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Cost unit

If an assistive product is used privately, the statutory health insurance funds often cover the costs. The entitlement and the requirements for this are regulated by law.

In addition to the statutory health insurance (GKV), other cost units may also be responsible. The question of responsibility for the assumption of costs depends on various factors.

Various cost units

The legal basis for the financing of assistive products by the statutory health insurance is § 33 SGB V.

According to this, insured persons are "entitled to be provided with hearing aids, body prostheses, orthopaedic and other assistive products which are necessary in individual cases in order to

  • to ensure the success of the medical treatment.
  • prevent an impending disability or
  • compensate for a disability

insofar as the assistive products are not to be regarded as everyday objects or are excluded pursuant to § 34 (4)".

In addition to the provision of the required assistive products, the claim also includes.

  • the necessary modification, repair and replacement of assistive products.
  • the vocational training in their use.
  • the necessary maintenance and technical controls.

The statutory long-term care insurance can be responsible for measures to improve the living environment (§ 40 para. 4 SGB XI). The prerequisite is the existence of a care degree. This financial support generally includes a subsidy of up to EUR 4,000 per measure. The subsidy is independent of income. If several people in need of care live together, a grant of up to EUR 16,000 can be applied for. However, a measure is only subsidised once, even if it benefits several persons in need of care and the construction measures are carried out at different times. The grant can be applied for again if the illness or disability worsens.

In addition, costs for nursing aids are covered by the nursing care insurance if there is no obligation to pay by the health insurance fund. In this case, a co-payment (personal contribution of the person insured for long-term care) must be made. Larger technical nursing aids are often provided on loan, so that there is no co-payment.

Costs for consumable products are reimbursed up to 40 EUR per month by the long-term care insurance fund.

For privately insured persons, the regulations of the Social Code do not apply to the financing of assistive products. Rather, the general insurance conditions and any individual supplementary agreements are decisive here.

In the case of private health insurance companies, the provision of assistive products depends on the individually concluded contract and the respective tariff scope.

For this reason, it is not possible to make a general statement on the financing of assistive products. Before signing a contract, it is important to obtain detailed advice on whether and to what extent the costs of assistive products are covered by the insurance.

Cost units for the provision of assistive products for private use can also be considered.

  • Accident insurance (SGB VII): for accidents at work and occupational diseases.
  • Social assistance (SGB XII): mainly for benefits for participation in life in the community, usually dependent on income and assets (subordinate)

Jurisprudence