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Apply for stress testing and occupational therapy from the statutory health insurance company


If, for example, you have been unable to work for a long time due to an accident or a serious physical or mental illness, you are entitled to support in your return to work. Occupational therapy and stress testing are intended to support you in this. They are part of the services of medical rehabilitation.
Your health insurance company will cover the costs if no other social security institution is responsible.

Normally, the costs for stress testing and occupational therapy are covered by your pension insurance provider. In some cases, an employers' liability insurance association or the Federal Employment Agency are also responsible.

Stress testing is an examination in which experts determine your health resilience. On the basis of various questions and tests, the following will be determined:

  • how capable you are physically, mentally and spiritually,
  • how well you can adapt to different social situations, and
  • where your strengths lie.

The stress test is intended to show whether you are resilient enough in the long run to return to your old profession or whether you need to take up a new appropriate profession.

Occupational therapy is defined as the practice of concrete work steps from professional life for the training and promotion of

  • Handcrafts
  • Manual and technical skills or
  • mental and psychological abilities, e.g. interest, self-confidence, perseverance, punctuality, appearance, sociability, willingness to cooperate.

The objectives of occupational therapy are

  • Improvement of resilience
  • maintaining and developing skills and abilities necessary for your professional reintegration.

Occupational therapy begins when occupational integration is not yet possible at the time of the stress test.

If you take part in an exercise test or occupational therapy financed by your health insurance company, you will continue to receive sickness benefit during this period.

Process flow

You can submit the application for the assumption of the costs of your stress test or occupational therapy by post or – in the case of many statutory health insurance companies – hand it in in person at the office.

  • Obtain a medical report in which your doctor recommends stress testing or occupational therapy.
  • Submit the medical report together with your application to your health insurance company. Your health insurance company now has 2 weeks to check whether it is responsible. If this is not the case, your health insurance company will forward your application to the responsible institution.
  • If the assumption of costs is approved, your health insurance company will issue you with a cost commitment. In addition, your health insurance company will be able to tell you the facilities with which it has a contract.
  • Once you have decided on a facility, present the cost commitment to them. In many cases, the health insurance company also transmits the cost commitment directly to the respective institution.
  • The costs of stress testing or occupational therapy are now covered by health insurance. You don't have to worry about anything anymore.

Requirements

Your statutory health insurance covers the costs of stress testing and occupational therapy if:

  • it is prescribed by a doctor and
  • no other social security institution is responsible. In most cases, the costs are covered by the pension insurance, the statutory accident insurance (employers' liability insurance association or accident insurance fund) or the employment agency. If they are not responsible, the statutory health insurance companies finance the treatment.

Which documents are required?

Your health insurance company will inform you which documents are required, for example a medical report on the necessity of the requested measures.

What are the fees?

You don't have to pay anything for the application.

What deadlines do I have to pay attention to?

You don't have to observe any deadlines.

Processing duration

It usually takes about 3 to 6 business days to process.

In order to process and make a decision quickly, your health insurance company must have the necessary information and, if necessary, documents complete and meaningful.
The health insurance company decides on applications promptly, whereby the statutory processing deadline is observed in order to protect patients' rights.

Please note that the stated processing time is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or records are sent to you or your health insurance company by post.
If necessary, the medical service must be involved. This will take up to an additional 5 weeks to process your request.

Applications / forms

  • Forms available: no
  • Written form required: no
  • Informal application possible: yes
  • Personal appearance required: no
  • Online service available: no

For further information on the application, please contact your health insurance company directly.

Appeal

  • Contradiction
  • Appeal to the Social Court

Technically approved by

Federal Ministry of Health (BMG)

Professionally released on

19.01.2023

Author

The text was automatically translated based on the German content.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)