Soziotherapie für Krankenversicherte beantragen

Insured persons who are seriously mentally ill and are not able to independently use medical or medically prescribed services 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 take advantage of outpatient medical and psychotherapeutic services. The aim is to strengthen your personal responsibility in such a way that you can do 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 feasible.

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

• doctor's prescription

• You are legally insured
• Due to severe mental illness, they are not able to make independent use of medical or medically prescribed services.
• The benefit must be approved by the health insurance company

• 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 treatment day

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.

• Insured persons are entitled to sociotherapy
• Preconditions:
  • Insured persons are not in a position to independently use medical or medically prescribed services due to serious mental illness
  • through sociotherapy, hospital treatment is avoided or shortened or hospital treatment is provided but not feasible
• Sociotherapy includes in individual cases 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 should be prescribed by a doctor
• Insured persons who have reached the age of 18 must make a co-payment
• the Federal Joint Committee has specified the requirements, type and scope of care in its Guideline on the Implementation of Sociotherapy in Contract Medical Care
• The health insurance funds conclude supply contracts with suitable persons or institutions

Contact your health insurance company.