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Source: BUS Sachsen-Anhalt (Linie6PLus)

Apply for full inpatient home care for those with long-term care insurance

Description

As a person insured for long-term care, you are entitled to care in a nursing home or another fully inpatient facility if home care or partial inpatient care is not possible or cannot be considered due to the special nature of your case.

In addition to the actual care services, the scope of benefits also includes social care and medical treatment care.

The maximum monthly amount that long-term care insurance funds pay for fully inpatient care services depends on your care level (as of 2021):

  • for care degree 2, a maximum of EUR 770.00
  • for care degree 3 a maximum of EUR 1,262
  • for care level 4 a maximum of EUR 1,775
  • for care degree 5 a maximum of EUR 2,005

In most cases, the costs of full inpatient care are higher than the amount covered by your long-term care insurance. You then pay a co-payment. This is the same for all residents within a facility, regardless of their care level. So if you have care level 5, for example, you pay the same amount as someone with care level 2.


From January 2022, your own contribution to care-related expenses will be reduced. The long-term care insurance fund will then pay a supplement to your own share. The supplement depends on the duration of the full inpatient care.
This supplement to your own contribution amounts to

  • 5 percent if you receive full inpatient care for up to and including 12 months,
  • 25 percent if you receive full inpatient care for more than 12 months,
  • 45 percent if you receive full inpatient care for more than 24 months,
  • 70 percent if full inpatient care is provided for more than 36 months.

The cost of care in a nursing home can vary greatly between facilities. In addition, you bear yourself:

  • Costs for room and board
  • under certain circumstances, costs for calculable investments. These are costs that the nursing home has, for example, for building rent or purchases. These costs can be passed on to the residents of the facility
  • Under certain circumstances, costs for additional services. These are also referred to as "comfort services". This refers, for example, to a single room, special meals or special care services.

If you cannot bear the additional costs yourself, your relatives must pay for them. However, children do not have to contribute to the costs of the nursing facility until their annual gross income exceeds EUR 100,000. If your relatives cannot cover the costs either, you will receive state support via the social welfare office.

If you live in a nursing home during the week and are cared for by relatives at home on weekends, you can apply for additional benefits for home care, for example care allowance or care aids.

If you need help choosing a suitable care facility, contact your care insurance fund or your nearest care support center.

  • You have care degree 2, 3, 4 or 5
    • If you have care degree 1, you can apply for the relief amount
  • You cannot be cared for at home or in a partial inpatient setting

  • If you already have a nursing degree: if applicable, notification from the nursing care insurance fund about the determination of the nursing degree (expert opinion of the Medical Service of the Nursing Care Insurance)
  • if necessary: power of attorney, guardian's identity card
  • if applicable: medical documents
  • if applicable: severely disabled person's ID card

Depending on the individual case, further documents may be required. Please contact your health insurance company for more information.

You do not have to pay anything for the application.

You will receive the benefit from your long-term care insurance fund only from the month in which you submitted the application, but at the earliest from the time when the eligibility requirements are met. If the application is not submitted in the calendar month in which the need for care occurred, but later, benefits will be granted from the beginning of the month in which the application was submitted. You should therefore submit the application in good time.
If the long-term care insurance fund does not issue the written decision within 25 working days after 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 immediately pay you EUR 70.00 for each week of exceeding the deadline. This does not apply if the long-term care insurance fund is not responsible for the delay or if you are already in full inpatient care and at least care level 2 has already been determined.


Processing usually takes about 2 to 6 working days.
For a quick processing and decision, your long-term care insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
The care insurance fund decides on applications promptly.
Please note that the processing time given is an average value for all care insurance funds. It may vary in individual cases.
The exact processing time also depends on the complexity of the individual case and may be longer accordingly. The same applies if documents or records are sent to you or your long-term care insurance fund by mail.
If the need for care or the entitlement to care benefits has not yet been determined in your case, or if an application is made to upgrade the care level, the Medical Service must be involved.
This usually extends the processing of your request by about 3 to 4 weeks.







  • Objection
  • Action before the social court

- Forms: yes

- Online procedure possible: Many statutory long-term care insurance companies offer an online procedure.

- Written form required: no

- Personal appearance required: no

You can submit the application for full inpatient home care by mail, for example, as well as - for many long-term care insurance companies - in person at the office or submit it online.

  • You submit the application for full inpatient care to your care insurance fund. If you are unable to do this yourself, you can authorize someone in writing.
  • If you have not yet been assigned a care level of at least 2, the long-term care insurance fund will commission the Medical Service or other independent assessment services to check whether you need at least this level of care.
  • The long-term care insurance fund evaluates the expert opinion, examines your application and informs you of the result.
  • Your nursing care insurance fund can give you a list of approved nursing homes where you can compare services and prices.
  • Your nursing care insurance fund will bill the service directly to the nursing care facility you have chosen.

In some federal states, you can apply for a nursing home allowance in addition to the benefits provided by your nursing care insurance fund.
You can change nursing homes at any time.


Federal Ministry of Health

Authority
Liste der Krankenkassen auf der Seite des GKV-Spitzenverbands (Spitzenverband Bund der Krankenkassen)