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Applying for long-term care benefits in kind for persons insured with long-term care


In the case of home care, as a person in need of care, you are entitled to benefits in kind such as body-related care, nursing care measures or help with housekeeping.

This home care assistance is usually provided by outpatient care or support services. Home care assistance is also possible if you live in a nursing home or in the household of family caregivers, but not in a nursing home or other fully inpatient facility.

Depending on the level of care, you have a certain monthly budget for care benefits in kind (as of 2021):

  • 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

If you do not receive the maximum amount of outpatient care benefits in kind, you can:

  • unused care benefits in kind into care allowance. This is referred to as a combination performance.

In addition to the care benefits in kind, you can use the relief amount. This is a monthly sum that serves to reimburse expenses incurred by the insured person in connection with, among other things, the use of services provided by outpatient care services within the meaning of § 36 SGB XI, but not of services in the area of self-sufficiency in care levels 2 to 5.

Process flow

You can apply for care benefits in kind (home care assistance through outpatient services), for example, by post or – in the case of many long-term care insurance funds – hand it in in person at the office or submit it online.   

  • You submit the application for care benefits in kind 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 at least to the extent of 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 also give you a list of approved care services where you can compare services and prices.
  • Your long-term care insurance company bills the outpatient care service directly.
     

Requirements

  • You have care level 2, 3, 4 or 5
    • in the case of care level 1, you can only apply for the relief amount
  • The care benefit in kind is provided by an approved outpatient care or support service (or individual staff) who have concluded a contract with your long-term care insurance fund.
     

Which documents are required?

  • If you already have a nursing degree: Notification from the long-term care insurance fund on the determination of the degree of care (report from the medical service of the long-term care insurance)
  • If applicable: power of attorney, supervisor ID card
  • 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?

The entitlement to care benefits in kind applies from the date of application, but at the earliest from the date on which the eligibility requirements are met. If the application is not made in the calendar month in which the need for care arose, but later, the benefits are granted from the beginning of the month in which the application is submitted. Therefore, you should submit the application in good time.
If the long-term care insurance fund does not issue the written decision within 25 working days of receipt of the application or if one of the assessment deadlines specified in the law is not met, the long-term care insurance fund must pay you EUR 70.00 immediately after the deadline has expired for each week in which the deadline is exceeded. This does not apply if the long-term care insurance fund is not responsible for the delay or if you are in full inpatient care and at least care level 2 has already been determined.
If you make use of a combined benefit of the person in need of care, you are bound for 6 months by the decision on the distribution of benefits in kind or in cash.
 

Processing duration

It usually takes about 1 to 2 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 the need for care or entitlement to care benefits has not yet been determined in your case, or if an application is made for an upgrade in terms of the level of care, the medical service must be involved. In certain cases, the Medical Service must carry out an assessment within 1 or 2 weeks of receipt of the application.
 

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)