Chronic condition statute
Persons with a chronic condition who meet the conditions are entitled to chronic condition statute.
The chronic condition status is automatically granted in three situations.
- Having high healthcare costs for eight consecutive quarters
For the quarters of 2018: at least 320.70 euros in medical expenses.
For the quarters of 2019: at least 325.35 euros in medical expenses.
The eight quarters must span two consecutive calendar years. The amount is indexed annually. Due to COVID-19, the year 2020 is neutralized for the condition of high healthcare costs.
To calculate the healthcare costs, the reimbursement from the health insurance and the co-payment are added together.
Are not eligible for the calculation: services and medicines not reimbursed by health insurance and supplements.
- Receive the healthcare fixed allowance
- Have a rare disease and high healthcare costs
The rare disease is listed on the Orphanet website.
The healthcare costs are at least equal to the above minimums for eight consecutive quarters.
Notification of rare or orphan disease
The fact that someone has a rare or orphan disease is proven by the rare disease certificate that the person concerned provides to CM. This certificate can only be completed by a medical specialist . In addition to the identification details, the certificate must state the full name of the condition as recorded in Orphanet.
What are the advantages?
The chronic condition status entitles you to:
- reduction of the ceiling for the maximum bill (MAF ) if the person with a chronic illness does not benefit from a reduction through other regulations.
- application of the third-party payment scheme if the healthcare provider agrees.
Doctors can use the Member Data service to check whether a patient is entitled to chronic condition status. This service can also be used to check insurability, care processes and the home pharmacist.