Ultrasound reimbursement sonosit for the whole breast

Synopsis of all changes in the BBhV on 07/26/2014

BBhV old version (old version)
in the version valid before July 26, 2014BBhV n.F. (new version)
in the version valid on 07/26/2014
by Article 1 V. v. July 18, 2014 Federal Law Gazette I p. 1154
(Text section unchanged)

Input formula
Chapter 1 General Regulations
§ 1 Purpose of the regulation
(Text old version)

§ 2 beneficiaries
(Text new version)

§ 2 Eligible persons
§ 3 civil servants abroad


§ 4 Eligible relatives


§ 4 Eligible persons
§ 5 competitions
§ 6 Eligibility of expenses
§ 7 References to the Social Security Code
§ 8 Exclusion of eligibility for aid
§ 9 Crediting of reimbursements and benefits in kind
§ 10 Eligibility for aid
§ 11 Expenses abroad
Chapter 2 Expenses in case of illness
Section 1 Outpatient Services
§ 12 Medical Services
§ 13 Services by alternative practitioners
§ 14 Dental Services
§ 15 Implantological, orthodontic, functional analysis and functional therapeutic services
§ 16 Expenses, material and laboratory costs
§ 17 Dental services for civil servants on revocation


§ 18 Psychotherapeutic Services
Section 19 Basic psychosomatic care
Section 20 Analytical psychotherapy based on depth psychology
Section 21 Behavioral Therapy


§ 18 Psychotherapy, basic psychosomatic care
Section 18a Common regulations for the forms of treatment based on psychoanalytical methods and behavioral therapy
Section 19 Psychoanalytically Justified Procedures
Section 20 Behavioral Therapy
Section 21 Basic psychosomatic care
Section 2 Other Expenses
§ 22 Medicines and bandages
Section 23 Remedies
§ 24 Complex Therapy and Integrated Care
§ 25 Aids, devices for self-treatment and self-control, body replacements
Section 26 Hospital Services
Section 27 Nursing at home
Section 28 Family and household help
Section 29 Family and household help abroad
Section 30 Sociotherapy
Section 30a Neuropsychological Therapy
§ 31 travel expenses
Section 32 Accommodation Costs
Section 33 Life-threatening or regularly fatal diseases
Section 3 rehabilitation
Section 34 Follow-up treatment and addiction treatment
Section 35 Rehabilitation Measures
Section 36 Requirements for rehabilitation measures
Chapter 3 Expenses in Nursing Cases
Section 37 care advice, entitlement to assistance for care services
Section 38 Home care, day care and night care
Section 39 Full inpatient care
Section 40 Palliative Care
Chapter 4 Expenses in other cases
Section 41 Early diagnosis examinations and preventive measures
Section 42 Pregnancy and childbirth
Section 43 Artificial insemination, sterilization, conception control and termination of pregnancy


Section 44 Death of the beneficiary


Section 44 Death of the beneficiary
Section 45 First aid, disinfection, communication aid and organ donation
Chapter 5 Scope of the aid
Section 46 Assessment of the aid
Section 47 Deviating assessment rate
Section 48 Limitation of Aid
Section 49 Retentions
Section 50 Load Limits
Chapter 6 Procedure and Jurisdiction
Section 51 Approval Procedure
Section 52 Allocation of Expenses
Section 53 (repealed)
Section 54 Application deadline
Section 55 Confidentiality
Section 56 Assessment bodies


Section 57 Administrative Regulations


Section 57 (repealed)
Chapter 7 Transitional and Final Provisions
Section 58 Transitional Provisions
Section 59 Entry into force
Appendix 1 (to Section 6, Paragraph 2) Excluded and partially excluded examinations and treatments
Annex 2 (to Section 6, Paragraph 3, Clause 4) Maximum amounts for the appropriateness of expenses for alternative practitioner services
Annex 3 (to §§ 18 to 21) Outpatient psychotherapeutic treatments and basic psychosomatic care measures
Annex 4 (to Section 22 (1)) Eligible medical devices
Appendix 5 (to Section 22, Paragraph 2, Number 1) Medicinal products that primarily serve to improve the quality of life
Annex 6 (to Section 22 Paragraph 2 Number 3 Letter c) Eligibility for non-prescription drugs


Annex 7 (to Section 22 (3)) groups of medicinal products for which fixed amounts apply


Annex 7 (to Section 22 Paragraph 3) Overview of the drug fixed amount groups for which a fixed amount applies
Annex 8 (to Section 22, Paragraph 4) Drugs excluded or restricted from the eligibility for aid
Annex 9 (to Section 23 Paragraph 1) Maximum amounts for eligible expenses for therapeutic products
Annex 10 (to Section 23 Paragraph 1 and Section 24 Paragraph 1) Authorized service providers for therapeutic products
Annex 11 (to Section 25 Paragraphs 1 and 4) Eligible expenses for aids, devices for self-treatment and self-control, body replacements
Appendix 12 (to Section 25 Paragraphs 1, 2 and 4) Ineligible aids, devices for self-treatment and self-monitoring


Appendix 13 (to Section 41 Paragraph 1) Additional early diagnosis examinations, preventive measures and vaccinations


Annex 13 (to Section 41, Paragraph 1, Clause 3) According to Section 41, Paragraph 1, Clause 3, early diagnosis examinations, preventive measures and vaccinations that are eligible for aid
Annex 14 (to Section 41 Paragraph 3) Early detection program for hereditary problems with an increased familial breast or ovarian cancer risk


§ 2 beneficiaries




§ 2 Eligible persons


(1) Unless paragraphs 2 to 5 stipulate otherwise, whoever is entitled to support at the time of the provision of the service is eligible for aid

1. Civil servant

2. Beneficiary or

3. Former civil servant

is.



(2) Eligibility for subsidies also requires that the person entitled to subsidies has salaries, official salaries, prospective payments, retirement pensions, transitional payments, widow's allowance, widower's allowance, orphan's allowance, maintenance contributions in accordance with Section II or Section V, in accordance with Section 22 (1) or in accordance with Section 26 (1) of the Civil Servant Supply Act or transitional allowance according to Section VI of the Civil Servant Supply Act. Eligibility for financial aid also exists if earnings are not paid due to parental leave or the application of restraint, credit or reduction regulations. The entitlement to allowance remains unaffected in the case of leave with no salary under the Special Leave Ordinance, if it does not last longer than one month.



(2) 1The eligibility for aid also presupposes that the person entitled to aid has salaries, official salaries, prospective salaries, retirement pensions, transitional payments, widow's allowance, widower's allowance, orphan's allowance, maintenance contributions in accordance with Section II or Section V, in accordance with Section 22 (1) or in accordance with Section 26 (1) of the Civil Service Welfare Act or transitional allowance according to Section VI of the Civil Service Pension Act. 2The entitlement to subsidies also exists if remuneration is not paid due to parental leave or the application of restraint, credit or reduction regulations. 3The entitlement to allowance remains unaffected in the case of leave with no salary under the Special Leave Ordinance, if it does not last longer than one month.

(3) Are not eligible

1. Honorary officers,

2. Civil servants whose employment relationship is limited to less than one year, unless they have been employed in the public service for at least one year without interruption within the meaning of Section 40 (6) of the Federal Salary Act, and

3. Civil servants and pension recipients who are entitled to benefits in accordance with Section 11 of the European Parliament Act, Section 27 of the German Parliament Act or corresponding priority provisions of state law.

(4) Those civil servants of the Federal Railroad Fund who were civil servants of the German Federal Railroad at the time of the merger of the Deutsche Bundesbahn and the Deutsche Reichsbahn are not eligible for aid under this Ordinance.

(5) Civil servants who are A-members of the Postbeamtenkrankenkasse are not eligible for aid under this ordinance, provided that the statutes provide for benefits in kind for expenses of these members that are eligible for aid and these are not limited by a maximum amount.





§ 4 Relatives eligible for consideration




§ 4 Eligible persons




(1) Spouses, domestic partners of beneficiaries are eligible if the total amount of their income (Section 2 (3) of the Income Tax Act) or comparable foreign income does not exceed 17,000 euros in the second calendar year before the application for the aid. If this total amount of income is not reached in the current calendar year, spouses and life partners are already eligible for consideration in the current year, subject to revocation. The income earned abroad by the spouses and civil partners of the beneficiaries in accordance with Section 3 is not taken into account. The total amount of income must be proven by submitting a photocopy of the tax assessment.

(2) Children are eligible if they are eligible for the family allowance of the beneficiary according to the Federal Salary Act. This applies to beneficiaries according to § 3, if

1. There is an entitlement to a foreign child allowance in accordance with Section 56 of the Federal Salary Act or

2. A foreign child allowance according to Section 56 of the Federal Salary Act is only not paid because there is a domestic household of one parent who is or was custodial of the child.



(1) 1Wives, spouses, domestic partners of persons eligible for aid are eligible if the total amount of their income (Section 2, Paragraph 3 in conjunction with Paragraph 5a of the Income Tax Act) or comparable foreign income does not exceed 17,000 euros in the second calendar year prior to the application for the grant. 2If this total amount of income is not reached in the current calendar year, spouses are already eligible in the current year, subject to revocation. 3 The income generated abroad by the spouses and civil partners of the persons entitled to aid under Section 3 is not taken into account. 4The total amount of income is to be proven by submitting a photocopy of the tax assessment. 5 If the tax assessment does not show the total amount of the income in full, other evidence may be requested.

(2) 1Children are eligible if they are eligible for the family allowance of the person entitled to subsidies under the Federal Salary Act. 2This applies to persons entitled to aid under Section 3, if

1. There is an entitlement to a foreign allowance pursuant to Section 53 (4) numbers 2 and 2a of the Federal Salary Act or

2. a foreign allowance according to Section 53 (4) nos. 2 and 2a of the Federal Salary Act is only not paid because one parent has a household in Germany who is or was custodial of the child.

(3) Relatives of orphans eligible for subsidy are not eligible.



(1) Eligibility for aid is based on an employment relationship

1. Eligibility for aid based on a pension entitlement as well as



2. the ability to be considered as a relative



2. the ability to be taken into account according to § 4



(2) Eligibility for subsidies on the basis of a pension excludes entitlement to subsidies on the basis of previous pension entitlements and as eligible relatives. Sentence 1 does not apply if the earlier pension entitlement results from an own employment relationship.

(3) Eligibility for aid on the basis of legal relationships under private law is based on provisions that are essentially comparable to this Ordinance



(2) 1The entitlement to subsidies on the basis of a pension excludes entitlement to subsidies on the basis of previous pension claims and as a person eligible for consideration. 2Sentence 1 does not apply if the earlier pension entitlement results from an own employment relationship.

(3) 1The eligibility for aid on the basis of legal relationships under private law is based on provisions that are essentially comparable to this ordinance

1. Eligibility for aid based on a pension entitlement and



2. the ability to be considered as a relative

in front. The entitlement to aid to be granted for part-time employees does not represent an essentially comparable provision.

(4) A child who is eligible for more than one beneficiary shall be considered by the beneficiary who receives the family allowance for the child. Beneficiaries of aid within the meaning of sentence 1 are persons who are entitled to aid, the scope of which is essentially comparable to the claim under this regulation, regardless of the respective basis for the claim. Sentences 1 and 2 do not apply to persons who are entitled to military medical care or who are entitled to medical welfare. The family allowance for the child is a benefit in accordance with Section 40 of the Federal Salary Act or the foreign child allowance in accordance with Section 56 of the Federal Salary Act or comparable benefits on a different legal basis.



2. the eligibility for consideration according to § 4

in front. 2No essentially comparable regulation is the quota entitlement for part-time employees.

(4) 1A child is taken into account with the person entitled to assistance who receives the family allowance for the child. 2 Eligible for aid within the meaning of sentence 1 are also persons who are entitled to aid, the scope of which is essentially comparable to the claim under this Ordinance, regardless of the respective basis for the claim. 3 Family allowance for the child within the meaning of sentence 1 are the benefits according to Sections 39, 40 and 53 of the Federal Salary Act or comparable benefits that are granted with regard to the child. 4Sentences 1 and 2 do not apply to persons who are entitled to medical care or medical care.

§ 6 Eligibility of expenses


(1) 1 In principle, only necessary and economically reasonable expenses are eligible for aid. 2 Other expenses are exceptionally eligible, provided that this ordinance provides for the eligibility.

(2) 1 The necessity of expenses for examinations and treatments generally presupposes that these are carried out according to a scientifically recognized method. 2 As a rule, examinations and treatments are considered unnecessary if they are excluded in Appendix 1.



(3) 1 Expenses for medical, dental and psychotherapeutic services are generally economically reasonable if they correspond to the fee framework of the fee schedule for doctors, dentists and for psychological psychotherapists and child and adolescent psychotherapists. 2 Expenses based on an agreement in accordance with Section 2 (2) of the Schedule of Fees for Doctors, Section 2 (3) of the Schedule of Fees for Dentists or Sentences 2 to 4 of the general provisions of Section G of the Annex to the Schedule of Fees for Dentists are deemed to be economically unreasonable . 3 Economically appropriate are also services that have been provided on the basis of agreements between statutory health insurance companies in accordance with Book Five of the Social Security Code or on the basis of contracts between private health insurance companies and service providers, provided that costs are saved as a result. 4The expenses for services by alternative practitioners are reasonable if they do not exceed the maximum amounts agreed between the Federal Ministry of the Interior and the alternative practitioners' associations in accordance with Appendix 2.

(4) 1 For those entitled to aid according to Section 3 and their dependents who are eligible for consideration, the customary local fees are deemed to be economically reasonable, taking into account the special circumstances abroad. 2 If maximum amounts according to Annex 11 apply, the purchasing power compensation applicable for the place of employment can be added in accordance with Section 7 of the Federal Salary Act.

(5) 1 If relatives eligible for aid and eligible relatives are included in a standard rate supplementary to aid pursuant to Section 257 (2a) or pursuant to Section 257 (2a) in conjunction with Section 315 of Book 5 of the Social Security Code or a basic rate pursuant to Section 12 (2).1a of the Insurance Supervision Act, the economic appropriateness of your expenses is assessed according to the fee regulations agreed in the contracts pursuant to Section 75 (3b) sentence 1 of the fifth book of the Social Security Code. 2 As long as there are no contractual fee regulations, the provisions of Section 75, Paragraph 3a, Clauses 2 and 3 of Book Five of the Social Security Code apply.



(3) 1 Expenses for medical, dental and psychotherapeutic services are generally economically reasonable if they correspond to the fee framework of the fee schedule for doctors, dentists and for psychological psychotherapists and child and adolescent psychotherapists. 2 Expenses based on an agreement in accordance with Section 2 (2) of the Schedule of Fees for Doctors, Section 2 (3) of the Schedule of Fees for Dentists or Sentences 2 to 4 of the general provisions of Section G of the Annex to the Schedule of Fees for Dentists are deemed to be economically unreasonable . 3 Economically appropriate are also services that have been provided on the basis of agreements between statutory health insurance companies in accordance with Book Five of the Social Security Code or on the basis of contracts between private health insurance companies and service providers, provided that costs are saved as a result. 4 Expenses for services by alternative practitioners are economically reasonable if they do not exceed the maximum amounts according to Appendix 2.

(4) 1 For persons who are eligible for subsidies according to § 3 or who are eligible for a subsidy according to § 3, the local fees are considered economically reasonable, taking into account the special circumstances abroad. 2 If maximum amounts according to Annex 11 apply, the purchasing power compensation applicable for the place of employment can be added in accordance with Section 55 of the Federal Salary Act.

(5) 1 If persons entitled to aid and who are eligible are insured in a standard tariff supplementary to aid in accordance with Section 257 (2a) or in accordance with Section 257 (2a) in conjunction with Section 315 of Book Five of the Social Security Code or a basic tariff in accordance with Section 12 (1a) of the Insurance Supervision Act, they are assessed the economic appropriateness of their expenses according to the fee regulations agreed in the contracts according to § 75 paragraph 3b sentence 1 of the fifth book of the Social Security Code. 2 As long as there are no contractual fee regulations, the provisions of Section 75, Paragraph 3a, Clauses 2 and 3 of Book Five of the Social Security Code apply.

(6) 1 In individual cases, the Federal Ministry of the Interior can, in agreement with the Federal Ministry of Finance, declare the one-off or ongoing involvement of the Federal Government as a grantor in general, non-customizable measures. 2 The Federal Ministry of the Interior may distribute the payments and reimbursements to be made for this to the federal institutions or agencies that grant aid under this Ordinance. 3 At the request of the Federal Ministry of the Interior, the institutions or bodies shall make appropriate deductions and payments. 4 The shares are based on the ratio of the actual aid expenditure in 2009; annual expenses under 1,000 euros are not taken into account. 5 At the request of at least five highest federal authorities or authorities of the indirect federal administration, the Federal Ministry of the Interior sets new shares according to the ratio of the actual aid expenditure in the previous year for future measures.

(7) 1 If, in individual cases, the rejection of the aid would represent particular hardship, the highest service authority, with the consent of the Federal Ministry of the Interior, can grant aid to alleviate the hardship. 2 The decision must be specifically justified and documented.



§ 8 Exclusion of eligibility for aid


(1) Expenses are not eligible for aid



1. of the beneficiaries and their dependents who are eligible for consideration and who are entitled to medical care according to Section 70 (2) of the Federal Salary Act or corresponding state law provisions,

2. for expert opinions which were not arranged by the assessment body but, upon request, by the beneficiary or by the relatives eligible for consideration,

3. for medical and dental certificates for relatives eligible for consideration with the exception of medically necessary certificates,



1. insofar as persons who are eligible for subsidy or who are eligible for subsidy are entitled to medical care in accordance with Section 70 (2) of the Federal Salary Act or corresponding state law provisions,

2. for expert opinions which were not arranged by the assessment body but at the request of the person entitled to aid or the person eligible for consideration,

3. for medical and dental certificates for eligible persons with the exception of medically necessary certificates,

4. for visiting preschool or school facilities or workshops for the disabled,

5. for career-promoting, vocational preparatory, vocational and curative educational measures,

6. for treatments as a result of medically not indicated measures, in particular aesthetic operations, tattoos or piercings, and

7. for treatments by the spouse, life partner, parents or children of the person being treated; in these cases only the material costs actually incurred are eligible.



(2) Furthermore, expenses are not eligible for aid if there is a claim for compensation against a third party that is not transferred to the employer or his agent.

(3) 1Not eligible for aid are legally stipulated co-payments and cost shares, deductibles according to Section 53 of Book Five of the Social Security Code as well as expenses for medicines, aids and remedies excluded from health care as well as deductions for administrative costs and lack of profitability audits for reimbursement according to Section 13, Paragraph 2 of the Fifth Book of the Social Code. 2 If these deductions for administrative costs and missing performance audits are not proven, 15 percent of the granted service is considered as the down payment.

(4) 1 Not eligible for aid are provided goods and services according to Section 2, Paragraph 2 of Book Five of the Social Security Code. 2 The reimbursement of costs for orthodontic treatment and, in the case of compulsorily insured persons according to Section 5 of Book 5 of the Social Code, including family-insured relatives according to Section 10 of Book 5 of the Social Code, including the reimbursement of costs according to Section 13, also counts as material and services according to Section 2, Paragraph 2 of Book Five of the Social Code of the Fifth Book of the Social Code. 3 In the case of persons who are granted a subsidy or employer's contribution to the health insurance contribution or who are entitled to non-contributory health care, goods and services also count as goods and services



(2) Furthermore, expenses are not eligible for aid if there is a claim for compensation against a third party that is not transferred to the employer or his agent.

(3) Statutory co-payments and cost shares, deductibles in accordance with Section 53 of Book Five of the Social Security Code as well as expenses for medicines, aids and remedies that are excluded from health care as well as deductions for administrative costs in the reimbursement of costs in accordance with Section 13 Paragraph 2 of Book Five are not eligible for assistance Social code.

(4) 1 In-kind and services rendered in accordance with Section 2, Paragraph 2 of Book Five of the Social Security Code are not eligible for assistance. 2 The reimbursement of costs for orthodontic treatment and, in the case of compulsorily insured persons according to Section 5 of Book 5 of the Social Code, including those with family insurance according to Section 10 of Book 5 of the Social Code, including the reimbursement of costs according to Section 13, also apply as material and services according to Section 2, Paragraph 2 of Book Five of the Social Code of the Fifth Book of the Social Code. 3 In the case of persons who are granted a subsidy or employer's contribution to the health insurance contribution or who are entitled to non-contributory health care, goods and services also count as goods and services

1. the amounts exceeding the fixed amounts for medication, bandages and aids according to the fifth book of the Social Security Code and

2. Expenses based on the fact that the insured did not make use of the goods and services to which they are entitled; this also applies if service providers in other member states of the European Union are used; Expenses for optional services in the hospital are excluded.

4 sentence 3 does not apply

1. for persons who receive benefits in accordance with Section 10 (2), (4) and (6) of the Federal Supply Act or regulations referring to it,

2. Voluntarily legally insured persons with a monthly contribution to health insurance of less than 21 euros as well

3. for eligible children who are covered by the compulsory insurance in the statutory health or pension insurance of another person.

(5) Paragraphs 3 and 4 do not apply to benefits under Book Twelve of the Social Code if claims have been transferred to the social welfare provider.



§ 9 Crediting of reimbursements and benefits in kind




(1) Insofar as expenses are borne or reimbursed by third parties due to legal provisions or employment contract agreements, they must be deducted from the eligible expenses before the aid is calculated. This does not apply to reimbursements and benefits in kind to beneficiaries who are part of the common health care system of the European Community. Maintenance claims by beneficiaries do not count as claims for reimbursement of costs.



(1) 1If expenses are borne or reimbursed by third parties due to legal provisions or employment contract agreements, they must be deducted from the eligible expenses before the aid is calculated. 2This does not apply to reimbursements and benefits in kind to beneficiaries who belong to the common health care system of the European Community. 3 Maintenance claims by persons entitled to aid do not count as claims for reimbursement of costs.

(2) The highest possible fixed allowance from the statutory health insurance must be deducted from expenses for dental prostheses, dental crowns and superstructures.



(3) If claims for reimbursement or benefits in kind have not been asserted against third parties, they must nonetheless be taken into account when determining the aid. Expenses for medication and bandages are to be stated in full. Other expenses, the fictitious performance portion of which cannot be proven or determined, are to be recognized in the amount of 50 percent of the expenses incurred as due reimbursement or payments in kind. Sentences 1 to 3 do not apply to



(3) 1If claims for reimbursement or benefits in kind have not been asserted against third parties, they must nonetheless be taken into account when determining the aid. 2Here, expenses for medication and bandages are to be stated in full. 3Other expenses, the fictitious portion of which cannot be proven or determined, are to be recognized in the amount of 50 percent of the expenses incurred as due reimbursement or benefits in kind. 4Sentences 1 to 3 do not apply to

1. Reimbursements and benefits in kind in accordance with Section 10 (2), (4) and (6) of the Federal Supply Act or in accordance with regulations that refer to them,

2. Eligible children who are covered by compulsory insurance in the statutory health or pension insurance of another person, and

3. Reimbursements and benefits in kind from statutory health insurance from a voluntary insurance relationship.



(4) In the case of beneficiaries according to Section 3 and their dependents who are eligible for consideration, the crediting of a performance component according to paragraph 3 sentences 1 to 3 can be dispensed with if the benefits due could not be used due to danger to life and limb or due to the special circumstances in the Abroad were actually not to be obtained.



(4) In the case of persons who are eligible for subsidy according to § 3 or who are eligible for a person eligible for subsidy according to § 3, the crediting of a performance share according to paragraph 3 sentences 1 to 3 can be dispensed with if the benefits due are not included due to danger to life and limb Could be claimed or actually could not be obtained due to the special circumstances abroad.

(version valid today)

§ 10 Eligibility for aid


(1) There is a legal entitlement to aid. The claim cannot be assigned and, in principle, cannot be pledged or attached. The seizure of a claim based on an eligible performance by the claimant is permissible insofar as the aid has not yet been paid.



(2) After the death of the beneficiary, the aid can be paid to the following accounts with discharging effect:



(2) After the death of the person entitled to the aid, the aid can be paid to the following accounts with discharging effect:

1. the deceased's remuneration account,

2. another account specified by the deceased in the application or in the power of attorney, or

3. an account of an heir identified by a certificate of inheritance or by another public or publicly certified document.



§ 11 Expenses abroad




(1) Expenses for services in a member state of the European Union are to be treated as expenses incurred in Germany. Section 6 (3) does not apply in these cases. Expenses for services outside the European Union are eligible up to the amount in which they were incurred in Germany and would be eligible.

(2) Expenses incurred outside the European Union in accordance with paragraph 1 are eligible for aid without limitation to the costs that would have arisen in Germany if



(1) 1Expenses for services in a member state of the European Union are to be treated as expenses incurred in Germany. 2§ 6 Paragraph 3 does not apply in these cases. 3Expenses for services outside the European Union are eligible up to the amount in which they were incurred in Germany and would be eligible.

(2) 1Expenses incurred outside the European Union in accordance with paragraph 1 are eligible for aid without restriction to the costs that would have arisen in Germany if

1. they arose during a business trip and the treatment could not have been postponed until the return home,

2. they do not exceed EUR 1,000 per illness for medical and dental services,



3. Those entitled to benefit or relatives who were eligible for assistance living near the German border had to go to the nearest hospital in the event of an acute need for treatment,

4. Relatives eligible for aid or eligible for consideration had to go to the nearest hospital for emergency care or



3. Persons entitled to aid or eligible for consideration living near the German border had to go to the nearest hospital in the event of an acute need for treatment,

4. persons eligible for aid or eligible for consideration had to go to the nearest hospital for emergency care or

5. Eligibility for aid has been recognized before the start of the trip.



Recognition according to sentence 1 number 5 is possible as an exception if a medical report commissioned by the assessment body proves that the treatment outside the European Union is absolutely necessary because this means that a significantly greater chance of success can be expected or treatment within the European Union is not possible is; In justified exceptional cases, recognition can take place retrospectively.

(3) In the case of beneficiaries according to § 3 and their relatives who are eligible, expenses that arise during a non-business stay outside the host country and outside the European Union are only eligible for subsidies to the extent that they are in the host country or in Germany would have arisen and would be eligible for aid. This does not apply in the cases of Section 31 (5).



2A recognition according to sentence 1 number 5 is possible as an exception if a medical report commissioned by the assessment body proves that the treatment outside the European Union is absolutely necessary because this means that a significantly greater chance of success can be expected or treatment within the European Union is not possible is; In justified exceptional cases, recognition can take place retrospectively.

(3) 1In the case of persons who are eligible for subsidy according to § 3 or who are eligible for subsidy according to § 3, expenses incurred during a non-business stay outside the host country and outside the European Union are only to the extent and up to Amount eligible for aid, as it arises in the host country or in Germany and would be eligible for aid. 2This does not apply in the cases of Section 31 (5).

(no earlier version available)

§ 12 Medical Services




Expenses for outpatient medical examinations and treatments are generally eligible in accordance with Section 6 in the event of illness. The provisions of Chapter 4 remain unaffected. Expenses for certificates of incapacity for work for the employer of the beneficiary are borne by the assessment office.



1Expenses for outpatient medical examinations and treatments are generally eligible in accordance with Section 6 in the event of illness. The provisions of Chapter 4 remain unaffected. 3 Expenses for certificates of incapacity for work for the employer of the person entitled to aid are borne by the assessment office.

(version valid today)

§ 13 Services by alternative practitioners




Expenses for services by alternative practitioners are eligible for aid in accordance with Section 6, Paragraph 3, Clause 4.



Expenses for services by alternative practitioners are eligible for aid in accordance with Section 6, Paragraph 3, Clause 4 and Section 22, Section 6.

§ 14 Dental Services




Expenses for outpatient dental and orthodontic examinations and treatments are generally eligible in accordance with Section 6. For dental prostheses and implantological services, a treatment and cost plan can be presented to the assessment office before treatment begins. The costs of the treatment and cost plan belong to the eligible expenses. Expenses for certificates of incapacity for work for the employer of the beneficiary are borne by the assessment office.



1Expenses for outpatient dental and orthodontic examinations and treatments are generally eligible in accordance with Section 6. 2For dentures and implantological services, a treatment and cost plan can be presented to the assessment office before treatment begins. 3The costs of the treatment and cost plan belong to the eligible expenses. 4 Expenses for certificates of incapacity for work for the employer of the person entitled to aid are borne by the assessment office.

§ 15 Implantological, orthodontic, functional analysis and functional therapeutic services


(1) 1 Expenses for implantological services in accordance with Section K of the Annex to the Schedule of Fees for Dentists are eligible for assistance

1. Major jaw or facial defects that are caused in

a) tumor operations,

b) inflammation of the jaw,

c) operations due to large cysts, for example large folicular cysts or keratocysts,

d) Operations as a result of osteopathies, provided that there is no contraindication for implant treatment,

e) congenital malformations of the jaw, cleft lip, jaw, palate, ectodermal dyplasia or

f) accidents,

2. Persistent extreme xerostomia, especially when treating a tumor,

3. generalized genetic failure of teeth,

4. Muscular malfunctions in the mouth and face area that cannot be deliberately influenced (e.g. spasticity) or

5. Implant-based dentures in the edentulous upper or lower jaw.

2 In the case of sentence 1 number 5, the expenses for a maximum of four implants per jaw, including existing implants for which subsidies or comparable benefits were granted from public funds, are eligible. 3 If none of the cases mentioned in sentence 1 numbers 1 to 5 apply, the expenses for a maximum of two implants per jaw, including existing implants for which subsidies or comparable benefits were granted from public funds, are eligible. 4 The expenses, including the material and laboratory costs according to §§ 4 and 9 of the fee schedule for dentists, are to be reduced according to the ratio of the number of ineligible to the total number of implants. 5 Expenses for superstructures are always eligible.

(2) 1 Expenses for orthodontic services are eligible if

1. is not yet 18 years of age at the start of treatment or

2. In the case of severe jaw anomalies, combined oral surgery and orthodontic treatment is carried out



and the assessment body has approved the expenses before the start of treatment on the basis of a treatment and cost plan presented. 2 Expenses for retention services are eligible for support up to two years after completion of the orthodontic treatment approved by the assessment body on the basis of the treatment and cost plan. 3 The expenses for the treatment and cost plan according to sentence 1 are eligible for aid. 4 In the event of a termination of orthodontic treatment or a change of orthodontist for which the beneficiary or relatives are responsible for the termination of orthodontic treatment or if the orthodontist changes, only those expenses are eligible for aid that are based on the treatment and cost plan to which the assessment body had approved are not billed.



and the assessment body has approved the expenses before the start of treatment on the basis of a treatment and cost plan presented. 2 Expenses for retention services are eligible for support up to two years after completion of the orthodontic treatment approved by the assessment body on the basis of the treatment and cost plan. 3 The expenses for the treatment and cost plan according to sentence 1 are eligible for aid. 4 In the event of a termination of an orthodontic treatment for which the person entitled to aid or the person eligible for consideration is responsible, or if the orthodontist changes, only those expenses that have not yet been billed according to the treatment and cost plan to which the assessment body had agreed are eligible.

(3) 1 Expenses for functional analysis and functional therapeutic services are only eligible for subsidies if one of the following indications is present:

1. TMJ and muscle diseases,

2. Gum disease as part of a systematic periodontal treatment,

3. Treatments with bite aids with adjusted surfaces in accordance with numbers 7010 and 7020 of the fee schedule of the fee schedule for dentists,

4. extensive orthodontic interventions including orthodontic or maxillofacial surgery



5. 1 extensive denture renovations. 2 These exist if at least eight posterior teeth in a jaw have to be restored with dentures, crowns or inlays, whereby missing teeth are treated as equivalent to those in need of renovation and the correct final bite position can no longer be determined in any other way.

2The beneficiary has to submit a copy of the dental documentation according to number 8000 of the annex to the schedule of fees for dentists to the assessment body.



5. extensive denture renovations.

2 The beneficiary has to submit a copy of the dental documentation according to number 8000 of the annex to the schedule of fees for dentists to the assessment body in need of rehabilitation, and the correct final bite position can no longer be produced in any other way. 4The person entitled to subsidies must submit a copy of the dental documentation to the assessment body according to number 8000 of the annex to the schedule of fees for dentists.


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*) Note d. Red .: Due to the incorrect change instruction in Article 1 No. 13 b) aa) V. v. July 18, 2014 (Federal Law Gazette I, p. 1154), Section 15 (3) sentence 2 should presumably be deleted.

§ 16 Expenses, material and laboratory costs




(1) Separately calculable expenses for expenses, material and laboratory costs in accordance with Section 4, Paragraph 3 and Section 9 of the Schedule of Fees for Dentists who undergo dental treatment in accordance with Sections C, F and K and numbers 7080 to 7100 of the Appendix to the Schedule of Fees for dentists are 40 percent eligible. This does not apply to indications according to § 15 paragraph 1 sentence 1 numbers 1 to 4.



(1) 1Separately calculable expenses for expenses, material and laboratory costs in accordance with Section 4, Paragraph 3 and Section 9 of the Schedule of Fees for Dentists who undergo dental treatment according to numbers 2130 to 2320, 5000 to 5340, 7080 to 7100 and 9000 to 9170 of the annex to the schedule of fees for dentists are 40 percent eligible. 2This does not apply to indications according to § 15 paragraph 1 sentence 1 numbers 1 to 4.

(2) If the portion attributable to the expenses mentioned in paragraph 1 is not proven, 40 percent of the total invoice amount is to be applied.



§ 17 Dental services for civil servants on revocation




(1) Expenses for dental services for civil servants on revocation and their relatives who are eligible for consideration are eligible, unless they are excluded in paragraph 2.



(1) Expenses for dental services for civil servants on revocation and persons who are eligible for them are eligible for aid, unless they are excluded in paragraph 2.

(2) Expenses for

1. prosthetic services,

2. inlays and crowns,

3. Functional analytical and functional therapeutic services as well

4. Implantological services.



Expenses according to sentence 1 are exceptionally eligible if they are based on an accident during the preparatory service or if the beneficiary has previously been employed in the public service for at least three years without interruption.



Expenses according to sentence 1 are exceptionally eligible if they are based on an accident during the preparatory service or if the person entitled to aid has previously been employed in the public service for at least three years without interruption.



§ 18 Psychotherapeutic Services




§ 18 Psychotherapy, basic psychosomatic care




(1) Psychotherapeutic services are services of basic psychosomatic care (Section 19), depth psychological and analytical psychotherapy (Section 20) and behavioral therapy (Section 21).

(2) Expenditures for deep psychological and analytical psychotherapy as well as behavior therapy are only eligible for support

1. Affective disorders (depressive episodes, recurrent depressive disorders, dysthymia),

2. Anxiety disorders and obsessive-compulsive disorder,

3. somatoform disorders and dissociative disorders (conversion disorders),

4. Adjustment disorders and reactions to severe stress,

5. eating disorders,

6. non-organic sleep disorders,

7. sexual dysfunction,

8. Personality and behavioral disorders

9. Behavioral and emotional disorders with onset in childhood and adolescence.

(3) In addition to or after somatic medical treatment of illnesses or their effects, expenses for psychotherapy are eligible for assistance

1. Mental and behavioral disorders due to psychotropic substances, in the case of addiction only if freedom from addictive substances or abstinence has been achieved or can be achieved within ten sessions,

2. Mental and behavioral disorders caused by opioids and simultaneous stable substitution-based treatment in the state of non-secondary use,

3. Mental illnesses due to early childhood emotional deficiencies or profound developmental disorders; in exceptional cases also in the case of mental illnesses that are related to physical damage or deformities in early childhood,

4. Mental illnesses as a consequence of severe chronic disease processes,

5. Psychological accompanying, secondary or residual symptoms of psychotic illnesses.

Eligibility for aid presupposes that the services are provided by a doctor or therapist in accordance with Annex 3, Sections 2 to 4. A session of deep psychological or analytical psychotherapy or behavior therapy comprises a treatment duration of at least 50 minutes for an individual treatment and at least 100 minutes for a group treatment.

(4) Expenses for psychotherapeutic treatments that belong to the scientifically recognized procedures and are billed in accordance with Sections B and G of the Annex to the Schedule of Fees for Doctors are eligible if

1. they serve to identify, heal or alleviate mental illnesses according to paragraph 1 for which psychotherapy is indicated,

2. after a biographical analysis or behavioral analysis and, if necessary, after a maximum of five, and in the case of analytical psychotherapy, a maximum of eight probatory sessions, the prerequisites for successful treatment are met and

3. Before the start of the treatment, the assessment body recognized the eligibility of the expenses on the basis of an expert opinion on the necessity and the type and scope of the treatment.

The report according to sentence 1 number 3 must be obtained from an expert who has been appointed by the National Association of Statutory Health Insurance Physicians in agreement with the Federal Associations of the Contractual Funds pursuant to Section 12 of the agreement on the use of psychotherapy in statutory health care between the Federal Association of Statutory Health Insurance Physicians and the Association of Substitute Funds e. V. has been appointed. For those entitled to aid under Section 3 and their relatives who are eligible for consideration, the report can be obtained from the health service of the Federal Foreign Office or from a doctor who has been commissioned by the health service of the Federal Foreign Office.

(5) For basic psychosomatic care, the requirements of Paragraph 4, Clause 1, Numbers 2 and 3 do not have to be met. Expenses for measures according to paragraph 4 sentence 1 number 2 are also eligible if psychotherapeutic treatment has proven to be unnecessary.

(6) expenses for

1. Katathymes picture life are only eligible within the framework of a superordinate depth psychological therapy concept,

2. Rational-Emotive Therapy is only eligible as part of a comprehensive behavioral treatment concept,

3. Outpatient psychosomatic follow-up care lasting up to six months after inpatient psychosomatic treatment is eligible for an appropriate amount.

(7) Before treatment by psychological psychotherapists, child and adolescent psychotherapists, a somatic assessment must be carried out at the latest after the trial sessions or before the initiation of the assessment process. This clarification must be carried out by a doctor and confirmed in writing in a consultant report.

(8) If the beneficiaries according to Section 3 or their relatives who are eligible for consideration do not have direct access to native-speaking psychotherapeutic treatments at the place of employment, the expenses for the following services are also eligible if the services are provided via the Internet:

1. Psychotherapy based on depth psychology in accordance with number 861 of the Annex to the Schedule of Fees for Doctors or

2. Behavioral therapy according to number 870 of the annex to the schedule of fees for doctors.

Up to 15 sessions are eligible for internet-based therapy. Psychotherapy based on depth psychology and behavioral therapy in groups as well as analytical psychotherapy as individual or group therapy may need to be converted after obtaining a new expert opinion. Expenses for services according to sentence 1 are only eligible if they are necessary in the context of a psychotherapeutic treatment started in Germany to further stabilize the success of the treatment. The therapy procedure can be carried out through individual contact by telephone or email.

(9) Not eligible are expenses for

1. simultaneous treatments according to §§ 19 to 21 and

2. the treatment methods listed in Appendix 3, Section 1.



(1) Expenditures for psychotherapy services in the forms of treatment based on psychoanalytical methods and behavioral therapy as well as for basic psychosomatic care services are eligible for assistance in accordance with paragraphs 2 and 3 as well as Sections 18a to 21.

(2) 1Before treatment by psychological psychotherapists or by child and adolescent psychotherapists, a somatic assessment must be carried out at the latest after the probatory sessions or before the initiation of the assessment process.2 In order to be eligible for assistance, the somatic assessment must be confirmed by a doctor in a written consultation report.

(3) Not eligible are expenses for

1. Simultaneous treatments according to Sections 19 to 21,

2. Services according to Section 1 of Appendix 3.

(no earlier version available)


§ 18a (new)




Section 18a Common regulations for the forms of treatment based on psychoanalytical methods and behavioral therapy




 

(1) Expenses for psychotherapy services are eligible for support

1. Mood disorders: depressive episodes, recurrent depressive disorders and dysthymia,

2. Anxiety disorders and obsessive-compulsive disorder,

3. somatoform disorders and dissociative disorders,

4. Adjustment disorders and reactions to severe stress,

5. eating disorders,

6. non-organic sleep disorders,

7. sexual dysfunction,

8. Personality and behavioral disorders.

(2) In addition to or after somatic medical treatment of illnesses or their effects, expenses for psychotherapy services are eligible for assistance

1. Mental and behavioral disorders

a) from psychotropic substances; in the case of addiction, only if drug-free or abstinence has been achieved or can probably be achieved within ten sessions,

b) through opioids and simultaneous stable substitution-based treatment in the state of non-secondary use,

2. Mental illnesses due to early childhood emotional deficiencies or profound developmental disorders, in exceptional cases also in the case of mental illnesses that are related to early childhood physical damage or deformities,

3. Mental illnesses as a result of severe chronic disease processes,

4. Psychological accompanying, secondary or residual symptoms of psychotic illnesses.