Deutsche Version: Beihilfe: Von A bis Z

Here you can find explanations from A to Z on the individual regulations regarding Beihilfe, a supplementary health plan for civil servants (and, in some cases, staff employed under a collective agreement) that pays subsidies towards certain medical costs. This information does not claim to be comprehensive and merely intends to provide important pointers that can save you and us inconvenience and unnecessary extra work. No legal entitlements may be inferred from this information.

General information (Allgemeines)

The calculation of Beihilfe subsidies is based on

• the amount of expenses eligible for subsidies
• the individual subsidy rate (% rate of reimbursement)
• reimbursement benefits provided by medical insurance/health insurance funds
• any potential entitlements vis-à-vis third parties (e.g. in the case of an accident)

Expenses that are medically necessary and economically reasonable in terms of their amount are eligible for Beihilfe subsidies if they result from the following:

• childbirth, illness, long-term care and death

The following groups of people are entitled to receive Beihilfe subsidies:

• civil servants, professors and emeritus professors of the University
• University staff employed under a collective agreement whose employment relationship with the University was established prior to 1 January 1999

Expenses related to the following people can be taken into account:

• the individual who is entitled to Beihilfe themself
• the spouse –⁠ who is not entitled to Beihilfe themself –⁠ of the individual entitled to Beihilfe if the spouse’s total income does not exceed the amount specified in Section 2 (1) No. 1b) of the BVO NRW in the calendar year prior to submitting a request for Beihilfe subsidies; for spouses who are separated, Beihilfe subsidies are only granted if the spouse is entitled to spousal maintenance from the individual entitled to Beihilfe
• children of the individual entitled to Beihilfe who are not entitled to Beihilfe themselves and are factored into the family supplement for civil servants pursuant to the Federal Civil Servants’ Remuneration Act (Bundesbesoldungsgesetz)

Civil servants who work part time receive Beihilfe subsidies in their full amount if they work at least half of the regular working time; in the case of staff employed under a collective agreement who work part time, Beihilfe subsidies are reduced proportionally. Beihilfe subsidies are also granted during parental leave (see also below under ‘Leaves of absence’).

Beihilfe subsidies must be requested at latest two years after the invoice was first issued or after the purchase date of medication, otherwise claims become time barred. The decisive factor in this regard is the date the request is received by the Beihilfe office (Beihilfestelle).

The request for Beihilfe subsidies is to be submitted either using the official forms (see under Forms (Formulare)) or via the app BeihilfeNRW. Current information on this can be found on the homepage of the Beihilfe information page.

The written request is to be signed by the individual entitled to Beihilfe or an individual who has written authorisation to do so.

Outpatient care (Ambulante Pflege)

The private long-term care insurance provider and the responsible body for determining Beihilfe subsidies each grant a share of benefits to cover outpatient care. A prerequisite for this is that the degree of care needed has been determined by the Health Insurance Medical Service (Medizinischer Dienst der Krankenversicherung) with regard to the individual requiring care.

Benefits for inpatient or outpatient care are to be requested using the request for Beihilfe subsidies and additionally with the care form. Staff employed under a collective agreement receive benefits for care exclusively from their statutory long-term care insurance provider.

Transport costs (Beförderungskosten)

Transport costs to attend non-local treatment (over 30 km away from the place the individual is residing, receiving treatment or staying) can only be deemed eligible for Beihilfe subsidies if the treatment is medically necessary. As a rule, only costs for regularly scheduled means of transportation are eligible for Beihilfe subsidies. Usually, the fares of the lowest transport class are taken into account, utilising all possibilities for reducing the fare.

If the vehicle of the individual entitled to Beihilfe or of a relative is used for urgent reasons (to be proven by a medical certificate), €0.35 per kilometre travelled is eligible for Beihilfe subsidies.

If ordered by a medical physician, costs for the use of a taxi, ambulance or a higher transport class can be eligible for Beihilfe subsidies. You can get more detailed information from the Beihilfe office. Costs are to be evidenced by supporting documents.

With regard to transport costs incurred abroad or by going abroad as well as return transportation from abroad, see ‘Requiring treatment abroad’.

Limitation of Beihilfe subsidies (Begrenzung der Beihilfe)

The amount of Beihilfe subsidies plus the amount of benefits paid by the insurer together may not exceed the amount of expenses eligible for Beihilfe subsidies in the underlying case. However, benefits from insurances covering daily sickness allowance, daily hospital allowance, daily long-term care allowance, supplementary long-term care, supplementary care pension and other fixed-sum insurance policies are not taken into account here, provided they do not exceed the amount of €100 per day.

For this reason, the responsible body for determining Beihilfe subsidies must always have a current copy of the insurance policy, showing the insured benefits and the reimbursement rate in each case.

Entitlement of children to receive Beihilfe subsidies / parents’ Beihilfe subsidy rate in the case of two children or more (Beihilfeanspruch für Kinder / Beihilfebemessungssatz der Eltern bei zwei oder mehr Kindern)

Regulation as of 1 January 2020:

A Beihilfe subsidy rate of 80% applies to a person whose expenses may be taken into account as the child of an individual entitled to Beihilfe.

If a person’s expenses may be taken into account due to being factored into the family supplement as the child of more than one individual entitled to Beihilfe or if they are married or living in a registered partnership and their spouse or registered partner is entitled to Beihilfe in addition to the parent entitled to Beihilfe, then Beihilfe subsidies for this person’s expenses are only paid to the individual entitled to Beihilfe who receives the corresponding portion of the family supplement.

If both parents are entitled to Beihilfe (regardless of which Beihilfe regulations – under federal or state law – give rise to the entitlement), the individual who receives the corresponding child-related portion of the family supplement receives the increased subsidy rate of 70%.

For parents entitled to Beihilfe who have designated one parent to receive the increased subsidy rate pursuant to the regulations applicable until 31 December 2019, this provision continues to apply until one of the parents revokes it.

Regulation until 31 December 2019:

A Beihilfe subsidy rate of 80% applies to a person whose expenses may be taken into account as the child of an individual entitled to Beihilfe. If the expenses of two or more people may be taken into account as the children of an individual entitled to Beihilfe or they are only not eligible for this because they are entitled to Beihilfe themselves, the subsidy rate for the parent entitled to Beihilfe is 70%. If both parents are entitled to Beihilfe, the subsidy rate for only one of them – who is to be designated by them – is 70% (the subsidy rate of the other parent continues to be 50%); this designation can only be transferred to the other parent in exceptional cases.

Limitation of financial burden (not applicable to staff under a collective agreement) (Belastungsgrenze (gilt nicht für Tarifbeschäftigte))

Section 15 of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW) limits the financial burden on those entitled to Beihilfe. The flat-rate cost containment sum (Section 12a of the BVO NRW), the co-payment in the case of dental benefits (Section 4 (1) No. 1 Sentence 7 of the BVO NRW) and excess amounts in the case of elective hospital services (Section 4 (1) No. 2 Sentence 2 and 3 of the BVO NRW) may not exceed the maximum financial burden of 2% of the gross annual remuneration of the individual entitled to Beihilfe (not factored into the gross annual remuneration are variable remuneration components, child-related portions of the family supplement, pension amounts from statutory pension insurance and from an additional pension and survivors’ benefits policy of the individual entitled to Beihilfe, and income from individuals whose expenses may be taken into account for Beihilfe subsidies). Remuneration received in the previous year is decisive in this respect. If this maximum financial burden is exceeded, no further excess amounts will be deducted.

Calculation of medical and dental fees (Berechnung der ärztlichen und zahnärztlichen Gebühren)

The costs invoiced by physicians are eligible for Beihilfe subsidies provided that they have been calculated in accordance with the German medical fee schedule (Gebührenordnung für Ärzte, GOÄ) or the German dental fee schedule (Gebührenordnung für Zahnärzte, GOZ). As a general rule, fee rates up to the 2.3x rate stipulated in the relevant fee schedule are eligible for Beihilfe subsidies in the case of medical and dental treatment, up to the 1.8x rate in the case of predominantly technical medical services and up to the 1.15x rate in the case of laboratory services. If there is sufficient medical justification on a personal basis, costs can be taken into account up to the 3.5x rate in the case of medical treatment, up to the 2.5x rate in the case of technical medical services and up to the 1.3x rate in the case of laboratory services. There are no other entitlements under Beihilfe regulations even if a fee agreement (deviating from the German fee schedules) is concluded with the dentist or doctor.

Particularly high-quality technical procedures (e.g. dental fillings) do not justify the maximum rate being exceeded under Beihilfe regulations.

Leaves of absence (Beurlaubungen)

In principle:

Provided an individual receives remuneration on a regular basis, they are entitled to receive Beihilfe subsidies (Section 1(1) of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW)). There are also special regulations for individual types of leave of absence.

Maternity leave

Maternity leave does not constitute a leave of absence. You continue to receive remuneration and continue to be entitled to receive Beihilfe subsidies.

Parental leave

(Sections 64 and 74 of the North Rhine-Westphalian Civil Service Act (Landesbeamtengesetz NRW, LBG NRW) in conjunction with the North Rhine-Westphalian Ordinance on Release from Work and Leave for Civil Servants (Freistellungs- und Urlaubsverordnung, FrUrIV NRW))

During parental leave, individuals are entitled to receive Beihilfe subsidies pursuant to Section 64 (5) of the LBG NRW under the following conditions:

• They are not eligible to have their expenses taken into account as a relative of another individual entitled to Beihilfe.
• Their spouse is not insured in the statutory health insurance system (in this case, they are entitled to family insurance in the statutory health insurance system pursuant to Section 10 of Book V of the German Social Code (Sozialgesetzbuch Fünftes Buch, SGB V) for the duration of the leave of absence for family-related reasons if part-time work is not undertaken).
• If both parents are civil servants and parental leave is taken by both together (with no part-time work or with part-time work under 50% of the full-time weekly working time), they are to designate one parent as an individual eligible to have their expenses taken into account on the part of the other.
• If part-time work of at least half of the regular weekly working time is undertaken during parental leave, there is a direct entitlement to Beihilfe pursuant to the BVO NRW. This applies accordingly if both parents take parental leave together.

Leave of absence for family-related reasons

(Section 64 of the LBG NRW)

There is no payment of remuneration during a leave of absence in order to care for children under the age of 18 or relatives in need of care.

During this leave of absence, individuals are entitled to receive Beihilfe subsidies pursuant to Section 64 (5) of the LBG NRW under the following conditions:

• They are not eligible to have their expenses taken into account as a relative of another individual entitled to Beihilfe.
• Their spouse is not insured in the statutory health insurance system (in this case, they are entitled to family insurance in the statutory health insurance system pursuant to Section 10 of Book V of the German Social Code (Sozialgesetzbuch Fünftes Buch, SGB V) for the duration of the leave of absence for family-related reasons if part-time work is not undertaken).

Special leave

(Section 71 of the LBG NRW)

• Special leave with continued payment of remuneration: the individual continues to be entitled to Beihilfe.
• Special leave without payment of remuneration: the individual is only entitled to Beihilfe if the leave of absence does not exceed 30 days in the calendar year.

Sabbatical year

(Section 65 of the LBG NRW)

A sabbatical year constitutes part-time employment. Remuneration continues to be paid; the entitlement to Beihilfe remains.

Leave of absence due to the labour market situation

(Section 70 of the LBG NRW)

Remuneration is not paid during the leave of absence; there is no entitlement to Beihilfe.

Part-time retirement

(Section 66 of the LBG NRW)

Remuneration continues to be paid; the entitlement to Beihilfe remains.

 

Glasses for computer work (Bildschirmarbeitsplatzbrille)

Glasses for computer work are not covered by the Beihilfe health plan. The employing university is responsible for assuming the costs. Before purchasing glasses for computer work, please contact the Staff Unit for Occupational Safety & Health and Environmental Protection, Sabine Dorsch, phone: +49 201 183 2058 or the corresponding office at your university. There you can receive information on the steps to be taken and the amount of the purchase price that can be reimbursed.

Employees of the University of Duisburg-Essen can find further information (in german) here.

Glasses (Brille)

If you are requesting Beihilfe subsidies for the initial purchase of glasses or contact lenses (the first purchase of glasses or contact lenses as defined in the regulations on Beihilfe), a medical prescription is strictly necessary. In the case of a replacement purchase of visual aids, it is possible to change from glasses to contact lenses or from contact lenses to glasses.

Expenses for glasses frames are eligible for Beihilfe subsidies up to the amount of €70.00.

Costs for the replacement purchase of glasses or contact lenses are eligible for Beihilfe subsidies in the case of individuals over the age of 14 if the lens strength has changed by at least 0.5 dioptres (spherical value). Costs for the replacement purchase of glasses in the case of unchanged vision are eligible for Beihilfe subsidies three years after the initial purchase or the last replacement purchase and up to an amount of €220.00 per lens (up to 5.75 dioptres) or €250.00 per lens (from 6 dioptres). The costs for extended-wear contact lenses over a period of 24 months (€170 per eye) constitute a reasonable cost for the initial or replacement purchase of contact lenses (yearly, monthly, daily or single-use lenses). In the case of a replacement purchase, you are entitled to choose whether you purchase glasses or contact lenses.

As a rule, if contact lenses have been prescribed or chosen, the costs for glasses in addition are not eligible for Beihilfe subsidies. This does not apply if, according to a medical prescription, the wearing of contact lenses must be interrupted occasionally for serious medical reasons (e.g. vision correction of 8 dioptres or more, irregular astigmatism, anisometropia of 2 dioptres or more). In terms of Beihilfe regulations, a change from glasses to contact lenses or from contact lenses to glasses for serious medical reasons is permitted at any time (a medical justification from a physician is required).

Additional costs for tinted lenses are only eligible for Beihilfe subsidies in the case of certain medical indications that must be stated on the medical prescription. In the case of an initial purchase, an optician’s prescription for this additional service cannot be approved for Beihilfe subsidies. Expenses for a premium anti-reflective coating are only eligible for Beihilfe subsidies in the case of high-index lenses of 6 dioptres or more.

Expenses for computer glasses are not eligible for Beihilfe subsidies (see also ‘Glasses for computer work’).

The optician’s invoice must provide information on the basic price of the lenses and the costs for the respective additional service (e.g. high-index lenses, tinting, standard anti-reflective coating). Beihilfe subsidies cannot be determined without this detailed information. You can find the corresponding form for opticians here.

Compensation for accidents at work (Dienstunfallfürsorge)

Costs that arise in connection with an accident at work or an accident on the way to or from work will be processed and paid to you by the Personnel Division. Please contact them to be provided with the corresponding accident report form (‘Anzeige über einen Dienst-/Wegeunfall’).

Requiring treatment abroad (Erkrankung im Ausland)

Expenses for medical treatment or childbirth abroad (Section 10 of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW)), for example during a holiday or in the case of individuals who are resident abroad, are only eligible for Beihilfe subsidies up to the amount of expenses for treatment or childbirth that would be eligible for Beihilfe subsidies at the place of residence within Germany or the last relevant place of work in Germany of the individual entitled to Beihilfe.

This comparison of expenses does not apply in the case of expenses incurred in

• a European Union (EU) member state
• a signatory state to the Agreement on the European Economic Area (EEA) or
• Switzerland

for outpatient treatment and inpatient services in public hospitals.
A comparison of expenses also does not apply in the case of treatment abroad within or outside the EU or EEA if the costs for the individual medical event (entire medical treatment) do not exceed the amount of €1,000.

Transport costs incurred with regard to treatment abroad are eligible for Beihilfe subsidies as set out in the ‘Transport costs’ section.

Please note that transport costs in areas outside of

• the EU
• another signatory state to the Agreement on the EEA or
• Switzerland
• or repatriation costs from these areas

are not eligible for Beihilfe subsidies.

This also applies if, for example, repatriation is medically necessary. As it cannot be ruled out that an individual entitled to Beihilfe or one whose expenses may be taken into account may still be burdened with considerable costs in the event of an accident or illness abroad, it is therefore strongly recommended that you take out appropriate private medical travel insurance for a stay abroad. If medical travel insurance is taken out, the annual insurance premiums are eligible for Beihilfe subsidies up to an amount of €10 for the person entitled to Beihilfe and for each person whose expenses may be taken into account. In the case of an event covered by insurance, the insurance benefit is always to be claimed regardless of whether Beihilfe subsidies are granted in relation to the insurance premiums.

Special regulation:
If treatment abroad is urgently required and no comparable treatment result is to be expected in Germany, expenses – following advance approval on the basis of an assessment by an appointed medical officer – are eligible for Beihilfe subsidies without any special restrictions. Beihilfe subsidies are also granted towards the necessary travel costs in this case.

Please note that all invoices from abroad that are not issued in German must be accompanied by an adequate translation (the costs of which are not eligible for Beihilfe subsidies). For example, the type of treatment (e.g. consultation, examination, injection) is to be stated so that a comparative calculation can be made with regard to the German medical or dental fee schedule if necessary.

Sums on invoices in foreign currency will be converted into euros on the day Beihilfe subsidies are determined on the basis of the official foreign exchange rate, unless the actual conversion rate is proven, for example through an exchange confirmation from the bank.

Health or preventive healthcare programmes (Gesundheits- oder Präventionskurse)

Health or preventive healthcare programmes in the fields of physical activity habits, nutrition, stress management and the use of addictive substances that have been approved by the statutory health insurance system as eligible for funding are subsidised up to the amount of €75 for a maximum of two programmes per calendar year.

Non-medical healing practitioner (Heilpraktiker)

As a rule, costs for treatment through a non-medical healing practitioner (Heilpraktiker/in) are eligible for Beihilfe subsidies. However, since treatment methods that are not scientifically recognised are sometimes used or medicinal products that are not scientifically recognised are sometimes prescribed, it is recommended that you contact the responsible body for determining Beihilfe subsidies before starting treatment.

In terms of the regulations on Beihilfe, the North Rhine-Westphalian fee schedule for non-medical healing practitioner services that is attached to the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW) as Annex 4 to Section 4 (1) No. 1 Sentence 5 applies.

Anthroposophic, homeopathic and phytotherapeutic products are not eligible for Beihilfe subsidies (even by way of exception), as it is not to be expected that products from these disciplines are scientifically recognised. This does not apply to children up to the age of 18.

Medical aids (Hilfsmittel)

Reasonable expenses for medically prescribed aids, devices and prostheses that are listed in Annex 3 to Section 4 No. 10 of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW) or that are listed and numbered in the catalogue of medical aids provided by the statutory health insurance or long-term care insurance fund are eligible for Beihilfe subsidies. The Beihilfe office must be involved in determining the reasonableness of expenses for medical aids in excess of €1,000.

Expenses for medically prescribed wigs are eligible for Beihilfe subsidies up to a maximum amount of €1,200, provided there is a corresponding medical indication (pathological hair loss changing the appearance, significant deformity, for example as a result of skull fractures, or extensive hair loss, for example due to chemotherapy). Expenses for a second wig are eligible for Beihilfe subsidies if the period of time for which a wig is to be worn will exceed 12 months according to a medical certificate. A replacement purchase is possible at the earliest after 24 months; this does not apply to children if the shape of their head has changed before the end of this period.

For medically prescribed hearing aids, an amount of €1,500 (per ear) has been established as the highest amount eligible for Beihilfe subsidies. For follow-up supply after the minimum wearing period (5 years), the assessment of a hearing aid acoustician is sufficient instead of a doctor's prescription.

For children up to the age of 10 with atopic eczema, the costs for two eczema-relief bodysuits per year are eligible for Beihilfe subsidies up to a maximum amount of €80 each.

Costs for a complete set of allergy-proof bedding (protectors) consisting of a pillow, duvet and mattress cover are eligible for Beihilfe subsidies up to a maximum amount of €120 (€240 for double beds).

The costs for a replacement purchase are eligible for Beihilfe subsidies after the following minimum use periods:

• two years in the case of children up to the age of 6
• four years in the case of children up to age of 16
• six years in the case of individuals over the age of 16

Aids eligible for Beihilfe subsidies do not include items that can also be used as part of an individual’s general life, such as lumbar support mattresses, heating pads, light therapy lamps for self-use and thermometers.

Vaccination (Impfung)

Vaccinations that are recommended by the Standing Committee on Vaccination (STIKO) are eligible for Beihilfe subsidies.

If vaccination costs arise due to required work-related travel, these costs are to be claimed as additional costs when requesting the reimbursement of travel expenses.

Dental implant treatments (Implantologische Leistungen)

Expenses for a maximum of ten dental implants are eligible for Beihilfe subsidies on the basis of a lump sum of up to €1000 per implant. This lump sum covers all costs for dental and maxillofacial treatment including any necessary anaesthesia and the costs for, for example, the implants themselves, implant abutments, connection elements needed for the implant, temporary implants, necessary tools (such as drills or burs), membranes and membrane pins, bone-related material and bone substitute, suture instruments, X-ray services, CAT scans and anaesthetics.

Costs for the superstructure supported by the implant are eligible for Beihilfe subsidies in addition to the lump sum. Existing implants for which Beihilfe subsidies were granted are to be counted towards the maximum number of ten dental implants.

To avoid misunderstandings, please note that the Beihilfe office will not pay €1000 per implant as a Beihilfe subsidy, but that only €1000 is eligible for Beihilfe subsidies. This means that the Beihilfe office applies the subsidy rate you are entitled to (e.g. 50%) to the lump sum.

In the case of the following medical indications, necessary and reasonable costs are eligible for Beihilfe subsidies as an exception to the lump-sum Beihilfe subsidy amount set out above:

1. Major jaw and facial deformities that are caused by

a) tumour surgery

b) jaw inflammation

c) surgery due to large cysts (e.g. large follicular cysts or keratocysts)

d) surgery due to bone disorders, provided there is no contraindication for implant treatment

e) congenital malformations of the jaw (cleft lip, cleft jaw, cleft palate, ectodermal dysplasia)

f) accidents

2. A persistent and severely dry mouth (xerostomia), especially in the context of tumour treatment

3. Generalised genetic dental aplasia

4. Involuntary muscular dysfunctions in the mouth and facial area (e.g. spasms)

5. Upper or lower jaw without teeth (without existing implants)

The prerequisite for this is that the Beihilfe office is presented with an estimation of costs and has recognised the necessity of the intended treatment and the reasonableness of the costs on the basis of an assessment by the responsible appointed dental officer before the start of treatment (in the procedure for granting prior approval).

Elective healthcare services (Individuelle Gesundheitsleistungen)

Costs for elective healthcare services (individuelle Gesundheitsleistungen) within the statutory health insurance system are not eligible for Beihilfe subsidies in the case of relatives insured on a compulsory basis who are eligible to have their expenses taken into account.

Costs for elective healthcare services (individuelle Gesundheitsleistungen) within the statutory health insurance system are eligible for Beihilfe subsidies within the context of Section 3 (1) and Section 4 of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW) in the case of individuals insured on a voluntary basis who are entitled to Beihilfe or relatives insured on a voluntary basis who are eligible to have their expenses taken into account.

Orthodontic treatment (Kieferorthopädische Behandlungen)

Orthodontic treatment is generally eligible for Beihilfe subsidies for individuals up to the age of 18.

The age limit does not apply in cases of severe jaw abnormalities that require combined jaw surgery and orthodontic treatment.

There may be an exception from this age limitation if an assessment by the appointed dental officer confirms before the start of treatment that there are exclusively medical reasons for the treatment and aesthetic reasons can be ruled out and that there is no alternative treatment available.

Combination treatments (Komplextherapien)

Combination treatments are interdisciplinary treatments for a single set of symptoms that are provided jointly by medical and, in some cases, non-medical staff.

Expenses for services that are provided in the form of outpatient, day-patient or inpatient combination treatments and are billed on a flat-rate basis are eligible for Beihilfe subsidies up to the amounts that a statutory health insurance provider has agreed with the service provider. The combination treatment must be provided by an interdisciplinary team.

Examples of combination treatment include programmes for dealing with asthma, outpatient withdrawal programmes, outpatient tinnitus therapies (flat-rate billing), outpatient chemotherapy according to the Braunschweig method, programmes for dealing with diabetes and medical services for the early detection and early support of children with disabilities and children at risk of disability provided by interdisciplinary early support centres in accordance with Section 30 of Book IX of the German Social Code (Sozialgesetzbuch Neuntes Buch, SGB IX).

Combination treatment does not include socio-educational and socio-paediatric services on their own.

Hospital costs (Krankenhaus)

In the case of inpatient, day-patient and pre-admission and post-discharge treatment, expenses for general hospital services that are billed pursuant to the German Hospital Fees Act (Krankenhausentgeltgesetz) or the Federal Healthcare Tariff Regulation (Bundespflegesatzverordnung) (DRG flat-rate billing) are eligible for Beihilfe subsidies.

For a stay in a hospital as defined in Section 107 (1) of Book V of the German Social Code (Sozialgesetzbuch Fünftes Buch, SGB V) that is not authorised pursuant to Section 108 of SGB V, for example certain private clinics, only comparable expenses that would have been incurred for medically equivalent treatment at the full-facility hospital (university hospital) nearest to the place of treatment are eligible for Beihilfe subsidies.

In terms of elective services, medical costs, insofar as these are billed in accordance with the German medical fee schedule (Gebührenordnung für Ärzte, GOÄ), and the costs of separately billed accommodation are eligible for Beihilfe subsidies. The lowest rate for a two-bed room in the relevant specialist department for elective service patients without separately billed additional comfort services is eligible for Beihilfe subsidies. Additional expenses for a single-bed room are not eligible for Beihilfe subsidies. In this case, the costs of a two-bed room will be recognised as eligible for Beihilfe subsidies as a substitute.
If a single-bed room has been selected, please enclose a corresponding price list from the hospital (usually an extract from the hospital rates list that is handed out upon admission) showing the costs of a two or multi-bed room together with the invoice regarding the hospital charges.

If accommodation is provided in a facility that provides both hospital and rehabilitative care (mixed facilities), it is important in which department the treatment is provided. A stay in the hospital department of a facility providing rehabilitative care requires prior approval. If this does not happen or if the health insurance provider has not recognised the medical necessity in advance, only medical care, medicines and medical treatments can be taken into account.

Excess payments in the case of inpatient hospital treatment

Expenses that are eligible for Beihilfe subsidies in the case of inpatient, day-patient, pre-admission and post-discharge treatment are reduced by deductibles (excess payments) for any planned elective services (separately invoiced medical treatment or accommodation). The following applies:

• There is a deductible of €15 for accommodation and €10 for medical treatment per day.
• In the case of treatment at hospitals that are not authorised pursuant to Section 108 of SGB V (private clinics), there is a flat-rate deductible of €25 per day.
• The deductible is to apply for a maximum of 20 days or up to a maximum of €500 per individual entitled to Beihilfe and per individual whose expenses may be taken into account per calendar year.

Medication (Medikamente)

Costs for all prescription-only medications are eligible for Beihilfe subsidies unless they are excluded from prescription under the statutory health insurance system in accordance with their prescribing guidelines (Arzneimittelrichtlinie).

Medications that do not require a prescription but are available over the counter from pharmacies only are eligible for Beihilfe subsidies in the context of treating serious illnesses (with specified indication fields) if they are considered the therapeutic standard and the doctor confirms this in a prescription. In order for the expenses to be eligible for reimbursement, the serious illness and the standard therapeutic agent prescribed for the treatment of this illness must be listed in Appendix I to Section F of the prescribing guidlines of the statutory health insurance system (Arzneimittelrichtlinie). In addition to Appendix I, Appendices II, V, and VI of the the prescribing guidlines of the statutory health insurance system (Arzneimittelrichtlinie) must also be taken into account.

As a rule, the following medications that are listed by way of example are not eligible for Beihilfe subsidies:

• products for the treatment of colds and flu-like infections (e.g. decongestants, painkillers, remedies to ease or relieve coughs)
• mouth and throat treatments, except in the case of fungal infections
• laxatives, except in the case of serious underlying diseases
• pre-mixed combinations of vitamins and other substances
• vitamin supplements, except in the case of a vitamin deficiency certified by a doctor
• medicinal products against travel sickness
• costs for medications whose use is primarily aimed at improving quality of life (e.g. products for a change in body shape, to stop smoking, to increase potency (Viagra), products against hair loss (Propecia, Regaine))
• gerontotherapeutics
• contraception from the age of 22 up to the age of 48 (by way of exception, the age limits are not applicable if the medication is prescribed by a doctor for the treatment of a condition irrespective of the regulatory medical approval and the necessity has been confirmed by an appointed medical officer)
• products that are suitable for replacing everyday necessities (e.g. bath additives, lotions, shampoos, skin creams, health food and dietary products, food supplements)

Anthroposophic, homeopathic and phytotherapeutic medicinal products are not eligible for Beihilfe subsidies (even by way of exception), as it is not to be expected that products from these disciplines are scientifically recognised. This does not apply to children up to the age of 18.

As a rule, costs for medication for individuals up to the age of 18 are eligible for Beihilfe subsidies.

You can find the circular issued by the North Rhine-Westphalian Ministry of Finance on 8 November 2010 regarding the lawfulness of the practice set out above here.

Examination and treatment methods not eligible for Beihilfe subsidies (Nicht beihilfefähige Untersuchungs- und Behandlungsmethoden)

Annex 6 to the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW) lists the examination and treatment methods that are not eligible or only eligible to a limited extent. The list is not exhaustive.

These include ACP therapy, acupressure, autohomologous immunotherapies, bioelectronic functional diagnostics (BFD), bioresonance therapy, craniosacral osteopathy, autologous blood ozone treatment, foot reflexology, kinesiology treatment, music and dance therapy, low-dose pulsed ultrasound, orthokine therapy, ozone therapy, oxygen-ozone autologous blood therapy, oxytherapy and hyperbaric ozone therapy.

It is strongly recommended that you obtain approval from the Beihilfe office (Beihilfestelle) before starting any special treatment.

Need for long-term care, care aids (not applicable to staff under a collective agreement) (Pflegebedürftigkeit, Pflegehilfsmittel (gilt nicht für Tarifbeschäftigte))

As a rule, if you are in need of long-term care, you will receive Beihilfe subsidies (Section 5 and Sections 5a to 5g of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW)) for domestic care, partial or full care in a care facility and for care aids.

The private long-term care insurance provider or the statutory long-term care fund makes the decision regarding the need for long-term care and the level of care required. The Beihilfe office adopts this decision. Please therefore ensure that you present the notification from the private or statutory long-term care insurance provider to the Beihilfe office.

Psychotherapy services (outpatient) (Psychotherapeutischen Leistungen (ambulant))

Psychotherapy services that are eligible for Beihilfe subsidies include basic psychosomatic care, psychodynamic and psychoanalytic psychotherapy, behavioural therapy and systematic therapy.

Outpatient psychotherapy treatments are only eligible for Beihilfe subsidies after prior approval by the Beihilfe office or your private or statutory health insurance provider on the basis of an assessment provided by an appointed medical examiner, with the exception of five introductory sessions (probatorische Sitzungen) or eight introductory sessions in the case of psychoanalytic psychotherapy.

You can obtain request forms for psychotherapy from the Beihilfe office.

Short-term therapy:

Expenses for short-term therapies are eligible without the approval of the Beihilfe office for up to 24 sessions as individual or group therapy. The number of sessions carried out must be counted towards the quota of treatments in accordance with Sections 4c to 4e of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW).

Acute treatment:

Expenses for acute psychotherapeutic treatment are eligible as individual therapy in units of at least 25 minutes up to 24 treatments per case of illness.

For persons who have not yet reached the age of 21 and persons with mental disabilities, expenses for acute psychotherapeutic treatment involving reference persons are eligible for up to 30 treatments.

If subsequent treatment in accordance with Sections 4c to 4e BVO NRW is intended, Section 4b (3) BVO NRW must be observed. The number of acute treatments carried out must be counted towards the quota of treatments in accordance with Sections 4c to 4e BVO NRW.

Sport-based rehabilitative treatment (Rehabilitationssport)

Expenses for medically prescribed sport-based rehabilitative treatment are eligible for Beihilfe subsidies in the amount agreed in the framework agreement between organisations responsible for the provision of rehabilitation for the social insurance system and the body organising participation for individuals with statutory health insurance in the following cases:

1. to prevent disability
2. to delay the loss of function of specific organ systems/body parts
3. following a completed inpatient rehabilitative programme, inpatient convalescence treatment for mothers, convalescence treatment for a parent and child or outpatient rehabilitative programme

Health or preventive healthcare programmes in the fields of physical activity habits, nutrition, stress management and the use of addictive substances that have been approved by the statutory health insurance system as eligible for funding are subsidised up to the amount of €75 for a maximum of two programmes per calendar year. Membership fees, expenses for visiting a sports centre or gym, for general fitness exercises and equipment, for necessary sportswear and for travel to a sports centre or gym are not eligible for Beihilfe subsidies.

Inpatient rehabilitative programmes (Section 6 of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW)), inpatient convalescence treatments for mothers, convalescence treatments for a parent and child (Section 6a of the BVO NRW) and outpatient convalescence treatments and rehabilitative programmes (Section 7 of the BVO NRW) (Stationäre Rehabilitationsmaßnahmen (§6 BVO), stationäre Müttergenesungskuren oder Mutter-/Vater-Kind-Kuren (§6 a BVO) und ambulante Kur- und Rehabilitationsmaßnahmen (§7 BVO))

The approval of inpatient rehabilitative programmes, convalescence treatments for mothers, convalescence treatments for a parent and child, and outpatient convalescence treatments and rehabilitative programmes is only possible four years after completion of the last convalescence treatment/rehabilitative programme (with the exception of a severe underlying condition).

Prior approval confirming that these forms of treatment are eligible for Beihilfe subsidies on the basis of an assessment by an appointed medical officer is necessary (with the exception of rehabilitative treatment following a hospital stay).

An inpatient rehabilitative programme is only eligible for Beihilfe subsidies if the appointed medical officer confirms that it cannot be substituted by a form of outpatient treatment. The inpatient rehabilitative programme must be provided by a facility that fulfils the requirements of Section 107 (2) of Book V of the German Social Code (Sozialgesetzbuch Fünftes Buch, SGB V), while convalescence treatments for mothers and convalescence treatments for a parent and child must be provided by facilities run by the Müttergenesungswerk organisation or facilities that fulfil the requirements of Section 111a of SGB V. A declaration form regarding this question will be sent to the applicant during the procedure for granting prior approval and is to be completed by the facility providing treatment. If these requirements are not fulfilled, no Beihilfe subsidies can be paid for accommodation, food and drink, health resort taxes and travel costs.

As a rule, expenses for board, lodging and treatment are eligible for Beihilfe subsidies to the amount that the selected facility has agreed with a social insurance institution. If additional services for medical care, medications or treatments (massages, physiotherapy, etc.) are invoiced separately, these are eligible for Beihilfe subsidies as a rule and the flat-rate amount agreed between the selected facility and the social insurance institution is to be reduced by 30%.

If the facility has not made an agreement with a social insurance institution, expenses for board and lodging are eligible for Beihilfe to the amount of the facility’s lowest daily rate but to a maximum of €120 per day and in addition to the treatment costs.

In the context of inpatient rehabilitative programmes, convalescence treatments for mothers and convalescence treatments for a parent and child, the following stipulations apply with regard to travel costs:

In the case of individuals who reside in North Rhine-Westphalia:

• A one-off fixed supplement of €50 is granted for treatment within North Rhine-Westphalia.
• €50 is also granted for treatment outside North Rhine-Westphalia; if the appointed medical officer confirms in the procedure for granting prior approval that a positive outcome can only be attained through treatment outside North Rhine-Westphalia, a supplement of €100 will be granted.

In the case of individuals who reside outside North Rhine-Westphalia:

• A fixed supplement of €100 can be granted, limited to the maximum amount of the actual costs incurred.

In the context of outpatient rehabilitative programmes, expenses for medical care, medications or treatments (massages, physiotherapy, etc.) are eligible for Beihilfe subsidies for a maximum of 20 days of the programme and exclusively in facilities that have concluded a care provision contract with a social insurance institution. If the facility invoices its services on a flat-rate basis (as is the standard case), expenses are eligible for Beihilfe subsidies to the amount of the flat rate that the facility has agreed with the social insurance institution. If there are serious health-related reasons, the attending physician may prescribe an extension of up to 10 further days of the programme.

Additional costs (food and drink costs, etc.) can be approved for Beihilfe subsidies up to an amount of €20 per day. Provided a facility does not have a free transportation service available, the necessary travel costs of up to €40 per day are eligible for Beihilfe subsidies.

In the case of outpatient convalescence treatments away from home (treatment at a health resort), a supplement of €60 per day for a maximum of 23 days is granted towards the costs of board and lodging, health resort taxes and travel costs. This supplement is reduced to €40 per day per person if two family members convalesce together in one resort. In the case of more than two family members convalescing together, the supplement amounts to €120 per day regardless of the total number of family members convalescing.

The supplement for any required companions is €40 per day. If there are serious health-related reasons, the attending physician (health resort physician) may prescribe an extension of up to 14 further calendar days.

In the case of convalescence treatments at a health resort, it is necessary to submit a request for special leave.

Family-accompanied rehabilitative programmes are also available for children up to the age of 14 with serious chronic illnesses (in particular cancer, cystic fibrosis, following cardiac surgery or following an organ transplant). Family-accompanied rehabilitative programmes must be medically prescribed. A procedure for granting prior approval on the basis of an assessment by an appointed medical officer is not necessary.

The aim of family-accompanied rehabilitative programmes is to enable rehabilitative care for all members of the family, regardless of whether each individual member fulfils the requirements for rehabilitative care.

Death (Sterbefälle)

Beihilfe subsidies are paid to the following individuals with regard to expenses eligible for Beihilfe that were incurred by a deceased individual entitled to Beihilfe, the pronouncement of legal death and funeral transportation costs:

• the surviving spouse
• the surviving registered partner
• the children of the deceased
• the parents of the deceased if the deceased was not married or in a registered partnership

Beihilfe subsidies can also be paid to other natural or legal persons in addition to the close family of the deceased individual entitled to Beihilfe. The prerequisite for this is that these persons are entitled to an inheritance (the legal basis for this is Section 14 of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW)).

Beihilfe subsidies are paid to the first of the above-mentioned individuals entitled to receive them who submits the supporting documents to the Beihilfe office.

The transportation costs for the body or urn are eligible for Beihilfe subsidies under the following conditions:

1. In the case of death within Germany

• from the place of death to the resting place or
• from the place of death to the nearest crematorium and from there to the resting place, up to a maximum of the costs of transportation to the family residence at the time of death

2. In the case of death abroad

• applying item 1 correspondingly in the case of an individual entitled to Beihilfe with a place of residence in Germany who was undertaking work-related travel
• up to the amount of the costs of transportation from the German border to the family residence in the case of an individual entitled to Beihilfe or a relative eligible to have their expenses taken into account with a place of residence in Germany and who was undertaking a private trip abroad
• up to the amount of the costs of repatriation to the family residence up to a maximum distance of five hundred kilometres in the case of an individual entitled to Beihilfe residing abroad or a relative residing abroad who was eligible to have their expenses taken into account

No Beihilfe subsidies are paid for further costs (e.g. burial costs, coffins, headstones).

Staff under a collective agreement (Tarifbeschäftigte)

As a rule, staff employed under a collective agreement have an entitlement to Beihilfe provided their employment relationship was established before 1 January 1999 and has continued without interruption (the legal basis for this is Section 1 (1) of the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Staff under a Collective Agreement (Beihilfenverordnung Tarifbeschäftigte NRW, BVOTb NRW)).

Expenses incurred after an interruption or the termination of the employment relationship are not eligible for Beihilfe subsidies. As a result, staff employed under a collective agreement

• who were hired after 31 December 1998 or
• who receive a pension

have no entitlement to the Beihilfe supplementary health plan.

Staff employed under a collective agreement who work less than the regular full-time weekly working time receive Beihilfe subsidies in proportion to their average regular weekly working time as agreed in their employment contract (the legal basis for this is Section 1 (2) of the BVOTb NRW).

Staff with compulsory statutory health insurance

This group of staff employed under a collective agreement is to depend on the benefits of their statutory health or accident insurance. They can only receive Beihilfe subsidies for dental prostheses. They receive a supplement in the case of childbirth.

The granting of Beihilfe subsidies for, for example, glasses, additional costs for dental fillings, functional analysis and functional therapy services provided by dental physicians, preventive healthcare services, excess payments for stays in hospitals or health resorts and medical consulting fees is excluded.

Staff with voluntary statutory health insurance

Since 1 April 1999, staff employed under a collective agreement who are entitled to a supplementary payment for health insurance costs in accordance with Section 257 of Book V of the German Social Code (Sozialgesetzbuch Fünftes Buch, SGB V) have been handled in the same way as staff with compulsory statutory health insurance, i.e. they are exclusively dependent on the benefits of their statutory health insurance or statutory accident insurance.

From this date, they have no longer been able to receive Beihilfe subsidies for elective hospital treatment, private medical services or treatment from a non-medical healing practitioner (Heilpraktiker/in).

Staff with private health insurance

In the case of staff employed under a collective agreement who have private health insurance and receive a supplementary payment towards their health insurance contributions pursuant to Section 257 of SGB V, expenses are only eligible for Beihilfe subsidies insofar as they go beyond the health insurance benefits to which the staff member is entitled.

Privately insured staff employed under a collective agreement who do not receive a supplementary payment are handled in the same way as civil servants.

See also the Ordinance Regarding the Granting of Beihilfe Subsidies to Staff Employed under a Collective Agreement in the Case of Childbirth or Illness (Verordnung über die Gewährung von Beihilfen in Geburts- und Krankheitsfällen an Tarifbeschäftigte, BVOTb NRW) of 30 November 2011in the version as amended by the ordinance dated 16 December 2016 (in German).

Accidents (Unfall)

As well as road traffic accidents, this also includes, for example falls within your residence, sporting accidents or dog bites. Since in many cases a third party is liable to pay damages, question 6g on the request form for Beihilfe subsidies must always be answered.

A precise description of the accident is to be attached (to the accident report) if a third party was involved in the accident.

In the case of an accident at a school, the statutory accident insurance provider is mainly responsible for medical treatment and rehabilitative care, among other things. It does not provide any benefits for outpatient treatments invoiced by private doctors. In this case, the amount eligible for Beihilfe subsidies corresponds to the total expenses that are eligible for Beihilfe subsidies minus the theoretical benefits that the accident insurance provider would have paid for the treatment.

Remedial treatments excluded or partially excluded from eligibility for Beihilfe subsidies due to a lack of scientific recognition or a lack of necessity (Annex 6 to the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW); this list is not exhaustive)

This includes, for example, acupressure, Ayurvedic treatment, biochemical light therapy, bioresonance therapy, blood crystallisation tests, cellular environment therapy, electro-acupuncture following Dr. Voll’s method, electro-neurodiagnostic tests, eurythmy therapy, fresh cell therapy, multi-step cancer therapy following Professor von Ardenne’s method, music and dance therapy, oxygen-ozone autohemotherapy, ozone autohemotherapy, ozone therapy, parenteral autovaccine treatment, RIV vaccine therapy for AIDS, Rolfing treatment, yoga exercises.

Expenses for the treatment of dyslexia and acalculia are not eligible for Beihilfe subsidies as these do not usually constitute illnesses.

Please enquire at the responsible body for determining Beihilfe subsidies as to whether a particular treatment is eligible for Beihilfe subsidies before commencing it.

Prior approval regarding Beihilfe eligibility (Vorherige Anerkennung von Beihilfen)

Prior approval is required in the case of:

• medical aids with a purchase price of over €1,000 that are not listed in Annex 3 to the North Rhine-Westphalian Ordinance on Beihilfe Subsidies for Civil Servants (Beihilfenverordnung NRW, BVO NRW) or in the catalogue of medical aids provided by the statutory health insurance or long-term care insurance,
• psychotherapy with the exception of acute and short-term therapies,
• inpatient rehabilitative programmes, convalescence treatments for mothers and convalescence treatments for a parent and child,
• outpatient rehabilitative programmes or convalescence treatments at a health resort,
• stays in the hospital department of a facility providing rehabilitative care,
• dental implants (see also the ‘Dental implant treatments’ section),
• Orthodontic treatment if the person being treated has reached the age of eighteen at the start of treatment,
• surgical measures purely to improve vision (No. 16 of Section II of Annex 6 to the BVO NRW).

It is strongly recommended to have particular remedial treatments reviewed in advance by the Beihilfe office (see also the text under ‘Examination and treatment methods not eligible for Beihilfe subsidies (Nicht beihilfefähige Untersuchungs- und Behandlungsmethoden)’).

Dental prostheses (Zahnersatz)

As a rule, the related medical services are eligible for Beihilfe subsidies up to the 2.3x fee rate plus 70% of the material and laboratory costs that are eligible for Beihilfe subsidies.

Supplement in the case of childbirth or adoption (Zuschuss bei Geburten bzw. Adoptionen)

In the case of childbirth or adoption (of children under the age of two), a supplement of €170 is available. This supplement is to be requested at latest one year after childbirth or adoption; otherwise, the entitlement to it expires.

Part-time staff employed under a collective agreement receive a proportional supplement.