OBJECTIVES: The aim of this study was to estimate complication rates and health care costs associated with influenza in Germany using routine health insurance claims data. Complications considered in the analysis were otitis media and community-acquired pneumonia (CAP). METHODS:  Our analysis was based on data from a German statutory sickness fund (>9 million insurants) over a 3-year period (2012-2014). A representative sample of 100,000 persons was drawn from all insurants diagnosed with influenza (ICD-10 codes J09-J11), and controls were matched one-to-one without replacement by age group, sex, insurance status (e.g. unemployed, student), and pharmaceutical costs of the previous year (proxy for morbidity), leading to 95,089 matched pairs. Complications were defined using the ICD-codes H65 to H67 for otitis media and J10.0, J11.0, and J12 to J18 for CAP. All complication rates and costs were calculated as the mean difference between the age-stratified influenza and control groups. Only inpatient costs were calculated directly using diagnosis-related groups. RESULTS:  The overall excess complication rate ranged from 5.4% (2013) to 7.7% (2014) for otitis media and from 8.2% (2013) to 9.4% (2014) for CAP. Otitis media was more likely to occur in younger age groups with a decline after the age of 5 years, whereas CAP showed a higher occurrence in younger (<14 years) and older (≥60 years) age groups. Excess costs for physician consultations per year and person in the influenza group varied from €2.56 (2013) to €6.60 (2014), and excess pharmaceutical costs ranged from €43.74 (2014) to €96.33 (2012). Average inpatient costs per hospitalised patient were €2,805 (without complications). CONCLUSIONS:  Complication rates of otitis and CAP for influenza patients were relatively stable in the study period but differed between age groups. Differences in costs between the influenza group and the control group were small but could be detected in the claims data.