Provide rehabilitation measures for insured persons

The responsibility lies with the respective health insurance company.

• Need for rehabilitation: Your performance is impaired and cannot be restored with individual measures such as physiotherapy and occupational therapy.
• Ability to rehabilitate: You are capable of rehabilitation, i.e. you are sufficiently resilient that necessary treatments can be carried out.
• Positive rehabilitation prognosis: According to medical assessment, you are likely to achieve individual rehabilitation goals.

• You must submit an informal application to your health insurance fund.
• Your health insurance fund will check whether the requirements for medical rehabilitation are met

• Insured persons who have reached the age of 18 pay a co-payment: in outpatient rehab per treatment day and in inpatient rehab per calendar day 10 euros each.
• The co-payment is calculated for a maximum of 42 calendar days per year. It is paid directly to the rehabilitation institution.
• In the case of follow-up rehabilitation immediately after hospital treatment, you will have to make additional payments for a maximum of 28 days. Co-payments which you have already made for another rehabilitation or inpatient hospital treatment within a calendar year will be taken into account.
• If you have little or no income, you can apply for exemption from the co-payment. Please contact your health insurance company.

In principle, you are only entitled to medical rehabilitation again after 4 years have elapsed. Exception: Rehabilitation can be granted within the four-year period if it is urgently required for medical reasons.

The health insurance fund must decide on applications for rehabilitation benefits within 2 months.

• § Section 40 Fifth Book of the German Social Code (SGB V)

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.

27.11.2020