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News on Statutory Health Insurance Policies |
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 Recently Germany has imposed new provisions to health
insurance policies; these covering dental plates and medicine costs.
Dental Plates
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 de-cided 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 en-ables 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 re-ceive 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 suf-ficient 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 differ-ence.
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).
 Alexander Baron von Engelhardt - Foreigners Attorney based in Berlin, specialising in domestic,
international, civil and commercial law. He also provides counseling
for start-ups.
Wilhelmstraße 94, D-10117 Berlin
Email:
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Website: www.Rechtsanwalt-AvE.com
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Finance 
