Zulassung als Vertragsarzt beantragen

Doctors and psychotherapists who treat persons with statutory health insurance and want to bill them via the health insurance company must have a contract medical license. You must apply for this at the responsible admission committee for doctors.

The committees grant approvals within the framework of requirements planning. The regional planning areas ensure nationwide coverage.

The admission obliges you to exercise the contract medical activity. You can apply for a full or half supply order.

Hint: In areas where there is an oversupply according to demand planning, you have to expect admission restrictions.

• Extract from the medical register with the following data:
  • Date of approbation
  • Date of entry in the medical register
  • Date of recognition of the right to use specialist, specialisation or additional titles
• Curriculum vitae
• Certificate of good conduct of document type O
• Declaration of service or employment relationships existing at the time of application (indicating the earliest possible end of the employment relationship)
• Statement as to whether you
  • are addicted to drugs or alcohol, or
  • have been addicted to drugs or alcohol within the last 5 years, or
  • have undergone a withdrawal cure for drug or alcohol addiction within the last 5 years and
  • that statutory impediments do not preclude the exercise of the medical profession.

• The competent authority may request further documents, e.g.
  • Certificates from the Associations of Statutory Health Insurance Physicians in whose area you were previously established or admitted to the health insurance practice
    (indicating the place and duration of establishment or authorisation and the reason for any termination)

You must present the documents in the original or as officially certified copies.

Hint: If you are unable to provide certificates of your medical activities, you must substantiate the facts to be proven in a different way. Check with the competent authority.

Prerequisites for admission are:

• You are registered in the medical register as a doctor or psychotherapist.
• Despite an employment relationship or other non-voluntary activities, you are available to the insured persons in the amount of time associated with your admission to care for those with statutory health insurance.
• They do not pursue any medical activity which is incompatible by its nature with that of a panel doctor.
• You are not only temporarily unable to properly exercise the activity of a panel physician for health or other serious reasons in your person.

Hint: In the event of impediments within the meaning of the second or third indent, you may be admitted under certain conditions.

You must remedy the reason for non-suitability no later than 3 months after the authorisation has become final. Activities in approved hospitals, preventive care or rehabilitation facilities do not stand in the way of a contract medical activity, provided that you are personally available to the insured persons to the extent of your approved care mandate.

• For the application for admission: 100,00 Euro
• Definitive fee (after admission has become final): 400.00 Euro

You must apply for admission in writing to the office of the Admissions Committee for Doctors responsible for your place of establishment (panel doctor's seat).

The application must contain the following information:

• for which panel doctor seat the authorisation is applied for
• under which medical title the authorisation is applied for

The Admissions Committee decides on the application by means of an order after oral proceedings. The decision states the date by which you must commence your activity as a panel physician at the registered office.

The decision will be served on you together with information on the right of appeal. All parties to the proceedings (e.g. KVH, regional associations of health insurance funds) may object to the decision.

They must commence the activity of panel physician by the date specified in the decision.

Hint: If there are important reasons, the Admissions Committee may, at the request of the doctor, subsequently set a later date for the commencement of the practice.

Exception: If you obtain a licence for a panel doctor's seat in a planning area that is affected by admission restrictions, you must commence the activity of panel physician within three months of notification of the decision, otherwise the licence expires. It is not possible to set a later date for the start of the practice.

Other

As a panel doctor, you must hold your consultation hours at the registered office. Further details are regulated by the Bundesmantelvertrag-Ärzte and the Arztersatzkassenvertrag.

If it improves the care of insured persons in other places, you can carry out contract medical activities there in the sense of a branch practice. You need the prior approval of the Association of Statutory Health Insurance Physicians. The provision of care to insured persons at the registered office of a panel doctor may be affected only slightly by the operation of a branch practice.

If you wish to transfer your registered office, you must apply to the Admissions Committee. The latter may only approve the transfer if this is not precluded by reasons of the contractual medical care. For example, a transfer is always excluded if there is an undersupply at the previous panel doctor's office.

You can appeal against the decision of the Admissions Committee to the Appeals Committee for Physicians within one month of notification.

An objection may be lodged against the decision within one month of notification. It must specify the decision against which it is directed. The objection must be lodged in writing or for transcription at the office of the Admissions/Appeals Committee.

To the

Forms for doctors and psychotherapists for download can be found on the website of the Association of Statutory Health Insurance Physicians Hesse -Admissions Committee