Treatment Application - You Have To Consider That

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Application for a spa stay

Does your back hurt all the time or do you suffer from circulatory problems? Depending on the intensity of the symptoms, a cure may be recommended by the doctor. This is often the case when an imminent disease can be prevented or avoided or there is a risk that an existing disease will worsen. A classic example of a spa stay with the indication of the musculoskeletal system are patients with major joint problems caused by wear and tear or incorrect loading…

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• How do I apply?
• Can the health resort be chosen by myself?
• Who is responsible for spa stays?
• How often can a spa stay be applied for?
• How long is an approved spa application valid?
• How are the costs going to be covered?

How do I apply?

In principle, all socially insured persons can apply for a spa stay. However, since a stay at a health resort is a voluntary service provided by the social security agency, there is no legal claim to it. An application is required for a spa stay. The application is made through the treating doctor. The doctor must always provide a detailed diagnosis so that the most suitable form of stay (correct indication, health resort) can be determined.

The application for a stay at the health resort is submitted to the responsible insurance company (pension or health insurance) for review. If the social insurance agency approves the application, appointments for the cure are made directly by the approved cure facility. The required application form can be downloaded from the social insurance website or is available from the health insurance contract partners (doctors) or can be requested directly from the responsible health insurance providers.

Submitting the application

The completed application can be sent to the responsible social insurance agency (health or pension insurance agency) or handed in personally to a service point. After submitting the application, it will be checked by the insurance company to determine whether certain insurance law and medical requirements for reimbursement of costs are guaranteed. The responsible insurance company will inform you in writing of the decision to apply for a spa stay. As soon as the competent social insurance agency has approved and commenced a stay at a health resort, this is deemed to be an inability to work due to illness according to the law.

Note It is possible to submit applications to any social insurance agency - even if another insurance agency is actually responsible. In this case, the application will be forwarded to the responsible insurance provider ("Allsparenservice").

Can the health resort be chosen by myself?

In principle, the insured person cannot choose the place of the health resort himself. As a rule, however, the social security agencies try to take into account the wishes given.

Note The social security agency must have a contractual relationship with the desired facility and the facility must offer the appropriate therapies with the prescribed quality for the indicated indication.

Who is responsible for spa stays?

Different social insurance carriers (health or pension insurance) are responsible for the stay at the spa. A certain insurance membership is required. Fundamentally, the relevant pension insurance is responsible for employees and recipients of a temporary disability, work or disability pension, and the health insurance provider for co-insured relatives and recipients of a retirement pension.

How often can a spa stay be applied for?

A spa stay can be applied for a maximum of two times within five years if medically necessary. More frequent use is only possible with “special medical justification” (eg MS patients with frequent relapses or patients with ankylosing spondylitis after medical necessity).

After a rejection of an application for the granting of a spa stay, a new application can be submitted in the event of a significant deterioration in the patient's health or a renewed illness. The medical assessment is carried out by the respective insurance company.

How long is an approved spa application valid?

In principle, the approval of a spa application is valid for twelve months. This means that you have to start the cure within one year of the date of approval - otherwise the approval expires.

How are the costs going to be covered?

Since there is no legal entitlement to a cure, the social security agencies are not obliged to finance the stay at the cure. If the social insurance company approves the stay at the spa, it also covers a large part of the costs. The patient pays a deductible depending on the income.

Note Since a stay at a spa is assessed as incapacity to work due to illness, you as an employee are entitled to continued payment from the company or sickness benefit from the health insurance company responsible for you.

Deductible

A deductible must be paid for the cure, which depends on the monthly income. You can find more information about the deductible or the exemption on the social security website.

Are the costs of an accompanying person covered?

If medically necessary, it is possible to request someone to accompany the cure. Find out directly from the responsible insurance company whether the accommodation costs of an accompanying person will be covered.