Apply for an outpatient preventive measure such as a cure for people with statutory health insurance
Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6Plus)
Service Description
An outpatient cure can help you to avert impending illnesses or the need for long-term care. You can apply to your health insurance fund for this preventive benefit.
The principle of outpatient care before inpatient care applies to preventive medical services.
Outpatient preventive services
On application and subject to certain conditions, your statutory health insurance fund will cover the costs of medical services for outpatient preventive care. Accommodation and meals are paid for by you as the insured person.
Outpatient preventive medical services are medical and therapeutic treatments, for example therapeutic baths or physiotherapy, which are provided by therapy centers in state-approved health resorts. You can choose the spa and therapy center together with your doctor. You organize your accommodation and meals yourself.
Medical necessity
Your health insurance company can only approve an outpatient preventive treatment if you have previously exhausted all therapy options at your place of residence. Your doctor must justify the necessity of the preventive care service to your health insurance company in your application.
A cure can be considered medically necessary if
- it can prevent an impending illness or avoid its worsening or
- the need for care is avoided or
- a risk to the health development of a child can be counteracted.
An outpatient cure should last a maximum of 3 weeks. An extension can only be considered if this is urgently required for medical reasons in order to achieve the preventive goal.
Teaser
An outpatient cure can help you to avert impending illnesses or the need for long-term care. You can apply to your health insurance fund for this preventive benefit.
Process flow
You can submit your application for outpatient preventive care in person, by post and, with many health insurance companies, online:
- During a consultation, your doctor will prescribe a preventive medical service for you.
- Your doctor will fill out the application form - sample 25 - together with you and explain the necessity of the measure.
- Send the completed application form to your statutory health insurance fund. You can hand in the application in person at the office, send it in by post or submit it online with many health insurance companies.
- Your health insurance company will check whether you are entitled to preventive care and inform you of the result.
- Together with your doctor, you will select a suitable state-approved health resort based on medical criteria.
Requirements
- Your doctor will prescribe the cure and justify the medical necessity to your health insurance company.
Which documents are required?
- Application for outpatient benefits
- In some cases, medical documentation may be required. You can find out what these are from your doctor or your health insurance fund.
What are the fees?
Under certain conditions, your statutory health insurance fund will cover the costs of outpatient treatment and a proportion of the costs for spa treatment. You pay for accommodation and meals. A subsidy from the health insurance company is possible.
What deadlines do I have to pay attention to?
In order for your health insurance company to approve your application, your last outpatient treatment must generally have taken place at least 3 years ago.
If there is an urgent medical need, a shorter time interval is also possible.
Processing duration
Processing time: 5 - 18 DaysFür eine schnelle Bearbeitung und Entscheidung müssen Ihrer Krankenkasse die notwendigen Informationen sowie gegebenenfalls erforderliche Unterlagen vollständig und aussagekräftig vorliegen. Die Krankenkasse entscheidet über Anträge zeitnah, wobei zum Schutz der Patientenrechte die gesetzliche Bearbeitungsfrist eingehalten wird. Bitte beachten Sie, dass es sich bei der angegebenen Bearbeitungsdauer um einen Durchschnittswert aller Krankenkassen handelt. Sie kann im Einzelfall abweichen. Die exakte Bearbeitungsdauer hängt darüber hinaus von der Komplexität des Einzelfalls ab und kann sich entsprechend verlängern. Gleiches gilt, wenn Dokumente oder Unterlagen per Post an Sie oder Ihre Krankenkasse versandt werden. Gegebenenfalls muss der Medizinische Dienst eingebunden werden. Dieser benötigt für die Bearbeitung Ihres Anliegens zusätzlich bis zu 5 Wochen.
Legal basis
Appeal
- Objection
- Action before the social court
Applications / forms
Forms available: Yes
Written form required: Yes
Informal application possible: No
Personal appearance necessary: No
Online services available: Yes
Author
Federal Ministry of Health (BMG)
The text was automatically translated based on the German content.
- Preventive medical services for people with health insurance Authorization in the outpatient sector
Remark: Display of performance in the source portal
