If you are chronically ill, you may have very high medical expenses. If you receive reimbursement for the chronically ill, a ceiling is put on your medical expenses. Your maximum co-payment is DKK 3,655 stated in reimbursement prices.
Application
It is your doctor who applies for reimbursement for the chronically ill.
When we assess your application, we look at whether your treatment is scientifically reasoned, and whether your total expenses for reimbursable medicine are estimated to exceed DKK 16,896 (your CTR balance). If you are under 18, your expenses must be estimated to exceed DKK 20,830.
Reply
It usually takes us about 14 days to reply to an application for reimbursement for the chronically ill submitted by a doctor. But, if the application needs special evaluation, it could take up to two months.
If your application is granted, you will receive a licence by ordinary mail, and the pharmacy can see your grant in the CTR register at the same time.
Only your doctor is informed if your application for reimbursement for the chronically ill has been refused. The doctor is given an explanation why it was refused.
How does the licence work?
If you have been granted a licence for the chronically ill, 100 % of your expenses for reimbursable medicine is subsidised when your CTR balance exceeds DKK 16,896 (DKK 20,830 if you are under 18).
You will never pay more than DKK 3,655 of your annual expenses for reimbursable medicine.
However, it requires that you always buy the cheapest medicine in a group of generic medicines. If you don't you must pay the difference between the cheapest and the more expensive medicine yourself.
For how long is my licence valid?
Most licences for the chronically ill are valid for five years. The licence is valid in overlapping reimbursement years, i.e. from the start of the reimbursement year running on the date of granting and until the end of the reimbursement year in which the grant expires.
In other words, the doctor must apply again when the licence's expiry date comes closer.
What does the licence cover?
Reimbursement for the chronically ill is available for reimbursable medicines when your CTR balance reaches the level triggering 100 %. This applies to both medicine with automatic reimbursement and medicine for which you have been granted single reimbursement.
