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Source: BUS Sachsen-Anhalt (Linie6PLus)

Apply for outpatient or inpatient hospice care from the statutory health insurance fund

Description

Palliative care is about the comprehensive care of people with incurable, progressive and far-advanced diseases with a limited life expectancy at the same time.

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 of great importance in order to live as self-determined a life as possible until the end. If you have statutory health insurance, you are entitled to individual advice and assistance on hospice and palliative care services.

Inpatient hospices

An inpatient hospice is a facility where people receive medical and nursing care until death. To allow for a quiet environment, small facilities with no more than 16 seats are necessary.

You can only be admitted to a hospice based on a physician's justification. This must include a diagnosis and the need for hospice care. Forms for the application procedure are available from your health insurance company.

If approved, the health insurance companies pay a subsidy for inpatient hospice care amounting to 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 cost coverage by the health insurance company should already be available in writing. Since time is usually of the essence here, the statutory health insurers strive to keep the processing time as short as possible so that admission to an inpatient hospice can take place quickly.

The transfer 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 homes, in inpatient care facilities, in facilities providing integration assistance for the disabled, and in facilities providing assistance for children and young people. However, they do not provide nursing or medical care. The services 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 rely on donations. A large part of the services is provided on a voluntary basis. Health insurance funds support outpatient hospice services upon application: In addition to personnel costs, the funding for outpatient hospice services also takes into account material costs, such as travel expenses for volunteers.

The need for inpatient hospice care must be confirmed in writing by a physician and must be submitted to the health plan for review and approval before it can be used.

Medical Condition:

  • There is a non-curable, progressive and advanced illness with a life expectancy that is limited to days, weeks or months according to the prescribing physician's assessment.
  • The present complaints are so pronounced that the previous care in the family, a full inpatient care facility or a full inpatient facility of the integration assistance is not sufficient.
  • Physician's certificate establishing the need for full inpatient hospice care

Care in an inpatient hospice or the use of an outpatient hospice service is free of charge for the person in need of care.

You do not have to observe any deadlines.

The processing time is usually 2 to 3 working days.

For rapid processing and decision-making, your health insurance fund must be provided with the necessary information as well as any required documents in a complete and meaningful manner.
The health insurance company decides on applications promptly, whereby the statutory processing period is adhered to in order to protect patients' rights.

Please note that the processing time indicated is an average value for all health 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 by mail to the person in need of care or his or her health insurer. If necessary, the medical service must be involved. This will take up to an additional 5 weeks to process your request.

  • Objection
  • Action before the social court
  • Forms available: yes
  • Written form required: no
  • Informal application possible: no
  • Personal appearance required: no
  • Online service available: no

As a general rule, there is no individual application process for outpatient hospice services for the utilization by the insured persons . The accompaniment by an outpatient hospice service can be claimed without approval by the health insurance company.

You can apply for coverage of the costs of an inpatient hospice service by mail or - in the case of many statutory health insurers - in person at the office.

  • After an application has been submitted, the medical service of the health insurance company will check the medical requirements, if necessary.
  • 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.

Federal Ministry of Health (BMG)

The text was automatically translated based on the German content.

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