İşitmeAtölyesiSGK & Reimbursement Guide
Conditions, required documents and the process for SGK reimbursement of hearing aids and auditory implants — based on official SUT provisions.
Disclaimer: The information on this page is compiled from official sources (SUT/SGK) and is for informational purposes only; it is not binding. For definitive and current information consult the official sources; for your personal situation consult your physician or audiologist.
Which device may be covered?
See a likely direction with a few selections. This tool is for information only; diagnosis and decisions require physician and audiologist evaluation.
Overview
Hearing aids and auditory implants are reimbursed by the Institution within the scope of the Social Security Institution Health Implementation Communiqué (SUT) and its annexes, when the defined conditions are met. Auditory implants (cochlear implant, bone-anchored hearing device, middle ear implant, auditory brainstem implant) are reimbursed only when applied in tertiary (third-level) healthcare providers.
Covered devices and implants
Select a device type to see its coverage conditions.
Hearing aid
SUT §3.3.32- The cost of digital programmable hearing aids is covered by the Institution (minimum technical features are defined in the SUT).
- In patients under 13 years of age, in-the-ear/in-the-canal devices are not reimbursed.
- The medical board report must state a permanent hearing loss.
- If determined by pure-tone/behavioral audiometry: air-conduction pure-tone average at 500-1000-2000-4000 Hz of 26 dB or greater in the relevant ear.
- If determined by ABR: thresholds obtained on tonal and click ABR of 30 dB or greater.
- Audiological tests are performed at the provider issuing the report; results are valid for 6 months.
- Ages 0-18: medical board report issued by a tertiary official healthcare provider with at least one ENT specialist.
- Over 18: medical board report issued by an official healthcare provider with at least one ENT specialist.
- Required audiological tests:
- 0-4 years: ABR and otoacoustic emission together with behavioral audiometry (approved by an ENT specialist or audiologist).
- Over 4, able to complete pure-tone: pure-tone audiometry (approved by an ENT specialist, audiologist or audiometrist).
- Over 4, unable to complete pure-tone: ABR and otoacoustic emission together with behavioral audiometry (approved by an ENT specialist or audiologist).
Cochlear implant
SUT §3.3.33.B- Covered in patients with bilateral severe-to-profound sensorineural hearing loss who do not benefit from hearing aids, as documented by a medical board report.
- The report must state no benefit from at least 3 months of binaural hearing aid use.
- Also covered when deemed appropriate by the Ministry of Health Scientific Advisory Board for Auditory Implants.
- At least one of the following criteria must be met:
- A difference of less than 4 years between receptive and/or expressive language age and chronological age, or receptive and/or expressive language of 4 years and above (ages 4-18, regardless of chronological age).
- Post-lingual hearing loss.
- Not reimbursed when applied to patients under 12 months of age.
- Audiological assessment is performed with audiometry, tympanometry, stapedial reflex threshold test, clinical otoacoustic emission test and ABR tests.
- In children over 2 and adults: bilateral average of thresholds at 500, 1000, 2000 and 4000 Hz worse than 80 dB, or 70 dB or worse in one ear and 90 dB or worse in the other; in patients able to complete speech discrimination, a score below 30%.
- In children 2 and under: bilateral sensorineural loss greater than 90 dB HL.
- Sufficient inner-ear development for electrode placement and the presence of the cochlear nerve must be shown by high-resolution CT and/or MRI.
- In post-meningitis hearing loss, provided the cochlear implantation criteria are met, it is covered by report without requiring the 3-month binaural hearing aid rule.
- In auditory neuropathy: covered when no benefit from at least 6 months of auditory rehabilitation and education is documented by audiological assessment and medical board report.
- Electroacoustic implant:
- Thresholds at 500 and 1000 Hz of 50 dB or better, at 2000-3000-4000 Hz of 80 dB or worse, and a speech discrimination score worse than 50%.
- For reimbursement, thresholds must be stable over the last 1 year.
- The medical board report is issued by 3 ENT specialists working at the same healthcare provider.
- The report must include, from the same provider, an audiological assessment by 1 audiologist and an assessment by 1 psychologist or 1 speech-language therapist.
- If the internal part loses function due to infection, cholesteatoma or tumor, only the surgically placed internal part is reimbursed by report, without a time requirement.
- Simultaneous or sequential bilateral cochlear implant (as stated in the report):
- Children aged 12-48 months meeting cochlear implantation criteria.
- Post-lingual post-meningitis severe sensorineural hearing loss meeting audiological criteria, regardless of age.
- In patients over 48 months (excluding those exactly 48 months), severe sensorineural hearing loss accompanied by bilateral blindness.
Bone-anchored device
SUT §3.3.33.C- Covered in patients aged 5 and over with bilateral hearing loss who do not benefit from conventional hearing aids in both ears or cannot use them for a stated medical reason.
- Also covered when deemed appropriate by the Scientific Advisory Board for Auditory Implants.
- Not reimbursed when applied to patients under 5 years. However, when applied with a headband or similar attachment to patients under 5 or those unfit for surgery, the sound processor is reimbursed.
- Bone-conduction hearing threshold not exceeding 60 dB at 500, 1000, 2000 and 4000 Hz, conductive or mixed type loss, and a speech discrimination score of 60% and above.
- Plus at least one of the following:
- Bilateral aural atresia.
- In unilateral aural atresia, permanent hearing loss in the other ear of 30 dB and above in patients aged 18 and under, and 40 dB and above in adults.
- Bilateral congenital outer and middle ear anomalies not surgically correctable, and extensive tympanosclerosis.
- Bilateral mastoidectomy cavity.
- Treatment-resistant chronic external otitis.
- Total hearing loss in one ear with conductive or mixed loss in the other.
- Medical board report with 3 ENT specialists at the same official provider, including an audiological assessment by 1 audiologist at the same provider.
- In patients with a headband, on the planned surgery date the transmitting system and components between the internal and external parts, and the surgically placed internal part, are reimbursed.
Middle ear implant
SUT §3.3.33.Ç- Covered in patients with bilateral hearing loss who do not benefit from conventional hearing aids in both ears.
- Also covered when deemed appropriate by the Scientific Advisory Board for Auditory Implants.
- For reimbursement, the report must state that hearing thresholds have been stable over the last 2 years.
- Sensorineural hearing losses:
- Sensorineural loss not exceeding 65 dB at 500 Hz, 70 dB at 1000-2000 Hz and 85 dB at 4000 Hz, with a speech discrimination score better than 50%.
- The report must state the absence of retrocochlear pathology.
- Conductive and mixed type hearing losses:
- Mixed or conductive loss with bone-conduction thresholds not worse than 60 dB and speech discrimination better than 50%.
- The report must state that the loss could not be corrected in a patient whose both ears have each been operated at least once.
- Special situations covered without the requirement of correction by a conventional device:
- Bilateral radical mastoidectomy cavity following prior ear surgery.
- Bilateral congenital outer and middle ear anomaly.
- Healthcare workers with a hearing aid indication who must use a stethoscope.
- Medical board report with 3 ENT specialists at the same official provider, including an audiological assessment by 1 audiologist at the same provider.
Auditory brainstem implant
SUT §3.3.33.D- Covered in patients with bilateral profound sensorineural hearing loss.
- Not reimbursed when applied to patients under 12 months.
- For patients not meeting the above criteria, covered when deemed appropriate by the Scientific Advisory Board for Auditory Implants.
- Covered in the presence of at least one of the following:
- Patients in whom CT and/or MRI show the cochlea and/or acoustic nerve to be absent, underdeveloped or damaged.
- In neurofibromatosis type 2 with bilateral acoustic tumors, application of the brainstem implant to the same side in the same session as unilateral tumor excision.
- Medical board report issued by 3 ENT specialists at the same official provider, including an assessment by 1 audiologist and 1 psychologist or 1 speech-language therapist at the same provider.
- Reimbursed when applied unilaterally.
Comparison table
At a glance; for full conditions see the relevant SUT article.
| Device | Minimum audiological threshold | Min. age | Report | SUT |
|---|---|---|---|---|
| Hearing aid | AC PTA ≥26 dB (ABR ≥30 dB) | By age (report) | ≥1 ENT | §3.3.32 |
| Cochlear implant | >2 yrs: >80 dB or 70/90 dB · ≤2 yrs: >90 dB HL | 12 months | 3 ENT + audiologist + psych./SLT | §3.3.33.B |
| Bone-anchored device | Bone conduction ≤60 dB (conductive/mixed) | 5 years | 3 ENT + audiologist | §3.3.33.C |
| Middle ear implant | SNHL / conductive-mixed thresholds | — | 3 ENT + audiologist | §3.3.33.Ç |
| Auditory brainstem implant | Bilateral profound SNHL | 12 months | 3 ENT + audiologist + psych./SLT | §3.3.33.D |
Report and documents
Basic documents required for a hearing aid (SUT §3.3.32).
Step-by-step process
ENT examination
Assessment at a contracted official healthcare provider.
Audiological test
By age, ABR/OAE or pure-tone audiometry; valid 6 months.
Report and e-prescription
The medical board report and e-prescription are issued.
Contracted center/company
SGK-contracted hearing aid center or implant company.
Device selection and delivery
The suitable device is provided; the cost is paid by the Institution to the center.
Accessories, batteries and renewal
Renewal periods
| Item | Renewal rule | Source |
|---|---|---|
| Hearing aid | Renewal before 5 years is not reimbursed | SGK / SUT |
| Earmold | Under 13: every 6 months · over 13: yearly · not at first purchase | SUT §3.3.32 |
| Auditory implant processor | Renewal periods defined in EK-3 lists; not covered before the period | SUT EK-3 |
Covered accessories and batteries
- The cochlear implant minimum kit contents (sound processor, transmitter, batteries, charging unit, cables, spare magnet, etc.) are defined in SUT §3.3.33.B.
- Earmold: every 6 months under 13, yearly over 13; not covered at the first device purchase.
- Sound processor and surgical internal-part costs are defined with SUT codes in the EK-3/J list.
Cost-sharing and exemptions
Cost-sharing
Cost-sharing is the amount paid by the general health insurance holder or their dependants to benefit from health services. The applicable services and rates are set out in SUT §1.8.
Exemptions
Additional fee: except for children who have not completed 18 years of age, an additional fee may be charged for auditory implant procedures in SUT annexes EK-2/B and EK-2/C — meaning no additional fee is charged for these procedures in children under 18. In addition, health services for newborns and surgical procedures for congenital anomalies are exceptional health services and no additional fee is charged (SUT §1.9).
Points to note
The earmold cost is not covered at the first device purchase.
In patients under 13, in-the-ear/in-the-canal devices are not covered.
Audiological tests must be performed at the same provider; results are valid for 6 months.
Auditory implants are covered only at the tertiary level.
Example scenarios
3 years old, bilateral severe SNHL
- Over 2 years, so cochlear implant audiological criteria: 500-1000-2000-4000 Hz average worse than 80 dB, or 70 dB in one ear and 90 dB in the other; if testable, discrimination below 30%.
- No benefit from hearing aids; no benefit from ≥3 months of binaural use documented by report.
- 3 ENT + 1 audiologist + 1 psychologist/SLT report; inner ear and cochlear nerve shown by CT/MRI.
- Applied at a tertiary provider. (SUT §3.3.33.B)
Unilateral aural atresia
- Bone-anchored device is considered at 5 years and over.
- Criteria: bone conduction not exceeding 60 dB at 500-1000-2000-4000 Hz, conductive/mixed loss, discrimination 60% and above.
- In unilateral aural atresia, permanent loss in the other ear ≥30 dB (age ≤18) or ≥40 dB (adult).
- 3 ENT + 1 audiologist report. Under 5, surgery is not covered; the processor is covered with a headband. (SUT §3.3.33.C)
Adult, moderate loss
- Hearing aid: permanent loss and 500-1000-2000-4000 Hz air-conduction average of 26 dB or greater (30 dB or greater by ABR).
- Over 18: report from an official provider with at least one ENT specialist.
- Audiological tests done at the issuing provider; results valid 6 months.
- Renewal before 5 years is not reimbursed. (SUT §3.3.32)
FAQ
General health insurance holders and their dependants with permanent hearing loss who meet the audiological/clinical criteria in the SUT.
Hearing aids are not renewed before 5 years; periods are defined in the SUT and its EK-3 annexes. Under certain conditions (growth-development in children; maintenance/repair not possible in adults), early renewal is possible with a report.
A medical board report with at least one ENT specialist, age-appropriate audiological test results and an e-prescription (SUT §3.3.32).
Cost-sharing and additional-fee rules are set out in SUT §1.8-1.9; the official SUT prevails for rates. No additional fee is charged for auditory implant procedures in children under 18.
Mini-glossary
SUT terms and abbreviations — for detail see the Glossary.
- Medical board report
- A medical report issued by a defined number of specialists (including at least one ENT specialist), required for reimbursement of a device/implant.
- Tertiary level
- Hospitals providing advanced diagnosis and treatment (training-research, university hospitals, etc.). Auditory implants are covered only at the tertiary level.
- Cost-sharing
- The amount paid by the insured or their dependants to benefit from a health service (SUT §1.8).
- Eligibility
- Checking active insurance and entitlement via the SGK system.
- EK-3
- SUT annex medical-material lists; contain the SUT code, item definition and price.
- MEDULA
- The SGK electronic record system through which health-service payments are processed.
Official sources
“The cochlear implant cost is covered by the Institution when applied to persons deemed appropriate by the Ministry of Health Scientific Advisory Board for Auditory Implants, or in patients with bilateral severe-to-profound sensorineural hearing loss meeting the criteria below who are documented by a medical board report as not benefiting from a hearing aid.”
SUT §3.3.33.B – Cochlear implant (translated)