Reimbursement of loss of earnings when accompanying mentally or physically disabled people on admission to hospital Granting
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 can stay overnight in or near the hospital and also 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 will decide whether an accompanying person is medically necessary.
Both you and the person accompanying you must have statutory health insurance.
In addition, the person with a disability to be accompanied must meet the following requirements:
- They receive integration assistance benefits They are not accompanied by employees of a provider of integration assistance for inpatient hospital treatment.
- benefits are not already being provided for accompanying the inpatient hospital treatment as part of social participation benefits
As a person accompanying a person with a disability, you must also meet the following requirements so that the health insurance fund can pay sickness benefit:
- You are a close relative or close relative within the meaning of the Caregiver Leave Act or
- You are a person from the closest personal environment and
- You do not provide any integration assistance services to the person you are accompanying in return for payment.
You apply for sickness benefit as an accompanying person with your statutory health insurance fund.
You will receive the sickness benefit for the entire duration of the inpatient admission. Accompanying the patient all day is also equivalent to being admitted. You are considered to be accompanied for a whole day if the time you are present in hospital, together with the times of your arrival and departure, is at least 8 hours.
Employees: As a rule, the statutory health insurance fund will reimburse 70 percent of your gross salary as an accompanying person, up to a maximum of 90 percent of your net salary.
Self-employed persons: The amount of your sickness benefit is 70 percent of your income from work over the past 12 months.
You can apply for sickness benefit as an accompanying person by post, in person at the office of many statutory health insurance funds or online.
- Obtain a certificate from the hospital confirming the medical necessity of the companion.
- Have the times of inpatient co-admission or all-day accompaniment certified.
- Submit the proof of the medical necessity of the accompaniment and the certificate of your attendance times together with the other necessary documents to the statutory health insurance fund.
- Inform your employer about your absence.
- The statutory health insurance fund will check your application and the documents and will contact you if there are any queries.
- The health insurance fund will pay you the sickness benefit.
- For employees: Your health insurance fund will only pay your sickness benefit after your employer has provided the health insurance fund with the necessary information about your pay.
- You and the person with a disability you are accompanying are covered by statutory health insurance.
- The person you are accompanying is being treated as an inpatient in hospital.
- Your admission to hospital as an accompanying person is medically necessary. A full-day accompaniment is treated in the same way. This means that the time you are present 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 the immediate family.
- The person you are accompanying receives integration assistance benefits. You will not receive sickness benefit from the health insurance fund if you accompany the person with a disability, for example as a personal assistant and receive payment for this. If you accompany the person with a disability as part of integration assistance, the costs will be covered by the integration assistance providers.
- Benefits are not already provided for accompanying inpatient hospital treatment as part of social participation benefits
- Certificate from the hospital confirming the medical necessity of the 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 usually reports the required remuneration data.
Note: In special cases, further documents may be required. Please contact your health insurance company for more information.
There are no costs.
There is no deadline.
- Objection
- Action before the social court
Many statutory health insurance companies offer forms. Please contact your health insurance provider for more information.
Federal Ministry of Health (BMG)
09.11.2023
The text was automatically translated based on the German content.
