Applying for home nursing care for persons with statutory health insurance
Your doctor may prescribe home nursing care if, for example, you need support after surgery or serious illness.
If you have statutory health insurance, home nursing care must be approved in advance by your health insurance company. You can then – if desired with the help of your health insurance company – select a suitable nursing service that is a contractual partner of your health insurance company.
Care can take place in your home, with your family or in another suitable place. These are, for example, assisted living forms as well as school and kindergarten for children and young people.
Home nursing 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. These include, for example, the placement of syringes or wound care.
- Domestic supply: These are household helps, for example shopping, washing or cleaning the apartment.
Support care
The so-called support care is necessary,
- if you have a serious illness,
- an acute worsening of an illness
- and you need support, especially after hospitalization, outpatient surgery or outpatient hospital treatment.
Supportive care usually includes basic care and domestic care. The statutory health insurance companies take over support care for each case of illness up to 4 weeks. An extension for medical reasons is possible.
Backup 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 in addition to treatment care, basic care and domestic care can also be paid.
Hospital avoidance care
You will receive the so-called hospital avoidance care,
- if treatment in hospital is not possible,
- you can return home earlier after hospital treatment thanks to home nursing,
- or hospital treatment can be avoided altogether by home nursing.
Hospital avoidance care includes treatment care and, if necessary, basic care and domestic care. Hospital avoidance care is covered by the statutory health insurance companies 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 nursing.
- You choose a nursing service that is a contractual partner of your health insurance company. On request, your health insurance company will support you in selecting a suitable provider.
- You submit the medical prescription to the nursing service. As a rule, the nursing service takes care of the application to your health insurance company. Alternatively, you can also 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 settles directly with your health insurance company.
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?
- Medical 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 additional payment does not apply if
- You need home nursing care due to pregnancy or childbirth.
- You are exempt from the statutory co-payment obligation.
What deadlines do I have to pay attention to?
You do not have to observe any deadlines. You or your nursing service must submit the medical prescription to your health insurance company before starting home nursing.
If you already receive home nursing care or wish 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.
Legal basis
Applications / forms
- Forms: no
- Online procedure possible: no
- Written form required: no
- Personal appearance required: no
Appeal
- Contradiction
- Action before 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.
