Kassenleistung

Kassenleistung refers to services or benefits that are covered and paid for by a statutory health insurance fund, known as a "Krankenkasse" in Germany. These services are generally considered medically necessary and are defined by law and by the regulations set forth by the health insurance providers themselves. The scope of Kassenleistung is determined by the German Social Code Book V (SGB V), which outlines the rights and obligations of both insured individuals and health insurance funds.

Examples of Kassenleistung typically include a wide range of medical care, such as doctor's visits, hospital stays, prescription medications, medically necessary treatments, preventive care services, and rehabilitation measures. The specific benefits covered can vary slightly between different Krankenkassen, although there is a baseline of services that all must provide. Patients usually have to co-pay for certain services, such as prescription drugs or dental prosthetics, with the remainder being covered by the Kasse.

Access to Kassenleistung is a fundamental aspect of the German healthcare system, ensuring that all individuals insured under statutory health insurance have access to necessary medical treatment. The principle is that healthcare should be accessible based on need rather than on an individual's ability to pay. Decisions on whether a service constitutes Kassenleistung are often made by medical advisory services within the Krankenkassen, who assess the medical necessity and appropriateness of the requested treatment according to established guidelines and evidence-based medicine.