Application to the health insurer to cover or refund costs (Germany)
Published byDocMuse
This document is in German
The PDF you download is in German — that is the language it has to be filed in, so it is not translated. Everything on this page is here to tell you what it says.
The application asking a German statutory health insurer (Krankenkasse) to pay for treatment, a medical aid or another service — before treatment, as a request for cost cover with the three-, five- or six-week decision deadline of § 13(3a) of Book V of the Social Code (SGB V), or afterwards, as a claim for reimbursement where the insurer missed the deadline, could not provide urgent care in time or wrongly refused it. In German, with no diagnosis in the letter: the enclosed prescription gives the medical reasons.
What you fill in
The details the document asks for.
- Insured
- Insured's address
- Health or long-term care insurer (Krankenkasse or Pflegekasse)
- Insurer's postal address
- City
- Date
- Health insurance number (Krankenversichertennummer)
- Cost cover before treatment, or reimbursement after
- Date of birth
- Treatment or service applied for (e.g. medical aid, operation, rehabilitation)
- Healthcare provider (hospital, clinic)
- Estimated cost
- IBAN
Preview
This document is produced for you. Your answers are typed into it and the finished PDF is yours to keep.
Common questions
- What happens if the German health insurer does not decide in time?
- The insurer must decide within three weeks of receipt, five weeks if it involves the Medical Service, and six weeks in the dental expert procedure (§ 13(3a) SGB V). If it does not give sufficient reasons for a delay in time, the application counts as approved. Since the Federal Social Court's judgment of 26 May 2020 (B 1 KR 9/18 R), though, that only means you may obtain the service yourself and claim the costs back. These deadlines do not apply to medical rehabilitation, where Book IX of the Social Code (SGB IX) governs deadlines and reimbursement (§ 13(3a) SGB V).
- Does German statutory health insurance refund invoices as a rule?
- No. Statutory health insurance provides its services in kind as a rule; it refunds costs only where the law provides for it (§ 13 SGB V). Anyone who pays for a service without applying first therefore risks bearing the cost. Apply for cost cover before treatment starts, and wait for the decision or for the deadline to pass.
- How is the application to a German health insurer handed in, and what if it is refused?
- This letter is enough for the application. Because the deadline runs from receipt, you should be able to prove when it arrived: hand it in against a stamp on a copy, or send it by registered post with a return receipt. If the insurer refuses, you can object within one month — in writing and signed, not by plain e-mail (§ 84 SGG).
How you can sign this document
- Print it and sign by hand. The signature lines in the document are left blank on purpose — sign on them in ink.
- Sign it yourself with a qualified electronic signature. If you already hold a QES — Evrotrust, B-Trust, StampIT, ZealiD or any qualified provider on the EU Trusted List, on a card, a USB token, in a mobile app or in the cloud — our signing guide explains step by step how to sign this exact file without invalidating it. Step-by-step help, and a way to check it worked
DocMuse sells documents, not legal advice. Acceptance always depends on the recipient's rules and your local law.
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