Stress testing and occupational therapy with the statutory health insurance; application for cost coverage

You can apply to your health insurance fund to cover the costs of stress testing and occupational therapy if no other social insurance agency is responsible.

Zum Antrag auf Belastungserprobung und Arbeitstherapie über den Kassen-Navigator des GKV-Spitzenverbands
You can apply for stress testing via the GKV-Spitzenverband's health insurance navigator.

If you have been unable to work for a long time, for example due to an accident or a serious physical or mental illness, you are entitled to support in your return to work. Occupational therapy and stress testing are designed to support you in this process. They are part of the medical rehabilitation services.
Your health insurance fund will cover the costs if no other social insurance agency is responsible.

Normally, the costs for stress testing and occupational therapy are covered by your pension insurance carrier. In some cases, an employers' liability insurance association or the Federal Employment Agency may also be responsible.

Stress testing is an examination in which specialists determine your ability to cope with stress. On the basis of various questions and tests, the aim is to determine

how physically, mentally and spiritually fit you are,
how well you can adapt to different social situations, and
what your strengths are.

Stress testing is intended to show whether you are resilient enough to return to your old job in the long run, or whether you need to take up a new appropriate job.

Occupational therapy is considered to be the practice of specific work steps from your work life to train and promote

manual skills,
manual-technical skills or
mental-psychological abilities, for example interest, self-confidence, perseverance, punctuality, appearance, sociability, willingness to cooperate.

The goals of occupational therapy are

the improvement of the ability to work under pressure
the maintenance and development of skills and abilities necessary for your professional reintegration.

Occupational therapy kicks in when vocational integration is not yet possible at the time of stress testing.

If you participate in stress testing or occupational therapy financed by your health insurance fund, you will continue to receive sick pay during this period.

Your statutory health insurance will cover the costs of stress testing and occupational therapy if:

this is prescribed by a doctor and
no other social insurance agency is responsible. In most cases, the pension insurance, the statutory accident insurance (employers' liability insurance association or accident insurance fund) or the employment agency will cover the costs. If these are not responsible, the statutory health insurance funds finance the treatment.

Required Documents

Your health insurance company will inform you which documents are required, for example a medical certificate on the necessity of the requested measures.

You can apply for reimbursement of the costs of your stress testing or occupational therapy by mail or - for many statutory health insurers - in person at the office or online.

Obtain a medical certificate in which your doctor recommends stress testing or occupational therapy.
Submit the medical report to your health insurance company along with your claim. Your health insurance fund now has 2 weeks to check whether it is responsible. If this is not the case, your health insurance fund will forward your application to the responsible institution.
If the assumption of costs is approved, your health insurance fund will issue you with a confirmation of costs. In addition, your health insurance fund can tell you the facilities with which it has concluded a contract.
Once you have decided on a facility, you submit the confirmation of costs to the facility. In many cases, the health insurance fund will also send the cost approval directly to the facility in question.
The costs of the stress testing or occupational therapy are now covered by the health insurance fund. You no longer have to worry about anything.

You do not have to pay anything for the application.

You do not have to observe any deadlines.

Processing usually takes about 3 to 6 working days.

For rapid processing and decision-making, your health insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to 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.
If necessary, the Medical Service must be involved. This will take up to an additional 5 weeks to process your request.