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


They can be admitted as an inpatient if a person with a disability is treated as an inpatient in hospital. For example, you will spend the night in or near the hospital and also receive your meals there. For the duration of the accompaniment, you can receive sick pay as a person with statutory health insurance under certain conditions if you have a loss of earnings due to 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 person with a disability to be accompanied must meet the following requirements:

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

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 sick pay:

  • You are close relatives or close relatives 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 for remuneration.

You can apply for sick pay as an accompanying person with your statutory health insurance company.

You will receive sick pay for the entire duration of your inpatient admission. The co-admission is also equivalent to all-day accompaniment. A full-day accompaniment exists 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 will reimburse you as an accompanying person for 70 percent of your gross salary, but a maximum of 90 percent of your net salary.

Full-time self-employed: The amount of your sick pay is 70 percent of your earned income for the past 12 months.
 

Process flow

You can apply for sick pay as an accompanying person by post and, at many statutory health insurance companies, hand it in in person at the office or submit it online.

  • Have the hospital issue you proof of the medical necessity of the accompaniment.
  • Have the times of inpatient admission or all-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 contact you if you have any questions.
  • The health insurance company will pay you 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. All-day accompaniment is equivalent. This means that the time of your presence in 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, for example, you accompany the person with a disability as a personal assistant and receive remuneration for it. If you accompany the person with a disability as part of the integration assistance, the costs are covered by the integration assistance providers.
  • Benefits are not already provided for the accompaniment of inpatient hospital treatment within the framework of social participation benefits

Which documents are required?

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

If applicable, proof of earnings or proof of loss of earnings. For employees, the employer regularly reports the required remuneration data.

Note: In special cases, additional documents 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
  • Lawsuit before the Social Court

What else should I know?

Many statutory health insurance companies offer forms. Please contact the responsible health insurance company for more information.

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.

competent Bodies


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Landkreis Emsland
Address: Ordeniederung 1 , 49716 Meppen
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Postal address: Post Office Box 15 62 , 49705 Meppen
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Stadt Papenburg - Rechnungsprüfung
Postal address: Post Office Box 1755 , 26857 Papenburg
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Address: Hauptkanal rechts 68/69, 26871 Papenburg
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