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 diseases 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 where people receive medical and nursing care until death. In order to provide a quiet environment, small facilities with a maximum of 16 seats are necessary.
You can only be admitted to a hospice on the basis of a medical justification. This must include a diagnosis as well as the need for hospice care. Forms for the application procedure can be obtained from your health insurance company.
If approved, the health insurance companies will pay a subsidy for inpatient hospice accommodation in the amount of 95 percent of the daily 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 reimbursement by the health insurance company should already be available in writing. Since time is usually of the essence here, the statutory health insurance companies 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 household, in inpatient care facilities, in facilities 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 health care system such as nursing services, nursing homes or clinics. They depend on donations. A large part of the services are 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 in the funding for outpatient hospice services, for example travel expenses of volunteers.
Process flow
As a general rule, there is no individual application procedure for outpatient hospice services to be used by insured persons. The accompaniment of an outpatient hospice service can be used without the approval of the health insurance company.
You can submit the application for reimbursement of the costs of an inpatient hospice service by post or - with many statutory health insurance companies - hand it in personally at the office.
- After 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 the period is not sufficient, a follow-up application can be submitted.
Who should I contact?
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 prerequisite:
- There is an incurable, progressive and advanced disease with a life expectancy that is limited to days, weeks or months according to the prescribing doctors.
- The present complaints are so pronounced that the previous care in the family, a fully inpatient care facility or a fully inpatient facility of integration assistance is not sufficient.
Which documents are required?
- Medical certificate to determine the need for full 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 pay attention to any deadlines.
Processing duration
The processing time is usually 2 to 3 business days.
For a quick processing and decision, your health insurance company must have the necessary information and, if necessary, the necessary documents complete and meaningful.
The health insurance company decides on applications in a timely manner, whereby the statutory processing deadline is observed in order to protect patients' rights.
Please note that the stated processing time is an average value of 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 requires an additional 5 weeks to process your request.
Legal basis
Applications / forms
- Forms available: yes
- Written form required: no
- Informal application possible: no
- Personal appearance required: no
- Online service available: no
Appeal
- Contradiction
- Action before 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.
