Has an application for cost coverage been submitted to the health insurance company? If an application for cost coverage is submitted to the health insurance company, an expert from the Medical Service decides in each individual case whether the intervention is actually medically necessary.
When should the health insurance company decide whether to cover the costs? According to §13 Abs. 3a SGB V it should decide until 09.03.2021 about the assumption of costs (the health insurance company itself wrote this in the letter of 04.02). Until 09.03.2021 I have not received any feedback.
What is the cost coverage of health insurance for contraception?
Health insurance coverage of costs for contraception. Insured persons up to the age of 20 are entitled to receive contraceptives, provided they are prescribed by a doctor. In individual cases, this is the contraceptive pill.
How does the AOK cover the cost of contraceptives? The AOK covers the costs of prescription contraceptives up to the age of 22. These include, for example, the pill, the mini-pill, contraceptive patches or the vaginal ring. However, the statutory co-payment must be paid from the age of 18.
How are public health insurance plans similar?
The scope of benefits is similar for public health insurance companies, while for private health insurance companies it depends on which tariff you are in, with regard to the reimbursement of services for which you have to pay in advance. The health insurance companies often provide information about the exact scope of benefits on their websites.
How are statutory health insurance funds financed? This is how statutory health insurance funds are financed. The financing of a statutory health insurance is based on three pillars. It is made up of contributions, federal subsidies and additional contributions. Contributions and federal subsidies are collected in the health fund and then distributed to the health insurance funds.
What are the deadlines for health insurance companies?
The deadlines within which the experts must comment are irrelevant for the deadlines within which the health insurance fund must make its decision. Thus, the health insurance fund must make its decision within 5 weeks even if the expert does not meet his deadline.
How long is the notice period for a statutory health insurance? Notice period is usually two months. By participating in optional tariffs, this commitment period can be up to three years before the health insurance company can be changed. Membership in a statutory health insurance fund can be terminated with two months' notice.
What is the deadline for the health insurance company's decision? The maximum period for the health insurance company's decision is 3 weeks. This period is extended to 5 weeks if an opinion of the medical service is necessary. However, the period may not be extended without informing the insured person.
Can the health insurance company not meet the deadlines? However, if the health insurance fund cannot meet the deadlines, it must inform the applicant of this in writing - and give reasons. If the deadline is not met and no notification is received from the health insurance fund, Section 13 (3a) SGB V comes into force with the following consequence: the benefit is deemed to have been approved after the deadline has expired.
How long does the health insurance company have to apply for the benefit?
The health insurance fund must decide within a period of 2 months from receipt of the application (legal regulation: § 18 SGB IX). An extension of the deadline is possible under certain circumstances. Only after the expiration of this significantly longer period is the requested benefit considered approved.
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