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Applying for home nursing care for people with statutory health insurance


Your doctor can prescribe home nursing care if you need support after surgery or serious illness, for example.

If you have statutory health insurance, home nursing must be approved in advance by your health insurance company. You can then – if you wish with the help of your health insurance company – select a suitable care service that is a contractual partner of your health insurance company.

Care can take place in your home, with your family or at another suitable location. These include, for example, assisted living as well as school and kindergarten for children and young people.

Home health care may include:

  • Basic care: This includes, for example, personal hygiene, nutrition and mobility.
  • Treatment care: Treatment care helps to cure the disease or not to make it worse. This includes, for example, the placement of syringes or wound care.
  • Housekeeping: These are household aids, such as shopping, washing or cleaning the home.

Supportive care

The so-called supportive care is necessary,

  • if you have a serious illness,
  • an illness is acutely worsening
  • and you need support, especially after a hospital stay, outpatient surgery or outpatient hospital treatment.

Supportive care usually includes basic care and domestic care. The statutory health insurance companies cover support care for each case of illness for up to 4 weeks. An extension for medical reasons is possible.
Fuse maintenance

If home nursing ensures the success of medical treatment, your statutory health insurance pays for the so-called security care. This includes treatment care for as long as it is medically necessary.

Some health insurance companies 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 will receive the so-called hospital avoidance care,

  • if treatment in hospital is not possible,
  • you can go home earlier after hospital treatment through home nursing,
  • or hospital treatment can be avoided altogether by home nursing.

Hospital avoidance care includes treatment care and, if necessary, additional basic care and domestic care. Statutory health insurance companies cover hospital avoidance care for up to 4 weeks per case of illness. An extension for medical reasons is possible.

Process flow

To receive home health care, you usually do the following:

  • Your doctor will prescribe home health care for you.
  • You choose a care service that is a contractual partner of your health insurance company. If you wish, your health insurance company will support you in choosing a suitable provider.  
  • You present the medical prescription to the nursing service. As a rule, the nursing service will take care of the application to your health insurance company. Alternatively, you can submit the medical prescription directly to your health insurance company.
  • Your health insurance company will check whether you can receive home health care.
  • If your health insurance company has approved the application, the nursing service will bill your health insurance company directly.
     

Requirements

  • Home nursing has been prescribed to you by a doctor.
  • There is no one in your household who could care for or provide for you to the extent required.
  • for supportive care: You are not in need of care with care level 2, 3, 4 or 5
     

Which documents are required?

  • Doctor's prescription

What are the fees?

Adults pay EUR 10.00 for each prescription as well as 10 percent of the costs as a statutory co-payment. This applies to the first 28 days of each calendar year.

The statutory co-payment does not apply if

  • You need home health care due to pregnancy or childbirth.
  • You are exempt from the statutory obligation to make additional payments.

What deadlines do I have to pay attention to?

You don't have to observe any deadlines. You or your nursing service must submit the medical prescription to your health insurance company before starting home care.

If you are already receiving home care or intend to receive it directly, the health insurance fund will only cover the costs of the services provided by the nursing service until the decision on approval has been made if the prescription is received by the health insurance fund no later than 3 working days after the prescription has been issued.
 

Applications / forms

- Forms: no
- Online procedure possible: no
- 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

25.12.2020

Author

The text was automatically translated based on the German content.

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