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Apply for combination benefit for long-term care insurants


If you are cared for at home, you are entitled to care benefits in kind. These include physical care services, nursing care measures or help with household management. In addition, the nursing care insurance fund will pay you a nursing allowance. The maximum monthly amount for care benefits in kind depends on your care degree:

  • for care level 2 a maximum of EUR 689.00
  • for care degree 3 a maximum of EUR 1,298
  • for care degree 4 a maximum of EUR 1.612
  • for care level 5 a maximum of EUR 1,995

You can combine care benefits in kind and care allowance. In this case, the benefit is referred to as a combination benefit. The costs are calculated on a pro rata basis: The more care benefits in kind you use, the less care allowance you receive. For example, if you claim 80 percent of all the care benefits in kind to which you are entitled, you will no longer receive 100 percent of the maximum care allowance, but 20 percent. If, on the other hand, you use only a few care benefits in kind, you will receive correspondingly more care allowance.

Your decision as to the ratio of cash benefits to benefits in kind is binding for 6 months.

Process flow

You can apply for a combination benefit by mail, for example, and - in the case of many long-term care insurance companies - you can hand it in personally at the office or submit it online.

  • Calculate the share of the care benefit in kind in the maximum monthly amount to which you are entitled for care benefits in kind according to your care level.
    • For example, if the monthly costs of the care benefit amount to 70 percent of the maximum amount, you will still receive 30 percent of the care allowance.
  • Submit the application for combined benefits to your long-term care insurance fund. If you are unable to do this yourself, you can authorize someone in writing.
  • If you have not yet been assessed for a care level of at least 2, the long-term care insurance fund will commission the Medical Service or other independent assessment services to check whether you are in need of care to at least care level 2.
  • The long-term care insurance fund evaluates the expert opinion, examines your application and informs you of the result.
  • Your nursing care insurance fund can give you a list of approved nursing care services where you can compare services and prices.
  • Your long-term care insurance fund settles the care benefits directly with the outpatient care service.

Requirements

  • You have care degree 2, 3, 4 or 5.
  • You are cared for at home.
  • You do not make full use of care benefits in kind.

Which documents are required?

  • If applicable: power of attorney, guardian's identity card
  • If applicable: notice from the long-term care insurance fund on the determination of the degree of long-term care (expert opinion of the Medical Service of the Long-Term Care Insurance)
  • if applicable: medical documents
  • if applicable: severely disabled person's ID card

Depending on the individual case, further documents may be required. Please contact your nursing care insurance fund for more information.

What are the fees?

You do not have to pay anything for the application.

What deadlines do I have to pay attention to?

If you claim a combination benefit, you are bound to this decision for 6 months. This means that you cannot change the ratio in which you combine care benefits and care allowance. An exception to this is if your condition deteriorates severely and you need more care.

Processing duration

Processing usually takes about 2 to 3 working days.

For rapid processing and decision-making, 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.
If necessary, the Medical Service may have to be involved. This usually extends the processing of your request by about 2 to 3 weeks.


Applications / forms

- Forms: yes

- Online procedure possible: many long-term care insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no

Appeal

  • Objection
  • Action before the social court

Technically approved by

Federal Ministry of Health

Professionally released on

22.11.2021

Author

The text was automatically translated based on the German content.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)