Krankenhausbehandlung für Krankenversicherte Finanzierung

As an insured person, you are entitled to hospital treatment. Treatment is provided on a full inpatient basis if the treatment objective cannot be achieved by partial, pre-hospital or post-hospital treatment or outpatient treatment including home nursing care.

Insured persons are entitled to treatment in an approved hospital. The benefit includes, in particular, medical treatment, nursing care, provision of medicines, remedies and aids as well as accommodation and meals. Hospital treatment also includes discharge management to support you in securing further care after hospital discharge. To this end, hospital doctors can prescribe medicines and, for a period of up to seven days, among other things, dressings, remedies and aids and home nursing care, as well as determining incapacity for work.

If there is no emergency, you need a hospital referral from your attending physician (general practitioner or specialist) to be admitted to a hospital.

For inpatient hospital treatment, the principle of "outpatient before inpatient" applies. Insured persons are thus only entitled to full inpatient treatment in an approved hospital if the treatment objective cannot be achieved by partial, pre- or post-inpatient or outpatient treatment including home nursing care.

Insured persons who have reached the age of 18 pay 10 euros per calendar day to the hospital from the beginning of the full inpatient hospital treatment within a calendar year for a maximum of 28 days. If, without compelling reason, insured persons choose a hospital other than one named in the medical referral, they may also be charged for all or part of the additional costs.

You should discuss whether hospital treatment is necessary with your attending doctor. This can be your family doctor or a specialist. If there is no emergency, you will need a hospital referral from your treating doctor (GP or specialist) to be admitted to hospital. As a rule, you do not need to contact your health insurance fund in advance in order to be admitted to hospital.

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If the health insurance company refuses to pay the benefit, you can lodge an objection. If the objection is not upheld, you can take legal action against it before the social court.

• Hospital treatment is provided on a full inpatient, inpatient-equivalent, day-care, pre- and post-inpatient and outpatient basis.
• Insured persons are entitled to full inpatient or equivalent inpatient treatment if the treatment objective cannot be achieved by partial inpatient, pre- and post-inpatient or outpatient treatment including home nursing.
• Hospital treatment includes all services that are necessary in individual cases for the medical care of the insured person in hospital according to the type and severity of the illness, in particular
  • medical treatment,
  • nursing care,
  • provision of medicines, remedies and aids,
  • accommodation and meals.
• Acute inpatient treatment also includes early rehabilitation services which are necessary in individual cases and which begin at the earliest possible time.
• Equivalent inpatient treatment includes psychiatric treatment in the home environment by mobile, medically-led multi-professional treatment teams.
• Hospital care also includes qualified physician assessment of ventilator status during the course of treatment and prior to transfer or discharge of ventilator patients.
• Hospital treatment also includes discharge management.
  
  

Statutory health insurance funds

The responsibility lies with your health insurance company.

If there is no emergency, you need a hospital referral from your attending physician (general practitioner or specialist) to be admitted to a hospital.