Apply for outpatient or inpatient hospice care from the statutory health insurance fund
Palliative care involves comprehensive care for people with incurable, progressive and advanced illnesses who also have a limited life expectancy.
Hospice and palliative care is usually associated with many questions. In addition to the choice of possible services, the selection of suitable outpatient or inpatient services is also of great importance in order to lead as self-determined a life as possible until the end. If you have statutory health insurance, you are entitled to individual advice and assistance on hospice and palliative care services.
Inpatient hospices
An inpatient hospice is a facility where people receive medical and nursing care until they die. In order to provide a peaceful environment, small facilities with a maximum of 16 places are required.
You can only be admitted to a hospice on the basis of a medical statement. This must include a diagnosis and the need for hospice care. You can obtain forms for the application procedure from your health insurance company.
If approved, the health insurance companies pay a subsidy for inpatient hospice stays amounting to 95% of the daily rate agreed with the respective hospice. 5 percent of the costs are covered by donations. There is no personal contribution.
Before admission to the hospice can take place, the declaration of cost coverage by the health insurance company should already be available in writing. As time is usually of the essence here, the statutory health insurance companies endeavor to keep the processing time as short as possible so that admission to an inpatient hospice can take place quickly.
The transfer from a nursing home to a hospice can only take place if the person in need of care can no longer be adequately cared for.
Outpatient hospice services
Outpatient hospice services support and accompany people in the last phase of their lives in their own homes, in inpatient care facilities, in facilities providing integration assistance for disabled people and in child and youth welfare facilities. However, they do not take on any nursing or medical activities. The services are free of charge.
Outpatient hospice services are not "service providers" in the healthcare sector, such as nursing services, care homes or clinics. They are dependent on donations. The majority of services are provided on a voluntary basis. Health insurance funds support outpatient hospice services on application: In addition to personnel costs, funding for outpatient hospice services also covers material costs, such as travel costs for volunteers.
Who should I contact?
Requirements
The need for inpatient hospice care must be confirmed in writing by a doctor and must be submitted to the health insurance fund for review and approval before it can be utilized.
Medical requirement:
- There is an incurable, progressive and advanced illness with a life expectancy which, in the opinion of the prescribing doctor, is limited to days, weeks or months.
- The existing symptoms are so severe that the previous care in the family, a full inpatient care facility or a full inpatient facility for integration assistance is not sufficient.
Which documents are required?
- Medical certificate to determine the need for full inpatient hospice care
What are the fees?
Care in an inpatient hospice or the use of an outpatient hospice service is free of charge for the person in need of care.
Process flow
As a general rule, there is no individual application procedure for outpatient hospice services for utilization by the insured person. The support provided by an outpatient hospice service can be used without the approval of the health insurance company.
You can apply for the costs of an inpatient hospice service to be covered by post and - with many statutory health insurance companies - you can also submit your application online or hand it in in person at the office.
- Once an application has been submitted, the health insurance company's medical service may check the medical requirements.
- If approved: The health insurance company confirms the assumption of costs in writing.
- The initial application is usually valid for 28 days. If this period is not sufficient, a follow-up application can be submitted.
What deadlines do I have to pay attention to?
You do not have to observe any deadlines.
Processing duration
The processing time is normally 2 to 3 working days.
In order to process and decide quickly, your health insurance company must have the necessary information and any required documents in a complete and meaningful form.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.
Please note that the processing time stated is an average value for all health insurance companies. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer. The same applies if documents or records are sent by post to the person in need of care or their health insurance fund. The medical service may need to be involved. It may take up to 5 additional weeks to process your request.
Further information
Appeal
- Objection
- Action before the social court
