Service Finder
Apply for care benefits in kind for people with long-term care insurance
Service Description
With home care, you as a person in need of care are entitled to benefits in kind such as physical care, nursing care measures or help with housekeeping.
This home care assistance is usually provided by outpatient nursing or care services. Home care assistance is also possible if you live in a shared care home or in the household of family carers, but not in a care home or other fully inpatient facility.
Depending on the care level, you are entitled to a certain monthly budget for care services in kind (as at: 2021)
- a maximum of EUR 689.00 for care level 2
- a maximum of EUR 1,298 for care level 3
- a maximum of EUR 1,612 for care level 4
- for care level 5, a maximum of EUR 1,995
If you do not claim the outpatient care benefits in kind up to the maximum amount, you can
- convert unused care benefits in kind into care allowance. This is known as a combination benefit.
In addition to the care benefits in kind, you can use the relief amount. This is a monthly amount that is used to reimburse expenses incurred by the insured person in connection with the use of services such as outpatient care services within the meaning of § 36 SGB XI, but not services in the area of self-care in care grades 2 to 5.
Process flow
You can submit the application for care benefits in kind (home care assistance from outpatient services) by post, for example, or - with many long-term care insurance companies - in person at the office or online.
- You submit the application for long-term care benefits in kind to your long-term care insurance fund. If you are not able to do this yourself, you can authorize someone else in writing.
- If you have not yet been assessed as having a care degree of at least 2, the long-term care insurance fund will commission the Medical Service or other independent expert services to check whether you have a need for care of at least care degree 2.
- The long-term care insurance fund evaluates the report, checks your application and informs you of the result.
- Your care insurance fund can also provide you with a list of approved care services where you can compare services and prices.
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Your care insurance fund will bill the outpatient care service directly.
Requirements
-
You have care level 2, 3, 4 or 5
- for care level 1, you can only apply for the relief amount
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The care benefit in kind is provided by an approved outpatient care or support service (or individual staff) that has concluded a contract with your care insurance fund.
Which documents are required?
- If you already have a care degree: Notification from the care insurance fund about the care degree (report from the Medical Service of the Care Insurance Fund)
- If applicable: power of attorney, guardian's certificate
- If applicable: medical documents
- If applicable: severely disabled person's pass
Depending on the individual case, further documents may be required. Please contact your care insurance fund for more information.
What are the fees?
You do not have to pay anything for the application.
What deadlines do I have to pay attention to?
The entitlement to long-term care benefits in kind applies from the date of application, but at the earliest from the date on which the conditions for entitlement are met. If the application is not submitted in the calendar month in which the need for care arose, but later, the benefits will be granted from the beginning of the month in which the application is submitted. You should therefore submit your 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 immediately pay you EUR 70.00 for each week that 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 have already been awarded at least care level 2.
If you claim a combination benefit from the long-term care fund, you are bound to the decision on the distribution of benefits in kind or cash benefits for 6 months.
Processing duration
Processing normally takes about 1 to 2 working days.
In order to process and decide quickly, your long-term care insurance fund must have the necessary information and any required documents in a complete and meaningful form.
The long-term care insurance fund decides on applications promptly.
Please note that the processing time indicated 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 may be longer. The same applies if documents or records are sent to you or your long-term care insurance fund by post.
If the need for care or the entitlement to care benefits has not yet been established in your case or if an application is made to upgrade the degree 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.
Legal basis
Applications / forms
- Objection
- Action before the social court
Appeal
- Forms: yes
- Online procedure possible: Many long-term care insurance companies offer an online procedure.
- Written form required: no
- Personal appearance necessary: no
Further Information
Author
The text was automatically translated based on the German content.
- Long-term care benefits in kind for people with statutory long-term care insurance Provision
Remark: Display of performance in the source portal
Technically approved by
Federal Ministry of Health
Professionally released on
22.11.2021
Source: Zuständigkeitsfinder Thüringen (Linie6PLus)