Service Finder
Applying for preventive medical services for those insured with statutory health insurance
Service Description
The principle of outpatient care before inpatient care applies to preventive medical services.
Outpatient preventive care services
On application and subject to certain conditions, your statutory health insurance fund will cover the costs of the medical services and spa treatment for outpatient preventive care. Accommodation and meals are paid for by you as the insured person.
Outpatient preventive medical services are medical and therapeutic treatments, for example therapeutic baths or physiotherapy, which are carried out by therapy centers in state-approved health resorts. You can choose the spa and therapy center together with your doctor. You organize your accommodation and meals yourself.
Inpatient preventive care services
If outpatient preventive care at a state-approved spa is not sufficient, for example because you are physically severely impaired or require intensive medical care, your health insurance provider must approve an application for inpatient preventive care. In addition to treatment, this also includes accommodation and meals at the spa clinic.
Medical necessity
Your health insurance company can only approve outpatient or inpatient preventive care if you have previously exhausted all treatment options at your place of residence. Your doctor must justify the necessity of the preventive treatment to your health insurance company in the application.
A cure can be considered medically necessary if
- it can prevent an impending illness or avoid its worsening or
- the need for care is avoided or
- a risk to the health development of a child can be counteracted.
Duration
The duration of outpatient preventive care services should be provided for a maximum of 3 weeks. An extension can only be considered if this is urgently required for medical reasons in order to achieve the preventive care objective.
Inpatient preventive services should be provided for a maximum of 3 weeks - unless an extension of the service is urgently required for medical reasons.
In individual cases, spa stays abroad are also possible; please contact your health insurance fund for more information.
Process flow
Proceed as follows to obtain preventive care:
- In a consultation, your doctor will prescribe a preventive medical service.
- For outpatient preventive care: Your doctor fills out the application form (sample 25) together with you and justifies the necessity of the measure.
- For inpatient preventive care: Your doctor fills out the application form from your health insurance fund together with you and justifies the necessity of the measure.
- You send the completed application form to your statutory health insurance fund. You can submit the application by post and - with many health insurance companies - also online or hand it in at the office.
- The health insurance company will check whether you are entitled to preventive care and inform you of the result.
- For outpatient preventive services: Together with your doctor, you will select a suitable state-recognized health resort based on medical criteria.
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For inpatient preventive care services: You are welcome to tell your health insurance company your wishes regarding a particular preventive care facility. Your health insurance company will check whether these wishes can be met.
Requirements
Your doctor will prescribe the cure and justify the medical necessity to your health insurance company.
Which documents are required?
In some cases, medical documentation may be required. You can find out what these are from your doctor or health insurance company.
What are the fees?
Under certain conditions, your statutory health insurance fund will cover the costs of outpatient treatment and a proportion of the costs for spa treatment. You pay for accommodation and meals. A subsidy from the health insurance company is possible.
In the case of inpatient treatment, the health insurance fund will cover the costs of treatment, accommodation and meals. You pay the usual co-payment.
What deadlines do I have to pay attention to?
For your health insurance fund to approve your application, your last outpatient cure must generally have been at least 3 years ago.
As a rule, your last inpatient treatment must have been at least 4 years ago.
Shorter intervals are also possible in both cases if there is an urgent medical need.
Processing duration
The processing time for outpatient benefits is usually 5 to 18 working days.
The processing time for inpatient benefits is usually 5 to 20 working days.
Your health insurance company must have all the necessary information and any required documents in a complete and meaningful form to ensure a quick processing and decision.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated 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 may be longer. The same applies if documents or records are sent to you or your health insurance company by post.
The Medical Service may need to be involved. It may take up to an additional 5 weeks to process your request.
Legal basis
Applications / forms
- Contradiction
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Action before the social court
Appeal
- Forms: yes
- Online procedure possible: Many statutory health insurance companies offer an online procedure.
- Written form required: yes
- Personal appearance necessary: no
Further Information
Author
The text was automatically translated based on the German content.
- Preventive medical services Authorization
Remark: Display of performance in the source portal
Technically approved by
Federal Ministry of Health
Professionally released on
02.12.2021
Source: Zuständigkeitsfinder Thüringen (Linie6PLus)
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