Apply for reimbursement from the statutory health insurance fund

Source: BUS Rheinland-Pfalz

If you have statutory health insurance, you can receive necessary treatments and therapies without having to pay in advance, for example by presenting your electronic health card (eGK) at the doctor's surgery or hospital. This is the principle of benefits in kind. Alternatively, you can have yourself treated privately and pay the bill for the treatment yourself first. This is called the cost reimbursement principle.
Under certain conditions, you can apply for reimbursement from your health insurance fund if you have informed them of your decision to seek private treatment before treatment begins.

You can choose to have your costs reimbursed for the following services:

outpatient medical care,
outpatient dental care,
inpatient care, for example in a hospital,
medically prescribed services such as home nursing care, physiotherapy, patient transportation or aids such as wheelchairs.

If you opt for reimbursement, you are bound to it for at least one calendar quarter for the respective service area.

Please contact your health insurance company for information on the exact procedure for reimbursement.
As a rule, the procedure is as follows:

Inform your health insurance company of your decision to have the costs reimbursed before treatment begins. You can usually do this by telephone or e-mail.
You will initially pay the invoice yourself after the treatment.
You can submit the application for reimbursement by post or - with many statutory health insurance companies - in person at the office or online.
As a rule, you fill out the application form from your statutory health insurance company and submit it to the health insurance company together with the necessary documents and your bank details.
The health insurance company will check your application and pay you the reimbursable amount if all requirements are met.

You have informed your health insurance company in advance of your decision to have your costs reimbursed.
You are taking advantage of services that are medically necessary and are included in the so-called benefits catalog of the statutory health insurance.
The service provider, for example your treating doctor, has a health insurance license. This means that, in principle, he or she could also bill via the electronic health card. Otherwise, you will need the approval of your health insurance provider.

Your health insurance company can only reimburse the costs up to the maximum amount that would have been incurred according to the principle of benefits in kind, i.e. as with billing via the electronic health card. This means that you may incur additional costs.
As a rule, your health insurance company will charge you for part of the processing costs. A maximum of 5 percent of the reimbursement amount is permitted by law.

Processing normally takes around 2 to 5 working days.
Your health insurance company must have the necessary information and any required documents in a complete and meaningful form in order to process and decide quickly.
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 stated is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent to you or your health insurance company by post.

Apply for reimbursement from the statutory health insurance fund

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Requirements

Which documents are required?

What are the fees?

What deadlines do I have to pay attention to?

Processing duration

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