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What You Need to Know About Medical Aids and Costs

The List of Medical Appliances

The list of medical appliances is compiled by the National Association of Statutory Health Insurers (GKV) according to paragraph 139 of Volume V of the Social Insurance Code (SGB V). It contains a list of medical appliances reimbursed by statutory health insurers.

Medical Aid Guidelines

The medical aid guidelines contain general regulation principles. They are decided by the Federal Joint Committee (GB-A) and serve to ensure the adequate, appropriate and economic care of the insured persons. The medical aid guidelines are primarily aimed at doctors and statutory health insurers, but also concern service providers and insured persons, since the supply claim is made compulsory.

Fixed Amounts

The health insurance companies have set fixed amounts for many aids. These stipulate the maximum amount a health insurance company will pay for the products in each aid category. If the patient requires a product that exceeds the fixed amount, he/she must pay the additional amount him/herself.

Currently there are fixed amounts for the following categories:

  • Inserts
  • Hearing aids
  • Incontinence aids
  • Aids for compression therapy
  • Visual aids
  • Stoma products

No fixed amounts have been agreed thus far for nursing equipment.

Top-up Payment for Aids

For all medical aids, the legislator requires a top-up payment of 10%. However, this should be a minimum of 5 Euros and a maximum of 10 Euros per month, and not more than the cost of the product itself. A limit of two per cent of the gross annual income (one per cent for chronically ill patients) applies.

The top-up payment limit of 10 Euros also applies to the average monthly requirement for consumables, e.g. incontinence pads.

ISC Prescriptions: What Should Be Considered?

Intermittent self-catheterisation (ISC) is a treatment that must be recommended and prescribed by a doctor. The doctor prescribes the correct size and quantity of catheters and aids to suit requirements and manual ability.

The doctor is free to decide whether he/she merely specifies the product type or a specific individual product. The doctor also gives practical instructions to patients, relatives or nursing staff.

Separate Prescription for Medical Aid

Catheters are aids that must generally be prescribed on a separate prescription. Special columns are provided on the prescription for the aid item number. If the item number is known, your doctor may specify this on the prescription.

The size of the catheter (diameter in Charriere (Ch) and length) should also be noted as well as the type (Nelaton or Tiemann tip). The number of items and/or consumption must also be provided e.g. per month. If the catheterisation is to be carried out at shorter intervals, this must be individually justified.

It is important that the diagnosis is also noted.