If an employee requires medical rehabilitation as a result of an accident or serious illness, he or she is entitled to have outpatient or inpatient therapy paid for. For unemployed people, on the other hand, there is often uncertainty: is it even possible to participate in rehab during unemployment? What requirements must be met for rehab benefits to be granted? Do I continue to receive unemployment benefits during the rehabilitation treatment??
In which cases rehabilitation is possible in case of unemployment?
In general, the same conditions apply to the unemployed as to employees or other groups of people, so that even during unemployment there is a right to medical rehabilitation to restore physical fitness. However, there must be a medical necessity for the rehab measure, it must be prescribed by a doctor and approved in advance by the responsible payer.
Who pays for rehabilitation during unemployment?
Statutory pension insurance
The legal pension insurance (DRV) steps in with a medical or vocational Reha in accordance with §10 Sozialgesetzbuch Sechstes Buch (SGB VI) if the ability to work of the concerning is endangered, can be clearly improved or restored by the rehabilitation measure and at the same time the insurance-legal conditions (§11 SGB VI) for appropriate achievements are given.
Health insurance
The health insurance fund is responsible for medical rehabilitation services aimed at maintaining or restoring health. However, only if the responsibility does not lie with another social insurance agency. While the pension insurance is usually responsible for employed persons, the health insurance fund is the right contact for pensioners or non-employed persons, for example.
Employment Agency and Social Welfare Office
The employment agency may cover the costs of occupational rehabilitation within the framework of participation in working life, but only in cases where no other social insurance agency is responsible. Also the social office steps in for medical or vocational rehabilitation only if there is no other insurance carrier.
In order not to make the application unnecessarily difficult for the person concerned, the application for the rehab measure can be made with any of the above-mentioned funding agencies. At the latest 14 days after receipt of the application, the addressed service provider must have clarified whether it is responsible. This declaration of competence is to avoid that the rehab application is shifted back and forth between the individual institutions and the procedure is unnecessarily protracted. If the application has not been passed on to another rehab provider, a decision on the requested benefits must be made within another 7 days. The claimant may appeal against a negative decision.
What happens in the event of a prolonged illness during unemployment??
If you have statutory health insurance and are ill for a longer period during unemployment, you will continue to receive unemployment benefits for up to six weeks, as with your employer. Since the insured person is not available to the labor market for health reasons, after this continuation of benefits exists from the 7. sickness week a claim to sickness benefit. The prerequisite for this is that the person concerned was not already ill before becoming unemployed or that the entitlement to unemployment benefit is suspended, for example in the case of a blocking.
Sickness benefit can be paid to legally insured persons for up to 78 weeks. According to § 47b SGB V, it corresponds to the amount of the unemployment benefit for unemployed persons. During the period of receipt, unemployment benefit or transitional allowance is suspended. the entitlement to benefits from the employment office ends.
In order for unemployment benefits to be paid again in the event of restoration of the ability to work after receipt of sickness benefits, the insured person must again appear in person at the employment office and register as unemployed. It is important to note that the application must be submitted no later than the first day after the receipt of sickness benefits.
Sickness benefit is tax-free and only has to be declared as a so-called income replacement benefit in the tax declaration form if the amount exceeds 410 euros per year.
Unemployment benefit, transitional allowance or sickness benefit during rehab in case of unemployment?
If rehabilitation is carried out during unemployment, recipients of unemployment benefits (ALG I or ALG II) receive transitional rehabilitation benefits under certain conditions. This is not paid automatically when rehabilitation is approved, but must be applied for. The German pension insurance is responsible for the costs of the transitional allowance. The transitional allowance can always be claimed if the patient receives medical services for participation in working life, receives wage replacement benefits in the form of unemployment benefits and has paid sufficient contributions to the statutory pension insurance
The Employment Agency is the cost bearer only in those cases in which vocational rehab is used – provided the insurance law requirements are met.
The amount of the transitional allowance is generally the same as the amount of the unemployment benefit if the person is receiving unemployment benefit I. In the case of recipients of ALG II, the transitional allowance is also based on the usual level of income. While receiving transitional allowance, unemployment benefits are suspended, both for ALG I and ALG II recipients.
Like the sickness benefit, the transitional benefit is also tax-free, but must be declared in the tax return as a wage replacement benefit.
Patients receive sickness benefit during medical rehabilitation if the statutory health insurance is also the provider of the rehabilitation measure.
Are co-payments for rehab required during unemployment?
In the case of inpatient rehab, a co-payment is generally required. This amounts to a maximum of 10 euros per day for a maximum of 42 days per calendar year. If the therapy takes place after treatment in a hospital, the duration of the co-payment is reduced to a maximum of 14 days per calendar year.
According to §32 of the German Social Security Code, Book Six (SGB VI), patients who are unemployed are exempt from co-payment
- receive transitional allowance, provided they do not receive any other income
- receive unemployment benefit II
- Monthly net less than 1.Earn 247 euros (as of 2019) or. whose net income from gainful employment is below this limit
In the case of a monthly net earned income or income in lieu of income of less than 1.869 euros, the daily co-payment can be reduced to an amount between five and nine euros.
For exemption from co-payments, a written application must be submitted together with the unemployment benefit statement. It is recommended to submit it at the same time as the application for medical rehabilitation.
What happens after rehab during unemployment?
If the patient was still entitled to ALG I before the start of rehabilitation, this remains valid when receiving transitional benefits for the duration of the rehabilitation treatments. So if the person concerned has previously received nine months of unemployment benefit 1, there is – with a usual entitlement of twelve months – a residual entitlement of three months of unemployment benefit after rehab, provided that the insured person is available to the labor market again.
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