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Partial reimbursement in the statutory health insurance system; obtaining
If you work in the area covered by statutory health insurance and a service regulation applies to you, you can arrange partial reimbursement. You initially pay for medical services yourself and are reimbursed for your expenses under certain conditions.
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Description
Civil service principles apply to certain employees of statutory health insurance funds and their associations, even if they are employed under private law. If a so-called service regulation applies to you, you can opt for partial reimbursement of benefits from your health insurance fund. The following can also opt for partial reimbursement
- civil servants who are members of a company health insurance fund or a miners' health insurance fund
- pension recipients for whom a service regulation applied - for example, company pensioners.
With partial cost reimbursement, you pay for services that would otherwise be billed via the electronic health card on an invoice. You submit the invoice to your health insurer and are then reimbursed for all or part of your out-of-pocket expenses.
The bylaws of your health insurance company specify whether and to what amount and for which services you can choose partial reimbursement and exactly how the procedure works.
As a rule, you agree in advance with your health insurance fund on partial cost reimbursement for a specific area of care.
Requirements
You are employed by a statutory health insurance fund or one of the health insurance associations and a service regulation is contractually defined for you. You have chosen partial cost reimbursement at your own request.
Partial cost reimbursement is also possible for:
- Pension recipients of statutory health insurance funds and their associations.
- Civil servants who are members of a company health insurance fund or a miners' health insurance fund.
Required documents
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Required Documents
- Rechnung der medizinischen Leistung
- Zahlungsbeleg
In Spezialfällen können weitere Unterlagen erforderlich sein. Bitte informieren Sie sich dazu bei Ihrer Krankenkasse.
Proceedings
Please ask your health insurance company about the exact procedure for partial cost reimbursement.
You can apply for partial cost reimbursement of services by mail and - for many statutory health insurance companies - in person at the office or online.
- Submit the required documents and your bank details to the health insurance company.
- If necessary, provide the health insurer with the account details for reimbursement.
- The health insurance company will review your application and pay you the reimbursable amount if all requirements are met.
Fees
You do not have to pay anything to apply for partial reimbursement.
Deadlines
You do not have to observe any deadlines for the application. The statutes of your health insurance company determine how long you are bound to the partial cost reimbursement for a care area. The statutory period is 2 years.
Processing time
Processing normally takes about 1 to 4 working days.
For rapid processing and decision-making, your health insurance fund must be provided with the necessary information and any required documents in a complete and meaningful manner.
The health insurance company decides on applications promptly, adhering to the statutory processing time limit in order to protect patients' rights.
Please note that the processing time indicated is an average value for all health insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your health insurer by mail.
Legal bases
Appeal
- Appeal against the rejection by the health insurance company
- Action before the social court
Status: 22.09.2022
Editorially responsible for prodecure description: Bundesministerium für Gesundheit
Source:
Federal Portal
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