Apply for substitute care in the social long-term care insurance

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If your private caregiver is ill, on vacation or cannot care for you temporarily for other reasons, your long-term care insurance fund will pay the costs for substitute care upon application. This substitute care can be provided by a family member or an outpatient care service, for example. Substitute care is sometimes called preventive care.

In order to be entitled to substitute care, you must, at the time of application

be classified in care level 2, 3, 4 or 5, and
have been cared for at home by the prevented caregiver for at least 6 months.
Care degree 2 does not have to have already existed during the 6-month pre-care period.
It is not necessary that the same caregiver must have cared for the person in need of care for 6 months.
The substitute care must be provided by the substitute caregiver to the extent of the respective care degree.
You can apply for substitute care for a total of up to 42 days in a calendar year. Substitute care is possible both
by the hour, if your caregiver is prevented from attending for less than 8 hours, as well as
on a daily basis.

The amount up to which your nursing care insurance company reimburses the costs depends on who pays for the substitute care.

If a family member up to the second degree or a person living in your household provides substitute care, proven costs can be reimbursed up to 1.5 times the care allowance, which are:
- for care level 2 EUR 474,00
- for care degree 3 EUR 817,50
- for care degree 4 EUR 1.092,50
- for care degree 5 EUR 1.351,50.
For all other persons or a nursing service, up to EUR 1,612.00 is reimbursed.
Alternatively, substitute care can take place in an inpatient facility such as a nursing home. Here, too, the nursing care insurance fund pays a maximum of EUR 1,612.00 of the costs.

If the close family member or the person living in your household incurs expenses such as travel costs or loss of earnings as a result of the substitute care, the long-term care insurance fund can also increase the reimbursement amount up to EUR 1,612.00.

For the period of substitute care, half of your previous care allowance will continue to be paid.

You can top up benefits for substitute care with up to 50 percent of your annual entitlement to short-term care. Your entitlement to short-term care is then reduced accordingly. You can find out how to combine the benefits in concrete terms from your long-term care insurance fund or from recognized advice centers, such as care support centers.

§ 39 Elftes Buch Sozialgesetzbuch (SGB XI)

You do not need to submit any documents for the application for substitute care.

You can prove the costs of the substitute care to the long-term care insurance fund with original invoices, or with receipts or other proof of payment, such as bank statements. You can submit the payment receipts informally or by form to your long-term care insurance fund.

You are cared for at home by a private caregiver.
You are classified at least in care level 2.
The incapacitated caregiver has been caring for you for at least 6 months.
Substitute care must be provided by the substitute caregiver to the extent of the respective care degree.

You do not have to pay anything for the application.

You can submit the application for substitute care by mail, for example, as well as - for many long-term care insurance funds - in person at the office or online.

You submit the application for substitute care to your long-term care insurance fund.
During the substitute care, you have the caregiver or care service issue receipts or invoices.
After the substitute care, you submit the original receipts or invoices to the long-term care insurance fund.
The long-term care insurance fund will review your claim and transfer the reimbursement amount to you.

Processing usually takes about 2 to 3 working days.
For a quick processing and decision, your long-term care insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
The care insurance fund decides on applications promptly.
Please note that the processing time given is an average value for all care insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your care insurance fund by mail.

You can apply for substitute care both before you use substitute care and after the fact.