As a matter of principle, costs for medical aids can only be met by statutory health insurance if the products are included in the list of aids. The list of aids is not binding in the legal sense, but it has a market-steering effect, as has been found by the established case-law of the highest courts. It provides comprehensive information on the obligation of the health insurance funds to pay, as well as on the nature and quality of the products that are available on the market.
The list of aids is drawn up and continually updated by the National Association of Statutory Health Insurance Funds considering the relevant statutory provisions. The products that are available on the market are allocated to various product groups according to their fields of deployment. Products are included in the list of aids at the request of the manufacturers (or of third parties empowered by them) if they have specific characteristics and meet certain quality criteria.
The relevant provisions for drawing up the list of aids were included analogously in the Act on Social Long-Term Care Insurance (Gesetz der sozialen Pflegeversicherung). The list of long-term care aids that is to be drawn up by the National Association of Statutory Health Insurance Funds is an annex to the list of aids.
Each product group is assigned a structure and a definition with indications under benefit law and a list of the indications justifying their supply. The indications are listed in greater detail along with the product type descriptions. Moreover, minimum quality requirements are published in the sub-product groups and service requirements are stipulated (section 139 of Book Five of the Social Code [SGB V]). These are to be taken into consideration in the contracts with service-providers (section 127 of Book Five of the Social Code). This guarantees that care is provided as needed, that its quality is assured and that it is provided regularly, and that it corresponds to the medical state-of-the-art (section 70 of Book Five of the Social Code).
The formation of a product group
- structure
- definition with scope of indications
- sub-product groups (requirements acc. to section 139 of Book Five of the Social Code)
- product type descriptions
- product overview.
Aids list web portal
The National Association of Statutory Health Insurance Funds has developed an online version of the aids list in accordance with section 139 of Book Five of the Social Code. This web-based application enables those who are interested to conveniently and targetedly call up all the information from the aids list, which they can sort, filter and where necessary print out.