Aids

In principle, the costs of medical aids can only be covered by statutory health insurance if the products are listed in the medical aids directory. The GKV-Spitzenverband has created a structured list for this purpose: https://hilfsmittel.gkv-spitzenverband.de/

Insured persons pay a co-payment of 10 percent of the dispensing price, with a minimum of 5 euros and a maximum of 10 euros. However, they must never pay more than the cost of the respective product. In the case of consumable aids, the co-payment is 10 percent of the total amount to be paid by the health insurance fund, up to a maximum of EUR 10 for the entire monthly requirement.

Approved service providers must be qualified to carry out their profession properly and professionally and meet the requirements for technical and personal suitability and performance and, where applicable, fulfill the necessary professional requirements. In order to avoid individual suitability tests, a so-called prequalification procedure was developed on the basis of recommendations of the GKV-Spitzenverband was introduced.

Insured persons of the BKK W&F can generally make use of all prequalified service providers.

We require a cost estimate for the planned treatment in order to check the assumption of costs. This is usually sent to us electronically by the service provider.

New: As of September 1, 2023, the exchange of cost estimates between pharmacies and the BKK W&F has largely been eliminated. To this end, the contracting parties have introduced an approval exemption limit of €250. In most cases, the provision of aids can now take place directly on site and without waiting times.

This is based on an agreement recently concluded between the German Pharmacists’ Association and the company health insurance funds. It covers the dispensing of aids such as inhalation and respiratory therapy devices, application aids for medication or consumables such as bandages, diabetic supplies or compression stockings. All company health insurance funds pay uniform prices for this.

For children and adolescents up to the age of 18, the BKK W&F covers the costs of spectacle lenses or medically necessary contact lenses up to the amount of the nationally uniformly agreed fixed price. The exact amount depends on various factors, such as the lens strength and type.

From the age of 18, it is possible to share the cost of spectacles or contact lenses if both eyes are severely visually impaired. Severe visual impairment is deemed to exist if the better eye does not provide more than 30 percent vision despite glasses or contact lenses. There is also the possibility of cost sharing if the following limits are exceeded:

• more than 6 diopters for short-sightedness or long-sightedness or
• more than 4 diopters for astigmatism.

Participation in spectacle frames and contact lens care products is not possible.

For adults, there is also a statutory co-payment for medical aids of 10 percent, with a minimum of five and a maximum of ten euros.

Note: VDU glasses are not covered by statutory health insurance and are therefore not reimbursed or subsidized by the BKK W&F.