Statutory health insurance

New regulations in 2005

Starting in January 2005, there are some new regulations on dental plates and medication under statutory health insurance cover.

Statutory health insurance

Previously, anybody who needed a more complex provision of an implanted dental plate (supra-construction) instead of a normal bridge had to bear the full costs. Health insurance companies only covered a percentage for a certain kind of dental plate in accordance with the diagnosis. If you decided to have something else, the health insurance did not cover it at all. Since January this has changed. Now, health insurance will pay a flat-rate grant, which will be paid for all kinds of dental plates. Now, the grant is orientated towards the problem, e.g. gaps between teeth or missing teeth to be replaced, and thus towards the diagnosis and no longer the treatment. The difference is that you can choose freely which recognized treatment to take — be it a supra-construction or model casting prosthesis.

The previous rules for hardship cases remain unchanged. Insured persons with low incomes (e.g., welfare recipients) who need dental plates will receive an extra grant from the insurance. This enables financially less prosperous persons to receive standard treatment free of charge. € 966 per month for a single person counts as low income.

But persons with normal incomes can also take advantage of the sliding scale on hardships and receive a higher flat-rate grant. This depends on the amount of your income. You have to pay three times the difference between your own income and the low income rate. Supposing you, as a single person, have an income of € 1,100. Your income is thus € 134 higher than the patient’s amount of co-payment, therefore you will have to co-pay for your bridge at most € 402.

New Flat Rates for Medicines

Statutory health insurance companies are obliged to watch their expenditures on medical costs not only for budgetary reasons but also because they are only responsible for covering a basic treatment standard and do not have to cover an enhanced and especially luxurious standard.

Statutory health insurance understands fixed amounts as maximal reimbursements for medicine. The health insurance company receives the costs for a medicine in respect to the sum determined by the top associations of the health insurance companies. The legal specifications presume that a sufficient selection of comparable medicines is available below or at the fixed sum. The physician can therefore select between therapeutically equivalent and qualitatively high value medicines. If the physician prescribes a medicine whose price lies over this limit, the insured person pays the difference. Physicians are obligated, however, to inform the insured person beforehand of this additional payment. The overall goal of these two concepts is to enable pharmaceutical companies to develop new medicines and keep them affordable for the patient (and his health insurance, respectively)

Starting in January 2005, fixed rates will also be applied to:

  • proton pump blocker (for stomach aches),
  • statine (to reduce cholesterol levels),
  • sartane (to reduce blood pressure) and
  • triptane (for migraine).

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This article has been provided by our partner Rechtsanwalt Alexander Baron von Engelhardt , legal expert for foreigners in Germany. For further information, go to www.vonengelhardt.com  .

Previously, anybody who needed a more complex provision of an implanted dental plate (supra-construction) instead of a normal bridge had to bear the full costs. Health insurance companies only covered a percentage for a certain kind of dental plate in accordance with the diagnosis. If you decided to have something else, the health insurance did not cover it at all. Since January this has changed. Now, health insurance will pay a flat-rate grant, which will be paid for all kinds of dental plates. Now, the grant is orientated towards the problem, e.g. gaps between teeth or missing teeth to be replaced, and thus towards the diagnosis and no longer the treatment. The difference is that you can choose freely which recognized treatment to take — be it a supra-construction or model casting prosthesis.

The previous rules for hardship cases remain unchanged. Insured persons with low incomes (e.g., welfare recipients) who need dental plates will receive an extra grant from the insurance. This enables financially less prosperous persons to receive standard treatment free of charge. € 966 per month for a single person counts as low income.

But persons with normal incomes can also take advantage of the sliding scale on hardships and receive a higher flat-rate grant. This depends on the amount of your income. You have to pay three times the difference between your own income and the low income rate. Supposing you, as a single person, have an income of € 1,100. Your income is thus € 134 higher than the patient’s amount of co-payment, therefore you will have to co-pay for your bridge at most € 402.

New Flat Rates for Medicines

Statutory health insurance companies are obliged to watch their expenditures on medical costs not only for budgetary reasons but also because they are only responsible for covering a basic treatment standard and do not have to cover an enhanced and especially luxurious standard.

Statutory health insurance understands fixed amounts as maximal reimbursements for medicine. The health insurance company receives the costs for a medicine in respect to the sum determined by the top associations of the health insurance companies. The legal specifications presume that a sufficient selection of comparable medicines is available below or at the fixed sum. The physician can therefore select between therapeutically equivalent and qualitatively high value medicines. If the physician prescribes a medicine whose price lies over this limit, the insured person pays the difference. Physicians are obligated, however, to inform the insured person beforehand of this additional payment. The overall goal of these two concepts is to enable pharmaceutical companies to develop new medicines and keep them affordable for the patient (and his health insurance, respectively)

Starting in January 2005, fixed rates will also be applied to:

  • proton pump blocker (for stomach aches),
  • statine (to reduce cholesterol levels),
  • sartane (to reduce blood pressure) and
  • triptane (for migraine).

-----------------------------------------------------------------------------------

This article has been provided by our partner Rechtsanwalt Alexander Baron von Engelhardt , legal expert for foreigners in Germany. For further information, go to www.vonengelhardt.com  .

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