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Applying for a combined benefit for long-term care insured persons


If you are cared for at home, you are entitled to care benefits in kind. These include body-related care services, nursing care measures or help with housekeeping. In addition, the long-term care insurance fund pays you care allowance. The maximum monthly amount for care benefit in kind depends on your level of care:

  • for care level 2 up to EUR 689.00
  • for care level 3 up to EUR 1,298
  • for care level 4 a maximum of EUR 1,612
  • for care level 5 a maximum of EUR 1,995

You can combine care benefits in kind and care allowance. In this case, it is referred to as a combination performance. The costs are calculated on a pro rata basis: the more care benefits in kind you claim, the less care allowance you receive. If, for example, you claim 80 percent of all the care benefits in kind to which you are entitled, you will no longer receive 100 percent of the maximum care allowance, but 20 percent. If, on the other hand, you only make use of a few care benefits in kind, you will receive correspondingly higher care allowance.

Your decision on the ratio of cash and non-cash benefits is binding for 6 months.

Process flow

You can apply for a combined benefit, for example, by post or – with many long-term care insurance funds – hand it in in person at the office or submit it online.   

  • Calculate the proportion of the care benefit in kind in the maximum monthly amount to which you are entitled for care benefits in kind according to your level of care.
    • If, for example, the monthly costs of the care benefit in kind are 70 percent of the maximum amount, you will still receive 30 percent of the care allowance.
  • Submit the application for a combined benefit to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing.
  • If you have not yet been diagnosed with a care level of at least 2, the long-term care insurance fund will commission the medical service or other independent expert services to check whether you need care to the extent of at least care level 2.
  • The long-term care insurance fund evaluates the report, examines your application and informs you of the result.
  • Your long-term care insurance company can provide you with a list of approved care services where you can compare services and prices.
  • Your long-term care insurance fund settles the care benefit in kind directly with the outpatient care service.
     

Requirements

  • They have care level 2, 3, 4 or 5.
  • They are cared for at home.
  • They do not make full use of care benefits in kind.
     

Which documents are required?

  • If applicable: power of attorney, supervisor ID card
  • If applicable: Notification from the long-term care insurance fund on the determination of the degree of care (expert opinion of the medical service of the long-term care insurance)
  • if applicable: medical records
  • If applicable: Severely disabled person's pass

Depending on the individual case, further documents may be required. Please contact your long-term care insurance company for more information.
 

What are the fees?

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

What deadlines do I have to pay attention to?

If you take advantage of a combined benefit, you are bound by this decision for 6 months. This means that you cannot change the ratio in which you combine care benefits in kind and care allowance. An exception is if your condition deteriorates significantly and you need more care.

Processing duration

It usually takes about 2 to 3 working 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.
If necessary, the medical service must be involved. As a result, the processing of your request is usually extended by about 2 to 3 weeks.
 

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

22.11.2021

Author

The text was automatically translated based on the German content.

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