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Schleswig-Holstein

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Apply for inpatient preventive services such as a cure for people with statutory health insurance

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6Plus)

Service Description

An inpatient preventive care benefit or cure can help you to avert impending illness or the need for long-term care. You can apply to your health insurance fund for preventive care benefits.

The principle of outpatient before inpatient care applies to preventive medical services. However, if outpatient preventive care at a state-recognized health resort is not sufficient because, for example

  • you are physically severely impaired,
  • you require intensive medical care or
  • it is necessary due to special family or professional circumstances,

your health insurance fund must approve an application for inpatient preventive care. In addition to treatment, this also includes accommodation and meals at the spa clinic.

Medical necessity

Your health insurance company can only approve inpatient treatment if you have previously exhausted all outpatient treatment options at your place of residence. Your doctor must justify the necessity of the treatment to your health insurance company in the application.

A cure can be considered medically necessary if

  • it can prevent an impending illness or avoid its worsening or
  • the need for care is avoided or
  • a risk to the health development of a child can be counteracted.

Duration

Inpatient preventive care services should be provided for a maximum of 3 weeks - unless an extension of the service is urgently required for medical reasons.

In individual cases, spa stays abroad are also possible, please contact your health insurance fund for more information.


Process flow

You can submit your application for inpatient preventive care in person, by post and, with many health insurance funds, online:

  • During a consultation, your doctor will prescribe a preventive medical service for you.
  • Together with your doctor, you fill out the application form from your health insurance company and explain why the treatment is necessary.
  • Send the completed application form to your statutory health insurance fund. You can submit the application by post and - with many health insurance companies - also online or hand it in at the office.
  • The health insurance fund will check whether you are entitled to a preventive benefit and inform you of the result.
  • You are welcome to inform your health insurance company of your wishes regarding a particular pension scheme. Your health insurance company will check whether these wishes can be met.
Requirements
  • Your doctor will prescribe the cure and justify the medical necessity to your health insurance company.
Which documents are required?
  • Application for inpatient preventive care or cure
  • In some cases, medical documentation may be required. You can find out what these are from your doctor or your health insurance fund.
What are the fees?

Your health insurance will cover the costs of treatment, accommodation and meals. You pay the co-payment.

What deadlines do I have to pay attention to?

In order for your health insurance company to approve your application, your last inpatient treatment must generally have taken place at least 4 years ago.
If there is an urgent medical need, a shorter time interval is also possible.

Processing duration

Processing time: 5 - 20 Days
Für eine schnelle Bearbeitung und Entscheidung müssen Ihrer Krankenkasse die notwendigen Informationen sowie gegebenenfalls erforderliche Unterlagen vollständig und aussagekräftig vorliegen. Die Krankenkasse entscheidet über Anträge zeitnah, wobei zum Schutz der Patientenrechte die gesetzliche Bearbeitungsfrist eingehalten wird. Bitte beachten Sie, dass es sich bei der angegebenen Bearbeitungsdauer um einen Durchschnittswert aller Krankenkassen handelt. Sie kann im Einzelfall abweichen. Die exakte Bearbeitungsdauer hängt darüber hinaus von der Komplexität des Einzelfalls ab und kann sich entsprechend verlängern. Gleiches gilt, wenn Dokumente oder Unterlagen per Post an Sie oder Ihre Krankenkasse versandt werden. Gegebenenfalls muss der Medizinische Dienst eingebunden werden. Dieser benötigt für die Bearbeitung Ihres Anliegens zusätzlich bis zu 5 Wochen.

Legal basis
Appeal
  • Objection
  • Action before the social court
Applications / forms

Forms available: Yes
Written form required: Yes
Informal application possible: No
Personal appearance necessary: No

Online services available: Yes

Weiterführende Informationen
Author
Forwarding service: Deep link to the original portal

Federal Ministry of Health (BMG)

The text was automatically translated based on the German content.

Teaser

An inpatient preventive care benefit or cure can help you to avert impending illness or the need for long-term care. You can apply to your health insurance fund for preventive care benefits.

Process flow

You can submit your application for inpatient preventive care in person, by post and, with many health insurance funds, online:

  • During a consultation, your doctor will prescribe a preventive medical service for you.
  • Together with your doctor, you fill out the application form from your health insurance company and explain why the treatment is necessary.
  • Send the completed application form to your statutory health insurance fund. You can submit the application by post and - with many health insurance companies - also online or hand it in at the office.
  • The health insurance fund will check whether you are entitled to a preventive benefit and inform you of the result.
  • You are welcome to inform your health insurance company of your wishes regarding a particular pension scheme. Your health insurance company will check whether these wishes can be met.

Requirements

  • Your doctor will prescribe the cure and justify the medical necessity to your health insurance company.

Which documents are required?

  • Application for inpatient preventive care or cure
  • In some cases, medical documentation may be required. You can find out what these are from your doctor or your health insurance fund.

What are the fees?

Your health insurance will cover the costs of treatment, accommodation and meals. You pay the co-payment.

What deadlines do I have to pay attention to?

In order for your health insurance company to approve your application, your last inpatient treatment must generally have taken place at least 4 years ago.
If there is an urgent medical need, a shorter time interval is also possible.

Processing duration

Processing time: 5 - 20 Days
Für eine schnelle Bearbeitung und Entscheidung müssen Ihrer Krankenkasse die notwendigen Informationen sowie gegebenenfalls erforderliche Unterlagen vollständig und aussagekräftig vorliegen. Die Krankenkasse entscheidet über Anträge zeitnah, wobei zum Schutz der Patientenrechte die gesetzliche Bearbeitungsfrist eingehalten wird. Bitte beachten Sie, dass es sich bei der angegebenen Bearbeitungsdauer um einen Durchschnittswert aller Krankenkassen handelt. Sie kann im Einzelfall abweichen. Die exakte Bearbeitungsdauer hängt darüber hinaus von der Komplexität des Einzelfalls ab und kann sich entsprechend verlängern. Gleiches gilt, wenn Dokumente oder Unterlagen per Post an Sie oder Ihre Krankenkasse versandt werden. Gegebenenfalls muss der Medizinische Dienst eingebunden werden. Dieser benötigt für die Bearbeitung Ihres Anliegens zusätzlich bis zu 5 Wochen.

Legal basis

Appeal

  • Objection
  • Action before the social court

Applications / forms

Forms available: Yes
Written form required: Yes
Informal application possible: No
Personal appearance necessary: No

Online services available: Yes

Weiterführende Informationen

Author

Forwarding service: Deep link to the original portal

Federal Ministry of Health (BMG)

The text was automatically translated based on the German content.

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