Zuzahlungen und/oder Eigenanteile der Krankenhilfe für Pflegekind/er beantragen

If a foster child's health insurance coverage is not sufficient for necessary measures, the youth welfare office may be able to cover necessary co-payments or personal contributions. As a rule, however, such costs are already covered by the monthly lump sums.

Children and adolescents under the age of 18 who have statutory health insurance are exempt from co-payments for prescription drugs, dressings and medical aids (with the exception of travel costs).

Additional co-payments and co-payments for health care services or health insurance for foster children in full-time care are generally covered by the public youth welfare agency.However, these costs are already covered by the monthly benefits to cover regularly recurring needs and the monthly benefits for one-off and annually recurring special needs. This applies, for example, to co-payments for dentures, visual aids, medication, travel costs or orthodontic services.

Only co-payments that are extraordinary in terms of their nature and extent can be additionally reimbursed in individual cases. However, not all medical services can be covered. Certain services are not covered by the statutory health insurance. This applies above all to measures that are not medically necessary or are more cosmetic in nature. Such measures are not covered by health assistance.

Evidence of the nature and extent of the costs

There is no cost for the application.

Copayments and co-payments are already covered by the monthly lump sums. Only extraordinary co-payments and additional payments, depending on their nature and extent, can be reimbursed in individual cases.

Please ask your local youth welfare office. In some cases, cost coverage must be applied for before the planned measure begins. There are also medical measures for which the Youth Welfare Office cannot assume the costs. This can be clarified during the consultation.

You can also apply for cost coverage via the online service "pflegekinderwesen-digital" using the form "Formless applications".

Certain medical services are not included in the scope of benefits of the statutory health insurance. As a rule, they are to be borne by the insured persons themselves.

Such services are not considered co-payments within the meaning of SGB V. They are also not covered within the framework of health assistance according to § 40 SGB VIII.

The youth welfare office therefore first checks whether and to what extent it may assume the costs for a co-payment or a personal contribution within the framework of health assistance.

The youth welfare office settles the assumed costs with the health insurance company.

The processing of applications by the Youth Welfare Office can take some time.

There is no deadline.

• Benefits of health care assistance - Co-payments and co-payments care
• Apply for co-payments and/or copayments of health care assistance for foster child/ren
• Responsible: Youth Welfare Office

The local youth welfare office