Overview of Benefits in the statutory health insurance
In the event of illness, it soon becomes clear that many of the statutory health insurance benefits require an own share in some areas. And some benefits are simply not available. Just what that can entail is shown by the following examples.
Drugs and dressings
The health insurance funds‘ catalogue of benefits only covers ethical drugs, i. e. those available on prescription only. Part of the cost of these drugs is paid by the health insurance fund. You have to pay a share of between 5 and 10 Euros for the drugs and dressings prescribed by your doctor.
If you need glasses or contact lenses, you must pay the full cost of these yourself. Subsidies are only paid in a small number of cases, e.g. for people with severely impaired vision.
Therapeutic aids and appliances (e. g. prostheses, wheelchairs and hearing aids)
You have to pay an own share of between 5 and 10 euros for simple therapeutic aids and appliances which have been prescribed by your doctor. If you prefer to use therapeutic aids and appliances meeting your personal wishes, the health insurance fund will only pay for the cost of the simple version. You have to make up the difference!
In most cases, the statutory health insurance fund will refuse to pay any costs for such therapies. They must be paid by you in full.
Depending on the dentist‘s findings, the statutory health insurance fund will pay a fixed subsidy of 50 % for the standard treatment in each case. This reimbursement increases to 65 % with documented regular prophylaxis (so-called „bonus card“).
Dental treatment includes basic medical care for adequate and appropriate early detection and treatment of disorders affecting the teeth, mouth and jaws, for example.
Professional teeth cleaning
these costs are not reimbursed as a matter of principle.
You are not free to choose a hospital, but will instead be treated in the nearest suitable, contractually affiliated hospital. You are not entitled to accommodation in a private or semi-private room. For every day spent in hospital, you have to pay 10 euros, up to a maximum of 28 days per year.
Workers and employees: If your illness continues for more than 6 weeks, you will lose your statutory entitle-ment to payment of the full wage or salary. The sickness benefit paid can very soon create painful gaps, as it is lower than the normal income.
Self-employed people: You must apply to the statutory health insurance fund for your entitlement to sickness benefit. If you do not actively take steps to ensure entitlement to cash benefits from private income protection insurance or statutory sickness benefit, you will not be protected against loss of income when ill.
Care if you require long-term nursing care
The statutory long-term care insurance scheme only provides for basic care. Month after month, you or your family must make up the difference between this basic provision and the actual costs incurred.
For some benefits that the statutory health insurance companies may only offer in a limited way or not at all supplementary private insurance is available.
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