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Reimbursement of loss of earnings in the event of accompaniment of mentally or physically disabled persons in the event of inpatient admission


You can be admitted as an accompanying person if a person with a disability is being treated as an inpatient in hospital. For example, you will spend the night in or near the hospital and receive your meals there. As a person with statutory health insurance, you can receive sickness benefit for the duration of the accompaniment under certain conditions if you have a loss of earnings due to the inpatient admission.

The hospital decides whether an accompanying person is medically necessary.

Both you and the person to be accompanied must have statutory health insurance.

In addition, the following requirements must be met by the person with a disability to be accompanied:

  • She receives integration assistance benefits She is not accompanied by employees of an integration assistance provider for inpatient hospital treatment.
  • services are not already provided for the accompaniment of inpatient hospital treatment within the framework of social participation services

As an accompanying person of a person with a disability, you must also meet the following requirements in order for the health insurance company to be able to pay sickness benefit:

  • You are a close relative within the meaning of the Care Leave Act or
  • You are a person from your closest personal environment and
  • They do not provide integration assistance services to the accompanied person in return for payment.

You submit the application for sickness benefit as an accompanying person to your statutory health insurance company.

You will receive sickness benefit for the entire duration of your inpatient admission. The co-admission is also equivalent to a full-day accompaniment. A full-day accompaniment is considered if the time of your presence in the hospital, together with the times of your arrival and departure, is at least 8 hours.

Employees: As a rule, the statutory health insurance company reimburses you as an accompanying person 70 percent of your gross salary, up to a maximum of 90 percent of your net salary.

Full-time self-employed: The amount of your sickness benefit is 70 percent of your earned income over the past 12 months.
 

Process flow

You can apply for sickness benefit as an accompanying person by post or hand it in person at the office of many statutory health insurance companies or submit it online.

  • Have the hospital issue you with proof of the medical necessity of the accompaniment.
  • Have the times of inpatient admission or full-day accompaniment certified.
  • Submit proof of the medical necessity of the accompaniment and the certificate of your attendance times together with the other required documents to the statutory health insurance company.
  • Inform your employer of your absence.
  • The statutory health insurance company will review your application and the documents and will contact you if you have any questions.
  • The health insurance company will pay you the sick pay.
    • For employees: Your health insurance company will only pay your sick pay after your employer has provided the health insurance company with the necessary information about your salary.

Requirements

  • You and the person with a disability you are accompanying are covered by statutory health insurance.
  • The person to be accompanied is treated as an inpatient in hospital.
  • Your inpatient admission as an accompanying person is medically necessary. A full-day accompaniment is equal. This means that the time of your presence at the hospital, together with your arrival and departure time, is at least 8 hours.
  • You have a loss of earnings.
  • You are a close relative or part of your closest environment.
  • The person to be accompanied receives integration assistance benefits. You will not receive sick pay from the health insurance company if you accompany the person with a disability, for example as a personal assistant, and receive a fee for it. If you accompany the person with a disability within the framework of integration assistance, the costs will be covered by the institutions of integration assistance.
  • Services for the accompaniment of inpatient hospital treatment are not already provided within the framework of social participation benefits

Which documents are required?

  • Certificate from the hospital about the medical necessity of the inpatient admission
  • Confirmation from the hospital about the days of attendance

If applicable, proof of earnings or loss of earnings. In the case of employees, the employer usually reports the required remuneration data.

Note: In special cases, additional documentation may be required. Please contact your health insurance company for more information.
 

What are the fees?

There are no costs.

What deadlines do I have to pay attention to?

There is no deadline.

Appeal

  • Contradiction
  • Appeal to the Social Court

What else should I know?

Many statutory health insurance companies offer forms. Please check with your health insurance company.

Technically approved by

Federal Ministry of Health (BMG)

Professionally released on

09.11.2023

Author

The text was automatically translated based on the German content.

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