Applying for home nursing care for people with statutory health insurance
Your doctor can prescribe home nursing care for you if you need support, for example, after an operation or serious illness.
If you have statutory health insurance, home nursing care must be approved in advance by your health insurance fund. You can then - with the help of your health insurance company if you wish - choose a suitable care service that is a contractual partner of your health insurance company.
The care can take place in your home, with your family or in another suitable place. These are, for example, assisted living facilities as well as school and kindergarten in the case of children and adolescents.
Home care may include:
- Basic care: this includes, for example, personal hygiene, nutrition and mobility.
- Treatment care: Treatment care helps to cure the illness or to prevent it from getting worse. This includes, for example, giving injections or treating wounds.
- Domestic care: This is help in the household, for example shopping, washing or cleaning the apartment.
Support care
The so-called support care is necessary
- if you have a serious illness,
- an illness becomes acutely worse
- and you need support, especially after a stay in hospital, an outpatient operation or outpatient hospital treatment.
Supportive care usually includes basic care and domestic care. The statutory health insurance funds cover supportive care for each case of illness for up to 4 weeks. An extension for medical reasons is possible.
Backup care
If home nursing care ensures the success of medical treatment, your statutory health insurance pays for so-called backup care. This covers treatment care for as long as it is medically necessary.
Some health insurance funds have stipulated in their statutes that basic care and domestic care can also be paid for in addition to treatment care.
Hospital avoidance care
You receive the so-called hospital avoidance care,
- if hospital treatment is not possible,
- you can return home sooner after hospital treatment thanks to home nursing,
- or if hospital treatment can be avoided altogether through home nursing care.
Hospital avoidance care includes treatment care and - if necessary - also basic care as well as domestic care. Hospital avoidance care is covered by the statutory health insurance funds for up to 4 weeks per case of illness. An extension for medical reasons is possible.
Which documents are required?
- Medical prescription
Requirements
- Home nursing has been prescribed for you by a doctor.
- There is no one in your household who could care for you or provide you with care to the extent required.
- For supportive care: You are not in need of care with care degree 2, 3, 4 or 5.
What are the fees?
Adults pay EUR 10.00 for each prescription and 10 percent of the costs as a statutory co-payment. This applies for the first 28 days per calendar year.
The statutory co-payment does not apply if
- you need home health care because of pregnancy or childbirth.
- you are exempt from the statutory co-payment obligation.
Process flow
To get home health care, you usually do the following:
- Your doctor prescribes home health care for you.
- You select a care service that is a contractual partner of your health insurance fund. If you wish, your health insurance fund will support you in selecting a suitable provider.
- You present the doctor's prescription to the nursing service. As a rule, the nursing service will take care of the application to your health insurance fund. Alternatively, you can submit the doctor's prescription directly to your health insurance fund.
- Your health insurance fund will check whether you can receive home nursing care.
- If your health insurance company approves the application, the nursing service will settle the bill directly with your health insurance company.
What deadlines do I have to pay attention to?
You do not have to observe any deadlines. You or your nursing service must submit the medical prescription to your health insurance fund before the start of home nursing care.
If you are already receiving home nursing care or want to receive it immediately, the health insurance fund will only cover the costs of the services provided by the nursing service until a decision has been made on the approval if the prescription is submitted to the health insurance fund no later than 3 working days after the prescription has been issued.
Appeal
- Objection
- Action before the social court
Applications / forms
- Forms: no
- Online procedure possible: no
- Written form required: no
- Personal appearance required: no
Contact point
Responsible authorities
GKV-Spitzenverband
