Soziotherapie für Krankenversicherte Finanzierung

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

Are you severely mentally ill and unable to make independent use of medical or medically prescribed services? If so, 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 so that you can manage without sociotherapeutic care in the long term.

Sociotherapy can be prescribed if it avoids or shortens hospital treatment or if it is necessary but not feasible.

For each 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.

• prescription

• You have statutory health insurance
• You are unable to access medical or medically prescribed services independently due to severe mental illness.
• The service must be approved by the health insurance fund

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

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.

• Insured persons are entitled to sociotherapy
• Prerequisites:
  • Insured persons are not in a position to make independent use of medical or medically prescribed services due to severe mental illness.
  • Sociotherapy avoids or shortens hospital treatment or hospital treatment is necessary but not possible
• Sociotherapy includes the necessary coordination of prescribed services in individual cases as well as guidance and motivation to make use of them.
• Entitlement exists for a maximum of 120 hours within three years per case of illness.
• Sociotherapy must be prescribed by a doctor.
• Insured persons who have reached the age of 18 have to make an additional 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 the care of panel doctors.
• The health insurance funds conclude care contracts with suitable persons or facilities.

The responsibility lies with the respective health insurance company.