Medical rehabilitation benefits for persons covered by 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 company 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, the pension insurance finances necessary rehabilitation services. Rehabilitation services 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.
You must apply for rehabilitation services. In most cases, the application is made after acute treatment in the hospital by the social services together with you (follow-up rehabilitation).
Your attending 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 rehabilitable, i.e. They are resilient enough to carry out necessary treatments.
- Positive rehabilitation prognosis: According to a 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 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 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 taken into account
- If you have little or no income, you can be exempted from the co-payment upon application. 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 approved within the four-year period if it is urgently required for medical reasons.
Processing duration
The health insurance company must decide on applications for rehabilitation services within 2 months.
Legal basis
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 Equality
Professionally released on
27.11.2020
Author
The text was automatically translated based on the German content.
