Services for children in a socio-pediatric center; application for cost coverage

Health insurance will cover treatment at an SPC if referred by the pediatrician.

Insured children are entitled to non-medical socio-paediatric services, in particular psychological, curative education and psychosocial services, if they are provided under medical responsibility and are necessary to detect an illness at the earliest possible stage and to draw up a treatment plan.

The aim of non-medical socio-paediatric services is to detect, prevent, heal or reduce the effects of damage or disorders in the physical, mental and social development of a child as early as possible. In particular, this includes diagnostics, psychotherapy and developmental and functional therapy measures, such as physiotherapy, occupational therapy and speech therapy.

The term "non-medical socio-paediatric services" means that these services are generally not provided by doctors, but predominantly by other, specially trained professional groups such as qualified psychologists, occupational and speech therapists, remedial teachers or social workers under the responsibility of a doctor.

Non-medical socio-pediatric services are provided in special education centers set up for this purpose.

Your health insurance fund will cover the costs of treatment in a special education center if

your child cannot be treated by suitable doctors or in suitable early intervention centers due to the nature, severity or duration of the illness or if there is a threat of illness,
the attending pediatrician considers treatment in an SPC to be medically necessary,
a medical referral to an SPC is made,
the pediatrician treating the child is a contract doctor, i.e. is licensed by a health insurance fund.
The treatment is carried out under medical responsibility.