Receive reimbursement of travel expenses for medically necessary services

Prerequisites

• The journey is related to a service provided by the statutory health insurance and is medically necessary.

Documents required

• Medical prescription for medical transport
• Trips in connection with outpatient treatment sometimes require approval from the health insurance company

Which documents you have to submit depends on the individual case. Please ask your health insurance provider.

Please note

Trips in connection with outpatient treatment can be prescribed – partly subject to the approval of the health insurance company – in the following exceptional cases:

• Medical transport of people in need of care and severely disabled people, namely people with a recognised severe disability (symbol “aG”, “Bl” or “H”) or people in need of care with care level 3 in the case of permanent mobility impairment and with care level 4 or 5.
  • Approval by the health insurance company is not required if a medical journey is prescribed, for example, by taxi or rental car.
  • However, approval is required if the transport must be carried out by ambulance due to the required medical care or professional positioning of the patient.
• If there is an illness that requires high-frequency treatment over a longer period of time, and this treatment or the course of the illness leading to this treatment affects the patient in such a way that transport is essential to avoid harm to life and limb. This applies, for example, to journeys to dialysis or to radiotherapy or chemotherapy for cancer patients.
• Patients whose treatment does not correspond to the above-mentioned case examples can apply for approval and review of their individual case by the health insurance company.

Deadlines

Whether and which deadlines apply depends on the individual case. Please check with your health insurance provider.

Procedure

Processing time

The processing time depends on the individual case. Please check with your health insurance provider.




If you need approval from your health insurance company, your health insurance company must usually decide within 3 weeks of receiving your application.

Fees

As a rule, you have to pay 10% of the fare yourself as a statutory co-payment. The co-payment is capped and amounts to

• at least 5.00 euros and


• maximum of 10.00 euros


• never more than the actual costs incurred.

If you have little or no income, you can apply to be exempted from the co-payment. Please contact your health insurance provider for this.

Legal remedies

• If the health insurance company refuses the service, you can appeal against it.


• If the objection is not remedied, you can appeal to the social court

Legal basis

Social Code (SGB) Fifth Book (V)


https://www.gesetze-im-internet.de/sgb_5/__60.html