Leistungen zur medizinischen Rehabilitation für Krankenversicherte Gewährung

Rehabilitation can help you avoid the permanent occurrence of a disability or need for care or to cope better with the consequences.

Rehabilitation can help you avoid the permanent occurrence 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 first checks 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 benefits. In most cases, the application is made after acute treatment in the hospital by the social service together with you (follow-up rehabilitation).

Your attending physicians can also encourage medical rehabilitation and issue a medical prescription for the application.

• You must submit an informal application to your health insurance fund.
• Your health insurance company checks whether the requirements for medical rehabilitation are met

• Need for rehabilitation: Your performance is impaired and cannot be restored with individual measures, such as physiotherapy and occupational therapy.
• Ability to rehabilitate: You are capable of rehabilitation, i.e. They are so resilient that necessary treatments can be carried out.
• Positive rehabilitation prognosis: According to medical assessment, you can probably achieve individual rehabilitation goals.

• 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 institution.
• In the case of follow-up rehabilitation immediately after hospital treatment, you must 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 credited
• If you have a low or no income, you can be exempted from the co-payment upon request. Please contact your health insurance company.

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

In principle, you are only entitled to medical rehabilitation again after 4 years. Exception: Rehabilitation can be approved within the four-year period if it is urgently required for medical reasons.

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.

The following conditions must be met in order for a medical rehabilitation measure to be approved:

• Need for rehabilitation: performance is impaired and cannot be restored with individual measures, such as physiotherapy and occupational therapy.
• Ability to rehabilitate: Patient is capable of rehabilitation, i.e. so resilient that necessary treatments can be carried out.
• Positive rehabilitation prognosis: Patient can probably achieve individual rehabilitation goals according to medical assessment.
• The health insurance company first checks whether another service provider is primarily responsible. In the case of employed persons, for example, pension insurance finances necessary rehabilitation services. As a rule, rehabilitation services for pensioners, mothers or fathers with children as well as for those in need of care are the responsibility of the statutory health insurance.

Please contact your health insurance company or the pension insurance provider.