Medical rehabilitation benefits for health insurers Granted
Rehabilitation can help you to avoid the permanent onset of a disability or need for care or to cope better with the consequences.
In order for your health insurance company to bear the costs of a rehabilitation measure, you must have statutory health insurance. Your health insurance company first checks whether another service provider is primarily responsible.
For employed persons, for example, the pension insurance finances necessary rehabilitation services. Rehabilitation benefits for pensioners, mothers or fathers with children as well as for those in need of care are usually the responsibility of the statutory health insurance.
Rehabilitation services must be requested by you. In most cases, the application is made after an acute treatment in the hospital by the social service together with you (follow-up rehabilitation).
Your treating physicians can also encourage medical rehabilitation and issue a doctor's prescription for the application.
The responsibility lies with the respective health insurance company.
- Need for rehabilitation: Your performance is impaired and cannot be restored with individual measures, such as physiotherapy and occupational therapy.
- Rehabilitation ability: You are capable of rehabilitation, i.e. They are resilient to such an extent that necessary treatments can be carried out.
- Positive rehabilitation prognosis: You can probably achieve individual rehabilitation goals according to a doctor's assessment.
Which documents are required?
- You must submit an informal application to your health insurance company.
- Your health insurance company checks whether the requirements for medical rehabilitation are met
What are the fees?
- Insured persons who have reached the age of 18 pay a co-payment: 10 euros per day of treatment in outpatient rehabilitation and 10 euros per calendar day in inpatient rehabilitation.
- The co-payment is calculated for a maximum of 42 calendar days per year. It is paid directly to the rehabilitation facility.
- In the case of a follow-up rehabilitation immediately after hospital treatment, you must pay for a maximum of 28 days. Co-payments that you have already made within a calendar year for another rehabilitation or inpatient hospital treatment will be credited
- If you have little or no income, you can be exempted from the co-payment on request. Please contact your health insurance company.
What deadlines do I have to pay attention to?
In principle, you are only entitled to medical rehabilitation again after 4 years. Exception: Rehabilitation can be granted within the four-year period if it is urgently needed for medical reasons.
The health insurance company must decide on applications for rehabilitation services within 2 months.
You can appeal against the decision of the health insurance company. If the objection is not remedied, you can file a complaint with the competent social court.
The text was automatically translated based on the German content.
Technically approved by
Lower Saxony Ministry of Social Affairs, Health and Equality
Professionally released on