Apply for stress testing and occupational therapy from the statutory health insurance fund
Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6Plus)
Service Description
Have you had a serious physical or mental illness or an accident and don't know if and when you will be able to work again? Your health insurance fund will cover the costs of stress testing and work therapy if no other social insurance provider is responsible.
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 when you return to work. Work therapy and stress testing are designed to support you in this. They are part of the medical rehabilitation services.
Your health insurance fund will cover the costs if no other social insurance provider is responsible.
Normally, the costs for stress testing and work therapy are covered by your pension insurance provider. In some cases, a professional association or the Federal Employment Agency may also be responsible.
The stress test is an examination in which specialists determine your health capacity. Various questions and tests are used to determine
- how capable you are physically, mentally and psychologically,
- how well you can adapt to different social situations and
- where your strengths lie.
The stress test should show whether you are resilient enough to return to your old job in the long term or whether you need to take up a new, suitable job.
Occupational therapy involves practicing specific work steps from your professional life to train and promote
- manual skills,
- manual and technical skills or
- mental-psychological abilities, for example interest, self-confidence, perseverance, punctuality, appearance, sociability, willingness to cooperate.
The aims of occupational therapy are
- the improvement of resilience
- maintaining and developing the skills and abilities required for your professional reintegration.
Occupational therapy is used if professional reintegration is not yet possible at the time of the stress test.
If you take part in a stress test or work therapy financed by your health insurance fund, you will continue to receive sickness benefit during this period.
Teaser
Have you had a serious physical or mental illness or an accident and don't know if and when you will be able to work again? Your health insurance fund will cover the costs of stress testing and work therapy if no other social insurance provider is responsible.
Process flow
You can apply for the costs of your stress test or work therapy to be covered by post or - in the case of many statutory health insurance funds - in person at the office.
- Obtain a medical certificate in which your doctor recommends a stress test or work therapy.
- Submit the medical certificate together with your application to your health insurance fund. 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. Your health insurance fund can also tell you which facilities it has a contract with.
- Once you have decided on a facility, present the cost approval to it. In many cases, the health insurance company will also send the cost approval directly to the respective facility.
- The costs of the stress test or occupational therapy will now be covered by the health insurance fund. You no longer have to worry about anything.
Requirements
Your statutory health insurance fund will cover the costs of stress testing and occupational therapy if
- this is prescribed by a doctor and
- no other social insurance provider is responsible. In most cases, pension insurance, 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 will finance the treatment.
Which documents are required?
Your health insurance company will inform you which documents are required, for example a medical report on the necessity of the measures applied for.
What are the fees?
You do not have to pay anything for the application.
What deadlines do I have to pay attention to?
You do not have to observe any deadlines.
Processing duration
Processing normally takes around 3 to 6 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.
The Medical Service may need to be involved. It may take up to an additional 5 weeks to process your request.
Legal basis
Appeal
- Objection
- Action before the social court
Applications / forms
- Forms available: no
- Written form required: no
- Informal application possible: yes
- Personal appearance necessary: no
- Online service available: no
For further information on the application, please contact your health insurance company directly.
Author
Spitzenverband Bund der Krankenkassen (GKV-Spitzenverband)
The text was automatically translated based on the German content.
- Stress testing and occupational therapy for people with health insurance Funding
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