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Schleswig-Holstein

Applying for substitute care under social long-term care insurance

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6PLus)

Service Description

If your private caregiver is unable to care for you due to vacation or illness, your care insurance fund will pay the costs of a replacement in certain cases.

If your private caregiver is ill, on vacation or temporarily unable to care for you for other reasons, your care insurance fund will pay the costs of substitute care upon application. A family member or an outpatient care service, for example, can provide this replacement care. Substitute care is sometimes also called respite care.

To be entitled to substitute care, at the time of application you must

  • be classified in care level 2, 3, 4 or 5 and
  • have been cared for at home by the unavailable carer for at least 6 months.
  • Care grade 2 does not have to have already existed during the 6-month previous care period.
  • It is not necessary for the same carer to have cared for the person in need of care for 6 months.
  • The replacement care must be able to be provided by the replacement caregiver to the extent of the respective care degree.
  • You can apply for substitute care for a total of up to 42 days per calendar year. Replacement care is possible both
  • by the hour, if your carer is unable to work for less than 8 hours, or
  • on a daily basis.

The amount up to which your care insurance fund will reimburse the costs depends on who is providing the replacement care.

  • If a family member up to the second degree or a person living in your household provides substitute care, proven costs can be reimbursed up to 1.5 times the care allowance, i.e:
    • EUR 474.00 for care level 2
    • EUR 817.50 for care level 3
    • EUR 1,092.50 for care level 4
    • EUR 1,351.50 for care level 5.
  • For all other persons or a care service, up to EUR 1,612.00 will be reimbursed.
  • Alternatively, substitute care can be provided in an inpatient facility such as a nursing home. Here too, the care insurance fund pays a maximum of EUR 1,612.00 of the costs.

If the close family member or the person living in your household incurs expenses such as travel expenses or loss of earnings as a result of the substitute care, the long-term care insurance fund can also increase the reimbursement amount to up to EUR 1,612.00.

Half of your previous care allowance will continue to be paid for the period of substitute care.

You can top up benefits for substitute care with up to 50 percent of your annual entitlement to short-term care. Your entitlement to short-term care is then reduced accordingly. You can find out how you can combine the benefits from your care insurance fund or from recognized advice centres, such as care support centres.


Process flow

You can submit the application for substitute care by post, for example, or - with many long-term care insurance funds - in person at the office or online.

  • You submit the application for substitute care to your care insurance fund.
  • During the substitute care, have the caregiver or care service issue you with receipts or invoices.
  • After the replacement care, you submit the original receipts or invoices to the long-term care insurance fund.
  • The long-term care insurance fund will check your application and transfer the reimbursement amount to you.
Requirements
  • You are cared for at home by a private caregiver.
  • You are classified in care level 2 or higher.
  • The incapacitated caregiver has been caring for you for at least 6 months.
  • Replacement care must be provided by the replacement carer to the extent of the respective care degree.
Which documents are required?

You do not need to submit any documents to apply for substitute care.

You can prove the costs of replacement care to the care insurance fund with original invoices, receipts or other proof of payment such as bank statements. You can submit the proof of payment to your care insurance fund informally or using a form.

What are the fees?

You do not have to pay anything for the application.

What deadlines do I have to pay attention to?

You can submit an application for substitute care both before the substitute care is used and afterwards.

Processing duration

Processing normally takes about 2 to 3 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.

Legal basis
Appeal
  • Contradiction
  • Action before the social court
Applications / forms

- Forms: yes

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

- Written form required: no

- Personal appearance necessary: no

Author
Forwarding service: Deep link to the original portal

The text was automatically translated based on the German content.

Technically approved by

Federal Ministry of Health

Professionally released on

28.10.2021

Teaser

If your private caregiver is unable to care for you due to vacation or illness, your care insurance fund will pay the costs of a replacement in certain cases.

Process flow

You can submit the application for substitute care by post, for example, or - with many long-term care insurance funds - in person at the office or online.

  • You submit the application for substitute care to your care insurance fund.
  • During the substitute care, have the caregiver or care service issue you with receipts or invoices.
  • After the replacement care, you submit the original receipts or invoices to the long-term care insurance fund.
  • The long-term care insurance fund will check your application and transfer the reimbursement amount to you.

Requirements

  • You are cared for at home by a private caregiver.
  • You are classified in care level 2 or higher.
  • The incapacitated caregiver has been caring for you for at least 6 months.
  • Replacement care must be provided by the replacement carer to the extent of the respective care degree.

Which documents are required?

You do not need to submit any documents to apply for substitute care.

You can prove the costs of replacement care to the care insurance fund with original invoices, receipts or other proof of payment such as bank statements. You can submit the proof of payment to your care insurance fund informally or using a form.

What are the fees?

You do not have to pay anything for the application.

What deadlines do I have to pay attention to?

You can submit an application for substitute care both before the substitute care is used and afterwards.

Processing duration

Processing normally takes about 2 to 3 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.

Legal basis

Appeal

  • Contradiction
  • Action before the social court

Applications / forms

- Forms: yes

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

- Written form required: no

- Personal appearance necessary: no

Author

Forwarding service: Deep link to the original portal

The text was automatically translated based on the German content.

Technically approved by

Federal Ministry of Health

Professionally released on

28.10.2021

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