Leistungen zur medizinischen Rehabilitation für Krankenversicherte Gewährung

Rehabilitation can help you avoid the permanent onset of a disability or need for long-term care, or help you cope better with the consequences.

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

In order for your health insurance fund to cover the costs of a rehabilitation measure, you must have statutory health insurance. Your health insurance fund will first check whether another service provider is primarily responsible.

In the case of employed persons, for example, the pension insurance will finance necessary rehabilitation services. Rehabilitation benefits for pensioners, mothers or fathers with children, and people in need of long-term care are usually the responsibility of the statutory health insurance.

You must apply for rehabilitation benefits. Usually, the application is made by the social service together with you after an acute treatment in hospital (follow-up rehabilitation).

Your attending doctors can also suggest medical rehabilitation and issue a medical prescription for the application.

• You must submit an informal application to your health insurance fund.
• Your health insurance fund will check 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. you are sufficiently resilient that necessary treatments can be carried out.
• Positive rehabilitation prognosis: According to medical assessment, you are likely to achieve individual rehabilitation goals.

• Insured persons who have reached the age of 18 pay a co-payment: in outpatient rehab per treatment day and in inpatient rehab per calendar day 10 euros each.
• 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 will have to make additional payments for a maximum of 28 days. Co-payments which you have already made for another rehabilitation or inpatient hospital treatment within a calendar year will be taken into account.
• If you have little or no income, you can apply for exemption from the co-payment. Please contact your health insurance company.

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

In principle, you are only entitled to medical rehabilitation again after 4 years have elapsed. Exception: Rehabilitation can be granted 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 appeal is not upheld, you can file a lawsuit with the competent social court.

The following requirements must be met 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.
• Rehabilitation capability: the patient is capable of rehabilitation, i.e. he or she is sufficiently resilient to be able to undergo the necessary treatment.
• Positive rehabilitation prognosis: Patient can probably achieve individual rehabilitation goals according to medical assessment.
• The health insurance fund first checks whether another service provider is primarily responsible. In the case of employed persons, for example, the pension insurance finances necessary rehabilitation services. As a rule, rehabilitation services for pensioners, mothers or fathers with children and people in need of long-term care are the responsibility of the statutory health insurance.

The responsibility lies with the respective health insurance company.