Applying for medical preventive services for insured persons of the statutory health insurance Unfortunately this specification of service has not yet been completely translated.
Outpatient or inpatient preventive care can help you avert the threat of illness or the need for long-term care. You apply for the preventive care benefit from your health insurance fund.
For preventive medical services, the principle applies: outpatient before inpatient.
Outpatient preventive care services
Upon application and under certain conditions, your statutory health insurance will cover the costs of medical services and spa medication for outpatient preventive care. Accommodation and meals are paid by you as the insured person.
Outpatient preventive medical services are medical and therapeutic treatments, for example, therapeutic baths or physiotherapy, which are carried out by therapy centers in state-recognized health resorts. You can choose the health resort and the therapy center together with your doctor. You organize your own accommodation and meals.
Inpatient preventive services
If an outpatient preventive treatment at a state-recognized health resort is not sufficient because, for example, you are physically severely impaired or require intensive medical care, your health insurance company must grant you an inpatient preventive treatment upon application. In addition to treatment, this also includes room and board in the spa clinic.
Your health insurance company can only approve an outpatient or inpatient preventive care benefit if you have previously exhausted all therapy offers at your place of residence. Your doctor must justify the necessity of the preventive 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 aggravation, or
- prevent the need for nursing care, or
- a risk to the health development of a child can be counteracted.
The duration of outpatient preventive services should be provided for a maximum of 3 weeks. An extension can only be considered if this is urgently required for medical reasons in order to achieve the preventive care goal.
Inpatient preventive 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, stays at a health resort abroad are also possible; please contact your health insurance company for more information.
In individual cases, medical documents may be required. You can find out what these are from your doctor or your health insurance provider.
- Forms: yes
- Online procedure possible: Many statutory health insurers offer an online procedure.
- Written form required: yes
- Personal appearance required: no
Zum Antrag auf ambulante medizinische Vorsorgeleistungen über den Kassen-Navigator des GKV-Spitzenverbands
Zum Antrag auf stationäre medizinische Vorsorgeleistungen über den Kassen-Navigator des GKV-Spitzenverbands
Your doctor prescribes the cure and justifies the medical necessity to your health insurance company.
§ 23 Absatz 2 und 4 Fünftes Buch Sozialgesetzbuch (SGB V)
§ 8 Zweites Gesetz über die Krankenversicherung der Landwirte (KVLG 1989)
Informationen zu medizinischen Vorsorgeleistungen für gesetzlich Krankenversicherte auf der Internetseite des Bundesgesundheitsministeriums
For a preventive service, proceed as follows:
- In a consultation, your doctor will prescribe a preventive medical service for you.
- For outpatient preventive care: Your doctor fills out the application form (model 25) together with you and justifies the necessity of the measure.
- For inpatient preventive care: Your doctor fills out the application form of your health insurance together with you and justifies the necessity of the measure.
- You send the completed application to your statutory health insurance fund. You can submit the application by mail and - for many health insurance companies - also online or hand it in at the office.
- The health insurance fund will check whether there is an entitlement to preventive care benefits and inform you of the result.
- For outpatient preventive care benefits: Together with your doctor, you will select a suitable state-recognized spa from a medical point of view.
For inpatient preventive care benefits: You are welcome to inform your health insurance company of your wishes regarding a specific preventive care facility. Your health insurance fund will check whether these wishes can be met.
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Federal Ministry of Health
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