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Apply for outpatient or inpatient hospice care from the statutory health insurance company


Palliative care is about the comprehensive care of people with incurable, progressive and advanced illnesses with a limited life expectancy.

Hospice and palliative care is usually associated with many questions. In addition to the choice of possible services, the selection of suitable outpatient or inpatient services is also of great importance in order to lead a life that is as self-determined as possible until the end. If you have statutory health insurance, you are entitled to individual advice and assistance with hospice and palliative care services.

Inpatient hospices

An inpatient hospice is a facility in which people receive medical and nursing care until death. In order to ensure a quiet environment, small facilities with a maximum of 16 places are necessary.

You can only be admitted to a hospice on the basis of a doctor's justification. This must include a diagnosis as well as the need for hospice care. Forms for the application process can be obtained from your health insurance company.

If approved, the health insurance companies pay a subsidy for the inpatient hospice stay in the amount of 95 percent of the day-related requirement rate agreed with the respective hospice. 5 percent of the costs are covered by donations. There is no personal contribution.

Before admission to the hospice can take place, the declaration of assumption of costs by the health insurance company should already be available in writing. Since time is usually of the essence here, the statutory health insurance companies therefore strive to keep the processing time as short as possible so that a quick admission to an inpatient hospice can take place.

The change from a nursing home to a hospice can only take place if the person in need of care can no longer be adequately cared for.

Outpatient hospice services

Outpatient hospice services support and accompany people in the last phase of life in their households, in inpatient care facilities, in institutions for integration assistance for disabled people and in child and youth welfare facilities. However, they do not take on any nursing or medical activities. The offers are free of charge.

Outpatient hospice services are not "service providers" in the healthcare sector such as nursing services, nursing homes or clinics. They are dependent on donations. A large part of the services is provided on a voluntary basis. Health insurance companies subsidize outpatient hospice services upon application: In addition to personnel costs, material costs are also taken into account when funding outpatient hospice services are provided, such as travel costs for volunteers.

Process flow

As a general rule, there is no individual application procedure for outpatient hospice services to be used by the insured. Accompaniment by an outpatient hospice service can be used without approval from the health insurance company.

You can apply for an inpatient hospice service to be covered by post or – in the case of many statutory health insurance companies – hand it in in person at the office.

  • Once an application has been submitted, the medical service of the health insurance company may check the medical requirements.
  • If approved: The health insurance company confirms the assumption of costs in writing.
  • The initial application is usually valid for 28 days. If there is not enough time, a follow-up application can be submitted.
     

Requirements

The necessity of inpatient hospice care must be confirmed in writing by a doctor and must be submitted to the health insurance company for review and approval before it can be claimed.

Medical requirements:

  • It is an incurable, progressive and advanced disease with a life expectancy that, according to the prescribing physicians, is limited to days, weeks or months.
  • The present complaints are so pronounced that the previous care in the family, a fully inpatient care facility or a fully inpatient facility for integration assistance is not sufficient.
     

Which documents are required?

  • Medical certificate to determine the need for inpatient hospice care

What are the fees?

Care in an inpatient hospice or the use of an outpatient hospice service is free of charge for the person in need of care.

What deadlines do I have to pay attention to?

You don't have to observe any deadlines.

Processing duration

The processing time is usually 2 to 3 business days.

In order to process and make a decision quickly, your health insurance company must have the necessary information and, if necessary, documents complete and meaningful.
The health insurance company decides on applications promptly, whereby the statutory processing deadline is observed in order to protect patients' rights.

Please note that the stated processing time is an average value for all health insurance companies. 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 the person in need of care or their health insurance company. If necessary, the medical service must be involved. This will take up to an additional 5 weeks to process your request.
 

Applications / forms

  • Forms available: yes
  • Written form required: no
  • Informal application possible: no
  • Personal appearance required: no
  • Online service available: no

Appeal

  • Contradiction
  • Appeal to the Social Court

Technically approved by

Federal Ministry of Health (BMG)
 

Professionally released on

19.01.2023

Author

The text was automatically translated based on the German content.

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