Medical care for recipients of benefits according to Book XII of the Social Code
In the case of recipients of income support who have compulsory insurance in the statutory health insurance fund and in the case of some voluntarily insured benefit recipients, social services must assume the payment of health insurance contributions. Assumption of the contributions of other voluntarily insured persons is at the discretion of the social welfare agency; i.e. these can be assumed. Recipients of income support who are privately insured are entitled to the assumption of contributions which ensure the basic rate of benefits of the health insurance fund.
The medical care of recipients of income support who were not covered by health insurance prior to the receipt of the benefit is assumed by the health insurance fund if they have been receiving income support for longer than a month. Persons entitled to receive benefits are to choose a health insurance fund for this purpose. If this does not take place, registration with a health insurance fund is undertaken by social services. The persons in question receive a health insurance card. However, they are not members of the health insurance fund; any costs of medical care are instead refunded to the health insurance fund by social services.
Persons entitled to receive benefits who are not covered by health insurance and who have been receiving benefits for less than a month are granted benefits by social services within the context of medical assistance.
All recipients of income support are subject to statutorily regulated additional payments for medicines, aids and resources as well as visits to doctors and hospital stays. Reference is made to the regulations in Book V of the Social Code.
The maximum amount of total additional payments per year is 2% of the amount normally required by the head of a household and is 1% in the case of people with chronic diseases.
Medical care under the Asylum Seekers Benefits Act
Asylum seekers and foreigners who have permission to reside or, because of a war in their homeland, have a residence permit in accordance with the Aufenthaltsgesetz (‘Residency Act‘) and foreigners with toleration of a stay as well as other people obliged to leave the country whose threat of deportation is still not or is no longer enforceable are entitled to medical care under the Asylum Seekers Benefits Act.
There are two groups of people entitled to benefits according to the Asylum Seekers Benefits Act:
- People entitled to benefits according to § 2 of the Asylum Seekers Benefits Act are insured with a health insurance fund of their choice, receive a health insurance card and are thus entitled to statutory health insurance benefits. The health insurance funds charge the social welfare agencies for the medical benefits. People entitled to benefits in accordance with § 2 of the Asylum Seekers Benefits Act are subject to the regulations governing additional payments.
You have to make additional payments for medicines, aids and remedies as well as visits to doctors and hospital stays. The same maximum additional payment limits apply as in the case of benefit recipients according to Book XII of the Social Code. The hardship clauses also apply to them.
- Medical care for people entitled to benefits in accordance with § 3 of the Asylum Seekers Benefits Act is limited (cf. § 4 of the Asylum Seekers Benefits Act). Only in the case of acute illnesses and pain states are benefits allowed for medical care. There are particular restrictions in the case of dentures. Dentures can only be allowed in exceptionals cases caused by a lack ov chewing ability. This restriction does not apply to dental treatment such as caries and root treatment.
Certain medical benefits are, however, granted to this group of people without restriction. These include benefits for screening examinations and for pregnant women. Pregnant women have an unlimited entitlement to screening examinations and services relating to childbirth and aftercare. Vaccinations for children and adults and certain other screening examinations can also be allowed without the existence of an acute disease.
Asylum seekers are entitled to the following benefits:
- screening examinations during pregnancy, services during child-birth and aftercare;
- statutory screening examinations for children
- vaccinations for children and tetanus, diphtheria and polio vaccinations for adults.
People entitled to benefits under § 3 of the Asylum Seekers Benefits Act receive a special medical treatment certificate from social services or the immigration authority and they present this to a doctor. The medical certificate is valid for one quarter of the particular calendar year. Recipients of benefits under § 3 of the Asylum Seekers Benefits Act do not have to make any additional payments.