Receive partial reimbursement of costs in statutory health insurance
Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6Plus)
Service Description
If you work in the area of statutory health insurance and a service regulation applies to you, you can agree a partial reimbursement of costs. You then initially pay for medical services yourself and are reimbursed for your expenses under certain conditions.
Certain employees of statutory health insurance funds and their associations are subject to the principles of civil service law, even if they are employed under private law. If you are subject to so-called service regulations, you can opt for partial reimbursement of benefits from your health insurance fund. You can also opt for partial reimbursement of costs
- civil servants who work for a company health insurance fund or a miners' health insurance fund
- pension recipients for whom a service regulation applies - for example company pensioners.
With partial reimbursement, you pay for services that would otherwise be billed via the electronic health card on account. You submit the invoice to your health insurance fund and then receive full or partial reimbursement of your expenses.
Your health insurance company's statutes specify whether and to what extent you can choose partial reimbursement and for which services, as well as the exact procedure.
As a rule, you will agree in advance with your health insurance company on the partial reimbursement of costs for a specific area of care.
Teaser
If you work in the area of statutory health insurance and a service regulation applies to you, you can agree a partial reimbursement of costs. You then initially pay for medical services yourself and are reimbursed for your expenses under certain conditions.
Process flow
Please contact your health insurance fund for information on the exact procedure for partial reimbursement of costs.
You can apply for partial reimbursement of benefits by post or - with many statutory health insurance companies - in person at the office or online.
- Submit the required documents and your bank details to the health insurance company.
- If necessary, provide the health insurance company with the account details for reimbursement.
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The health insurance company will check your application and pay you the reimbursable amount if all requirements are met.
Requirements
You are employed by a statutory health insurance fund or one of the health insurance associations and a service contract has been concluded for you. You have opted for partial reimbursement of costs at your own request.
Partial reimbursement is also possible for
- Pension recipients for whom a service regulation applied, for example company pensioners
-
civil servants who are members of a company health insurance fund or a miners' health insurance scheme
Which documents are required?
- Invoice for the medical service
- Proof of payment
In special cases, further documents may be required. Please contact your health insurance company for more information.
What are the fees?
You do not have to pay anything for the application for partial reimbursement.
What deadlines do I have to pay attention to?
You do not have to observe any deadlines for the application. How long you are bound to the partial cost reimbursement for a care area is determined by your health insurance fund's statutes. The statutory period is 2 years.
Processing duration
Processing normally takes around 1 to 4 working days.
In order to process and decide quickly, your health insurance company must have the necessary information and any required documents in a complete and meaningful form.
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.
Legal basis
Appeal
- Appeal against a negative decision by the health insurance company
- Action before the social court
What else should I know?
There are no indications or special features.
Author
National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)
Forwarding service: Deep link to the original portal
The text was automatically translated based on the German content.
