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Provision of medical rehabilitation benefits to persons insured with health insurance


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 to cover the costs of a rehabilitation measure, you must have statutory health insurance. Your health insurance company will first check whether another service provider is primarily responsible.

In the case of employed persons, for example, pension insurance finances necessary rehabilitation services. Rehabilitation services for pensioners, mothers or fathers with children and for those in need of care are usually the responsibility of the statutory health insurance.

Rehabilitation services must be applied for by you. In most cases, the application is submitted after acute treatment in hospital by the social services together with you (follow-up rehabilitation).

Your treating physicians can also suggest medical rehabilitation and issue a doctor's prescription for the application.

Competent authority

The responsibility lies with the respective health insurance company.

Requirements

  • 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: According to the doctor's assessment, you are likely to be able to achieve individual rehabilitation goals.

Which documents are required?

  • You must submit an informal application to your health insurance company.
  • Your health insurance company will check 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 follow-up rehabilitation immediately after hospital treatment, you will have to pay an additional fee for a maximum of 28 days. Co-payments that you have already made for other rehabilitation or inpatient hospital treatment within a calendar year will be credited
  • If you have little or no income, you can be exempted from the co-payment upon 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 have elapsed. Exception: Rehabilitation can be granted within the four-year period if it is urgently needed for medical reasons.

Processing duration

The health insurance company must decide on applications for rehabilitation services within 2 months.

Appeal

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.

Technically approved by

Lower Saxony Ministry of Social Affairs, Health and Gender Equality

Professionally released on

27.11.2020

Author

The text was automatically translated based on the German content.

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