All diagnostic and therapeutic methods, which are covered by this health insurance, are listed in a catalog of approved methods. Catalogs exist for diagnostic and therapeutic methods for outpatients as well as for medications. For hospital stays the companies pay fixed rates per hospital day. Until recently, it was possible for health insurance companies to reimburse diagnostic and therapeutic methods outside the catalog if this was agreed on an individual case by case decision. Due to a new regulation in Germany, health insurance companies do not have this possibility any longer.
Reimbursement is restricted to catalog listed methods exclusively.
Whether or not any new method will be included in the catalog is decided by a committee made up of the social insurance companies and representatives of their contracted physicians. The procurement for application of new methods is based at the social insurance companies and the boards of their contracted physicians only. Scientific Medical Societies and other organizations do not have the right for application. The decisions taken by the committee have to be approved by the Ministry of Health thereafter. Accepted methods are then integrated in the catalog of approved methods and will be published likewise as new governmental regulations or laws.