Soziotherapie für Krankenversicherte Finanzierung

Insured persons who are seriously mentally ill and are unable to make use of medical or medically prescribed services independently are entitled to sociotherapy.

Are you seriously mentally ill and unable to make use of medical or medically prescribed services independently? Then you are entitled to sociotherapy as a person with statutory health insurance.

Sociotherapy includes practical life instructions that enable you to make use of outpatient medical and psychotherapeutic services. The aim is to strengthen your personal responsibility in such a way that you can manage without sociotherapeutic care in the long term.   

Sociotherapy may be prescribed if it avoids or shortens hospital treatment or if it is necessary but not practicable.

Depending on the case of illness, you are entitled to 120 hours of sociotherapy within three years. The health insurance funds conclude contracts with suitable persons or institutions for the provision of sociotherapy.

• medical prescription

• You are legally insured
• Due to severe mental illness, they are unable to make use of medical or medically prescribed services independently.
• The benefit must be approved by the health insurance fund

• If you are at least 18 years old and are not exempt from the statutory co-payments, you pay a co-payment of ten percent for each calendar day.
• However, the own contribution is at least five and a maximum of ten euros per day of treatment

You can appeal against the decision of the health insurance fund. If the objection is not remedied, you can file a complaint with the competent social court.

• Insured persons are entitled to sociotherapy
• Preconditions:
  • Insured persons are unable to make use of medical or medically prescribed services independently due to serious mental illness
  • through sociotherapy, hospital treatment is avoided or shortened or hospital treatment is required but not feasible
• In individual cases, sociotherapy includes the necessary coordination of the prescribed services as well as guidance and motivation for their use.
• Entitlement exists for a maximum of 120 hours within three years per case of illness
• Sociotherapy is to be prescribed by a doctor
• Insured persons who have reached the age of 18 must make a co-payment
• the details of the prerequisites, type and scope of care have been determined by the Federal Joint Committee in its Guideline on the Implementation of Sociotherapy in Contract Medical Care
• The health insurance funds conclude supply contracts with suitable persons or institutions

Please contact your health insurance fund or your panel doctor.