🧭 Rights and entitlements in chronic illness: an overview
In brief
There is no single statutory definition of "chronic illness" that applies equally in all areas. Instead, each area of law sets its own criteria: for the health insurer's co-payment exemption (Zuzahlungsbefreiung), what matters is whether you count as "seriously chronically ill" under the Chroniker-Richtlinie (chronic illness guideline) (§ 62 SGB V). For a severe disability card (Schwerbehindertenausweis), what matters is the degree of disability (GdB) under the Versorgungsmedizin-Verordnung. For a care level (Pflegegrad), what matters is your degree of independence in everyday life. For a reduced earning capacity pension (Erwerbsminderungsrente), all that matters is your remaining capacity to work on the general labour market.
This page gives an overview of the most important entitlements around a permanent physical illness – from co-payments through sick leave to pensions – and points to the individual topic pages. For the detailed application for a severe disability card and degree of disability, and for many compensation for disadvantages, see the separate Wegweiser "Disability"; for mental illness in particular, see the Wegweiser "Depression" and "Burnout & Exhaustion".
Step by step
- Sort out your entitlementsFirst clarify what kind of entitlement you are after: ongoing treatment costs (health insurer), income during incapacity for work (sickness benefit, Krankengeld), earning capacity (pension insurance) or compensation for disadvantages in everyday life (Versorgungsamt).
- Find the responsible bodyThe health insurer is responsible for treatment, co-payments, aids and appliances and sickness benefit; for a pension due to reduced earning capacity and medical rehabilitation, often the Deutsche Rentenversicherung (German pension insurance); for the severe disability card and GdB, the Versorgungsamt (pension and social welfare office); for a care level, the long-term care insurer (Pflegekasse).
- Have your diagnosis documentedAsk your treating practice to document your diagnoses, the duration of treatment and the course of the illness well – you will need these documents for practically every one of the applications mentioned.
- Keep an eye on deadlinesMany entitlements are tied to deadlines (e.g. objection deadlines of one month) – the individual topic pages state the deadlines that apply.
- Use advice servicesUse independent advice services before you submit an application or take action against a notice of decision (Bescheid) (see Advice and contact points).
Deadlines
- A recognised GdB or a co-payment exemption is not automatically carried over: for a care level, reduced earning capacity pension or severe disability card you each need a separate application to the office responsible.
- The criteria for "seriously chronically ill" (§ 62 SGB V), for a GdB or for a care level differ considerably in substance – a rejection in one procedure says nothing about the chances of success in another.
- For compensation for disadvantages around the severe disability card and GdB, and for care levels in detail, see the Wegweiser Disability; for mental illness, see the Wegweiser Depression and Burnout & Exhaustion.
In depth · legal basis, figures and practice – for advisers and professionals
Why there is no uniform definition
The term "chronic illness" appears in several places in German social law, but is defined independently each time. The most concrete definition is the one for the co-payment exemption: under the Chroniker-Richtlinie of the Federal Joint Committee (Gemeinsamer Bundesausschuss), a person counts as "seriously chronically ill" if they have been medically treated at least once per quarter for at least one year and additionally meet one of the following conditions: care level 3, 4 or 5; a degree of disability or reduction in earning capacity of at least 60 due to the illness; or continuous medical care without which a life-threatening deterioration, a permanent impairment of quality of life or a reduced life expectancy would be expected (see Co-payment exemption and burden limit).
How the systems interact
Legally independent of this is the question of whether an illness counts as a disability within the meaning of § 2 SGB IX (a lasting deviation from the age-typical condition, existing for at least six months, with impaired participation) and what degree of disability (GdB) results from it under the Versorgungsmedizin-Verordnung. Again independently, a care level is determined under the assessment instrument of the Medizinischer Dienst (medical service) on the basis of independence in six areas of life (§§ 14, 15 SGB XI). And independently of that, the pension insurance, for a reduced earning capacity pension, examines solely how many hours per day gainful employment on the general labour market is still possible (§ 43 SGB VI).
Why a diagnosis alone is usually not enough
In none of the procedures mentioned does a diagnosis alone automatically lead to a benefit. What matters in each case is the actual impact in the individual case – which is why careful medical documentation of the course of the illness and the specific limitations is worthwhile for every application.
A question about your situation that this page does not answer? Write to us or use the contact form – we will tell you which office is responsible and what to bring. Free of charge, without individual legal advice.