you think. Do not wait unnecessarily, though: payment receipts become hard to reconstruct after years.

How long does the ÖGK take to process it?

ÖGK publishes no binding service-level agreement. Based on patient experience and statements from regional offices, processing typically takes two to six weeks, depending on workload and submission route. Electronic submission via WAHonline or Meine ÖGK is usually faster than postal mail because the review chain starts earlier. If eight weeks pass without a decision, contact the customer service at your regional ÖGK office.

ÖGK offices by province: where you submit

ÖGK runs at least one regional office per federal state. Postal and in-person submissions go there, online submissions run centrally through Meine ÖGK. The full list of customer service points is on gesundheitskasse.at.

Federal state	ÖGK main location
Burgenland	Eisenstadt
Carinthia	Klagenfurt
Lower Austria	St. Pölten
Upper Austria	Linz
Salzburg	Salzburg
Styria	Graz
Tyrol	Innsbruck
Vorarlberg	Bregenz
Vienna	Wienerbergstraße 15–19, 1100 Vienna (plus branch offices)

Current addresses and opening hours live on the ÖGK customer-service-points overview. We avoid linking to single addresses because they change; the ÖGK page is the only reliable primary source.

ÖGK, SVS or BVAEB: who covers whom?

Not every Wahlarzt patient is insured with ÖGK. The 80 % logic applies at all three major insurers, but portals and routes differ.

• ÖGK (Österreichische Gesundheitskasse). Covers employees and many pensioners. Online via Meine ÖGK, by post to the regional office, in person at customer service.
• SVS (Sozialversicherung der Selbständigen). Covers the self-employed, tradespeople and farmers. Fastest route: the svsGO app (photograph the invoice) or the svsGO customer portal via ID Austria. Post and in-person submission are still available. The 42-month deadline applies here too. Deep dive in the Self-Employed Health Insurance (SVS) guide.
• BVAEB (Versicherungsanstalt öffentlich Bediensteter, Eisenbahnen und Bergbau). Covers civil servants, railway employees and mining staff. Own forms, own statute. Current submission routes live on bvaeb.at.

If you switch insurer mid-treatment, for example through a job change, submit with the insurer that was responsible on the treatment date.

Chief-physician authorisation: when it is mandatory

Some services are only reimbursed with a prior chief-physician authorisation (chefärztliche Bewilligung). Typical cases are MRI and CT scans, certain medicines outside the standard reimbursement code and individual therapies. Without authorisation, no refund flows, even with a cleanly issued invoice.

For scheduled appointments, discuss the indication with the referring doctor and obtain the authorisation before attending. For MRI and CT waiting times, the 20-day rule in the Gesamtvertrag is also relevant. We cover that specifically in the MRI costs guide Austria 2026.

If the refund is lower than expected

The decision arrives, the amount is smaller than you estimated. Steps to take before getting angry:

1. Request a breakdown. ÖGK must disclose on request which Kassentarif was applied to which service. Without that breakdown any objection is a blind shot.
2. Check your own records. Was the diagnosis fully transmitted? Were all individual services on the invoice? Missing codes often lead to flat-rate scoring.
3. File an informal objection. A simple letter to the regional office is enough. State the decision number, treatment date and the points you want re-assessed.
4. Contact the ÖGK Ombudsstelle. ÖGK runs an ombuds office for praise, suggestions and complaints. The route runs through the contact form on gesundheitskasse.at or by phone via customer service.
5. Final step: administrative court. Within the deadline stated in the decision (usually four weeks), you can file a complaint with the Federal Administrative Court. For that path, legal advice (for example through the Austrian Chamber of Labour, Arbeiterkammer) is advisable.

This article does not replace individual legal or tax advice. The steps above are an orientation, not a procedural guarantee.

Wahlarzt vs Kassenarzt in short

A contracted doctor (Kassenarzt) has an agreement with the statutory insurer, settles via the e-card, you pay nothing out of pocket. A Wahlarzt has no such contract. You pay the full bill and recover a part through cost reimbursement. The quality of care depends on the doctor, not on the status.

Many Austrians switch to a Wahlarzt because public doctor waiting times run into weeks for specialists in many provinces. The comfort has a price, and this guide makes that price transparent.

When private doctor insurance actually pays off

A private doctor supplementary insurance (outpatient cover) pays 80 to 100 percent of the invoice, minus the ÖGK refund. The difference to the standard scenario is tangible:

Item	No cover	80 % tariff	100 % tariff
Wahlarzt bill	€150	€150	€150
ÖGK refund	€40	€40	€40
Supplementary insurance pays	—	€88	€110
Your out-of-pocket	€110	€22	€0

Monthly premiums observed on the Austrian market (durchblicker.at, Wiener Städtische, UNIQA, Merkur) vary by age and tariff level:

• 80 % tariff: roughly €25 to €75 per month
• 100 % tariff: roughly €40 to €120 per month

Whether the policy pays off depends on your usage. As a rough guideline: three to four private doctor visits a year plus one more expensive scan bring many tariffs close to break-even. Occasional Wahlarzt users often save more by covering the gap themselves. An age-based cost breakdown is in our Private Health Insurance Monthly Costs guide.

Frequently asked questions

How much do I really get back from a Wahlarzt?

ÖGK reimburses 80 percent of the Kassentarif for the same service, not 80 percent of your invoice. Because private doctors set fees freely, only 10 to 30 percent of what you actually paid tends to come back. The exact share depends on specialty, federal state and scope of treatment.

How long does ÖGK take to process the bill?

Two to six weeks is the usual window, depending on workload and submission route. Electronic submission via WAHonline or Meine ÖGK is usually faster than postal mail. If eight weeks pass without a decision, contact your regional ÖGK customer service.

How long do I have to submit the invoice?

The deadline is 42 months from the date of treatment, not the invoice date. If you find an older Honorarnote, you still have time, but do not wait too long: payment receipts get hard to reconstruct over the years.

Do I have to submit the bill myself?

Since 1 July 2024, private doctors with at least 300 patient contacts per year must submit through WAHonline themselves. In that case you only pay the bill and receive the refund automatically. Smaller practices require patient submission via Meine ÖGK, by post or in person.

Which documents does ÖGK need?

You need the Honorarnote with date of treatment, diagnosis and detailed service description, a proof of payment such as a bank statement, e-banking confirmation or pay-slip note, and the chief-physician authorisation for approval-bound services. Without proof of payment ÖGK will not refund.

Is a Wahlarzt the same as a Privatarzt?

For ÖGK reimbursement purposes, yes. Both have no contract with statutory health insurance. Wahlarzt is standard in Austrian usage, Privatarzt appears more often in marketing material. The label does not change your refund.

Can I submit an unpaid invoice?

No, ÖGK only reimburses bills that have been paid. A paid stamp on the Honorarnote is usually not enough if no transaction can be proven. Always attach a bank statement, an e-banking confirmation or a pay-slip note.

What do I do if the refund is too low?

Ask for a breakdown of the Kassentarife applied. Check whether diagnosis and individual services were fully transmitted. If justified, file an informal objection with the regional office. The ÖGK Ombudsstelle mediates in unclear cases, final step is a complaint with the Federal Administrative Court.

Conclusion

Wahlarzt reimbursement through ÖGK is legally clear, but many people run the math from the wrong reference. The 80 percent apply to the Kassentarif, not the Wahlarzt amount. In practice only 10 to 30 percent of a Honorarnote tends to come back. The electronic submission duty since 1 July 2024 and the mandatory e-card connection of all private doctors from 1 January 2026 ease the admin. The financial gap stays.

Anyone who sees a Wahlarzt regularly should run the numbers on supplementary insurance calmly. Premiums rarely pay off for occasional users but do for regular users with planned diagnostics. A broader basis for that decision is in the Health Insurance Austria Guide 2026.

Sources

• Österreichische Gesundheitskasse: Wahlärzt:innen and submission
• ÖGK: WAHonline and WAZAonline
• ÖGK: Customer service points (regional offices overview)
• ÖGK: Ombudsstelle
• sozialversicherung.at: Submit a Wahlarzt bill
• Ministry of Social Affairs: Simpler cost reimbursement from 1 July 2024
• SVS: Cost reimbursement after private doctor visit (svsGO)
• Vienna Medical Chamber: Wahlärzt:innen-Kostenrückersätze
• Gesundheitsportal: Wahlarzt costs

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Disclaimer: The amounts, deadlines and processes quoted are based on information from the Austrian Health Insurance (ÖGK), sozialversicherung.at and the Vienna Medical Chamber as of May 2026. Kassentarife and reimbursement modalities may change and differ by federal state, insurer and specialty. For binding information, contact your regional ÖGK office. CheckEverything.at assumes no liability for the accuracy, completeness or current relevance of the information and does not replace individual legal or tax advice.