Health insurance companies do not always cover the full cost of a benefit. Find out here what the cost components are and how much you will have to pay yourself.
The essentials in summary:
- There are different cost components: additional payment, additional costs, surcharge and own contribution.
- Additional payments must also be made for medical assistance.
- Insured persons are always entitled to assistance that is financed by the health insurance company, without any additional payment.
There are many different costs related to consumer aid and subsidies: additional payment, additional costs, additional payment, personal contribution.
Aid includes a large number of products, such as
- incontinence aids,
- compression socks,
- shoe insoles,
- prosthetics,
- Wheelchairs or
- Hearing aids.
You can find out exactly what the grants include here.
You are eligible to receive the benefit as a cash benefit from your health insurance company. This means that the health insurance company provides the benefit to the insured person and contracts with a service provider (e.g., a medical supply store) to do so. You can find out more about it here.
If aid is granted, it is often necessary to contribute towards the costs in a number of ways:
Statutory additional payments for medical care
As with the provision of medication or hospital stays, insured persons are also legally obliged to pay additional costs for the provision of medical aid.
For medical benefits, the rule of a 10 percent surcharge applies – minimum 5 euros and maximum 10 euros. You pay this amount to the provider of the benefit. Children up to the age of 18 are exempt from the surcharge.
For aids that are intended for consumption and therefore needed repeatedly (e.g. insulin syringes), you pay an additional 10 percent of the cost per package – but a maximum of 10 euros for the entire monthly need for such aids.
Under certain conditions, it is possible to be exempt from additional statutory payments. Information can be found here.
Additional costs or additional aid payments
After the health insurer has approved the application for assistance, the insured receives sufficient medical assistance from medical supply stores, ophthalmologists and orthopedic technicians who have concluded contracts with the health insurer.
The aids are mostly standard versions, for which no additional costs are required. As a rule, these models (“cash devices”) are sufficient to cover the necessary medical needs.
Since the amendments to the Medical and Medical Assistance Act, service providers are obliged to advise insured persons on the correct provision of medical assistance in each individual case. This also includes advice on additional free aids. The service provider must confirm this with the insured person’s signature in a consultation protocol. As a rule, other more expensive aids will also be shown.