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Applying for substitute care in social long-term care insurance


If your private caregiver is ill, on vacation or temporarily unable to care for you for other reasons, your long-term care insurance fund will pay you the costs of substitute care upon request. This representation can be taken over, for example, by a family member or an outpatient care service. Substitute care is sometimes called preventative care.

To be eligible for substitute care, at the time of application, you must:

  • be classified in care level 2, 3, 4 or 5 and
  • have been cared for at home by the prevented caregiver for at least 6 months.
  • Care level 2 does not have to have already existed during the 6-month pre-care period.
  • It is not necessary for the same caregiver to have cared for the person in need of care for 6 months.
  • It must be possible for the substitute caregiver to provide substitute care to the extent of the respective level of care.
  • You can apply for replacement care for a total of up to 42 days per calendar year. Substitute care is possible for both
  • hourly, if your caregiver is unable to attend for less than 8 hours, as well as
  • daily.

The amount up to which your long-term care insurance fund reimburses the costs depends on who pays for the replacement care.

  • If a family member up to the second degree or a person living in your household provides substitute care, proven costs can be reimbursed up to 1.5 times the care allowance, which are:
    • for care level 2 EUR 474,00
    • for care level 3 EUR 817,50
    • for care level 4 EUR 1,092.50
    • for care level 5 EUR 1,351.50.
  • For all other persons or a nursing service, up to EUR 1,612.00 will be reimbursed.
  • Alternatively, substitute care can take place in an inpatient facility such as a nursing home. Here, too, the long-term care insurance pays a maximum of EUR 1,612.00 of the costs.

If the close family member or the person living in your household incurs expenses such as travel expenses or loss of earnings as a result of the substitute care, the care insurance fund can also increase the reimbursement amount to up to EUR 1,612.00.

For the period of substitute care, half of your previous care allowance will continue to be paid.

You can top up replacement care benefits with up to 50 percent of your annual entitlement to short-term care. Your entitlement to short-term care will then be reduced accordingly. You can find out how you can combine the services in concrete terms from your long-term care insurance fund or from recognised counselling centres, such as care support centres.
 

Process flow

You can, for example, submit the application for substitute care by post or – in the case of many long-term care insurance companies – hand it in in person at the office or submit it online.

  • You submit the application for substitute care to your long-term care insurance fund.
  • During substitute care, you will ask the caregiver or nursing service to issue receipts or invoices.
  • After the replacement care, you submit the original receipts or invoices to the nursing care fund.
  • The long-term care insurance fund will review your application and transfer the reimbursement amount to you.
     

Requirements

  • You will be cared for at home by a private caregiver.
  • They are classified at least in care level 2.
  • The caregiver who is unable to attend has been caring for you for at least 6 months.
  • Substitute care must be provided by the substitute caregiver to the extent of the respective level of care.
     

Which documents are required?

You do not need to submit any documents to apply for substitute care.

You can prove the costs of replacement care to the nursing care insurance company with original invoices, or by receipts or other payment documents such as bank statements. You can submit the payment receipts informally or by form to your long-term care insurance fund.
 

What are the fees?

You don't have to pay anything for the application.

What deadlines do I have to pay attention to?

You can apply for substitute care both before using the substitute care and afterwards.

Processing duration

It usually takes about 2 to 3 business days to process.
In order to process and make a decision quickly, your long-term care insurance fund must have the necessary information and, if necessary, documents complete and meaningful.
The long-term care insurance fund decides on applications in a timely manner.
Please note that the stated processing time is an average value for all long-term care insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and can be extended accordingly. The same applies if documents or records are sent by post to you or your long-term care insurance fund.
 

Applications / forms

- Forms: yes

- Online procedure possible: Many long-term care insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no

Appeal

  • Contradiction
  • Appeal to the Social Court
     

Technically approved by

Federal Ministry of Health

Professionally released on

28.10.2021

Author

The text was automatically translated based on the German content.

Source: Serviceportal Niedersachsen (Portalverbund des Bundes und der Länder)