Surcharge & Exemption
There are different rules for medical aids, nursing aids, and consumables: statutory co-payments, additional costs, personal contributions, nursing care box budgets, or self-purchase. ADAM helps to sort out the terms clearly and prepare the next steps.
Sort payment method
Many misunderstandings arise because different contributions are named identically. For exemptions, receipts, and the next step, it is important to know which payment method is involved.
The legally stipulated personal contribution for many medical aids covered by health insurance.
Can count towards the load limit.
Costs that may arise if an execution goes beyond what is necessary or if a different model is desired.
Generally not exempt from co-payments.
For technical care aids provided by the long-term care insurance fund, a co-payment may apply.
Alternative to medical aids provided by health insurance.
If there is no cost coverage, or if a quick or comfort-oriented solution is desired.
Not automatically part of the statutory co-payment.
Key Figures
These values provide guidance. The actual classification depends on the supply chain and the assessment by the health insurance fund or long-term care insurance fund.
€5–10
10% of the till amount, minimum €5, maximum €10 – but never more than the actual cost.
max. €10/month
10% of the cost, maximum €10 for the entire monthly requirement.
max. €25
10%, maximum €25 per care product; larger technical care products are often provided on loan.
up to €42/month
For a care degree and home care, this path via the care insurance fund can be relevant. This is not a normal co-payment for medical aids.
€0
Children and adolescents are exempt from statutory co-payments in many GKV (statutory health insurance) co-payment contexts.
Estimate without obligation
Estimate your personal annual burden limit and whether a review by your health insurance company might be useful.
For computer and application
Only statutory co-payments count towards the exemption limit. Additional costs, private purchases, or private supplementary services should not be confused with statutory co-payments.
The health insurance company will examine the specific recognition.
Prepare practically
Good documentation helps to clearly distinguish between statutory co-payments, additional costs, and exemptions.
Retain receipts for statutory co-payments.
Relevant for calculating the personal co-payment cap.
If already present, keep for further supply.
Helps classify whether it concerns a statutory health insurance service.
It is important to distinguish between statutory co-payments and additional costs.
Relevant if long-term care insurance, care box, or technical care aids are affected.
Calmly classify additional costs
The statutory co-payment is not automatically everything that may have to be paid personally. What matters is whether additional costs, desired services, or self-purchase arise.
A particular model or version is desired.
Equipment goes beyond what is necessary.
Care provided by a non-participating or non-contracted provider may result in additional costs.
If a fixed amount applies and is exceeded, an additional amount may arise.
Additional accessories may need to be checked separately.
If no statutory health insurance coverage is used, it does not constitute a statutory co-payment.
Individual long-term care insurance process
Consumable medical aids are covered by the long-term care insurance fund. The monthly allowance is a separate benefit path and should not be confused with the standard co-payment for medical aids.
For care levels and home care, up to €42 per month may be relevant.
It concerns consumables such as gloves, disinfectant, protective equipment, or bed pads.
For this, the nursing care insurance route is important, not the standard prescription co-payment.
The selection should correspond to the actual care requirements.
The ADAM care box configurator helps to prepare the selection.
Clear responsibilities
ADAM can clearly classify co-payments, additional costs, and supply channels in connection with the provision of aids. Your health insurance company will verify your official exemption and limit of financial burden.
ADAM co-payment method
You don't have to keep these terms apart on your own. ADAM helps you sort out copayments, additional costs, the long-term care insurance process, and documents related to your care.
Clarify payment methodDistinguish between statutory co-payments, additional costs, long-term care insurance co-payments, or out-of-pocket purchases.
Collect receiptsKeep receipts and supporting documents.
Check load limit2% or 1% in the case of a serious chronic illness as a guideline.
Submit an application to the health insurance fundWith receipts and proof of income. The health insurance fund will carry out a binding verification.
Indicate exemption for continued careHave your exemption certificate or ID ready for new supplies.
Choose a suitable introduction
Choose the entry point that best fits your situation.
Brief answers for guidance. The binding calculation and exemption are handled by the health insurance fund.
For many medical aids provided by the statutory health insurance, the co-payment is 10% of the covered amount, with a minimum of €5 and a maximum of €10. However, you will never pay more than the actual costs.
Not always. The specific co-payment depends on the medical aid, the supply channel, age, exemption status, and the health insurance fund's assessment.
The statutory co-payment is the legally required personal contribution. Additional costs may arise if a preferred model, comfort features, or a service beyond what is necessary is chosen.
As a rule, only statutory co-payments count towards the out-of-pocket maximum. Additional costs, out-of-pocket purchases, or private elective services typically do not count.
If your statutory co-payments reach your personal annual limit, it may be advisable to submit an application to your health insurance fund. The limit is generally 2% of annual gross income for living expenses, or 1% for those who are severely chronically ill.
No. The exemption must be applied for with the health insurance provider. Receipts and proof of income may be important for this.
Co-payment receipts, proof of income, exemption notices, prescriptions, invoices for medical aids, and other documentation can be helpful. The health insurance fund decides what is accepted on a case-by-case basis.
The exemption limit applies to the calendar year. As a rule, the exemption must be reviewed or applied for anew each year.
Children and adolescents are exempt from co-payments in many areas of statutory health insurance. The specific classification should be verified with the health insurance provider.
For technical aids provided by the long-term care insurance fund, adult care recipients generally pay 10%, up to a maximum of €25 per aid. Larger technical aids are often provided on a loan basis.
Consumable care aids are covered by the long-term care insurance fund. If you have a care level and receive home care, up to €42 per month may be relevant. This is not the same as the standard co-payment for medical aids.
ADAM does not issue exemption notices and does not replace the review process conducted by the health insurance fund. However, we can help organize co-payments, additional costs, the long-term care insurance fund procedure, and documentation related to the provision of care.
Personal Support
Briefly describe your situation. ADAM helps to provide a clear understanding of aids, prescriptions, care levels, care packages, co-payments, and potential additional costs.
Careful. Understandable. Without promises of relief.
