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Schleswig-Holstein

Applying for combined benefits for people with long-term care insurance

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6PLus)

Service Description

If you are cared for at home by relatives, you can receive a combination of care allowance and the services of an outpatient care service at the same time.

If you are cared for at home, you are entitled to care benefits in kind. This includes physical care services, nursing care measures or help with housekeeping. The care insurance fund will also pay you care allowance. The maximum monthly amount for care benefits in kind depends on your care level:

  • for care level 2, a maximum of EUR 689.00
  • maximum EUR 1,298 for care level 3
  • maximum EUR 1,612 for care level 4
  • maximum EUR 1,995 for care level 5

You can combine care benefits in kind and care allowance. In this case, this is referred to as a combination benefit. The costs are calculated on a pro rata basis: The more care benefits in kind you claim, the less care allowance you receive. For example, if you claim 80 percent of all the care benefits in kind to which you are entitled, you will no longer receive 100 percent of the maximum care allowance, but 20 percent. If, on the other hand, you only claim a few long-term care benefits in kind, you will receive correspondingly more care allowance.

Your decision on the ratio of cash and non-cash benefits you claim is binding for 6 months.


Process flow

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

  • Calculate the share of the care benefit in kind of the maximum monthly amount that you are entitled to according to your care degree for care benefits in kind.
    • For example, if the monthly costs of the care benefit in kind amount to 70 percent of the maximum amount, you will still receive 30 percent of the care allowance.
  • Submit the application for combined benefits to your care insurance fund. If you are not in a position to do this 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 have a need for care of at least care level 2.
  • The long-term care insurance fund evaluates the report, checks your application and informs you of the result.
  • Your care insurance fund can provide you with a list of approved care services where you can compare services and prices.
  • Your care insurance fund will settle the care benefit in kind directly with the outpatient care service.
Requirements
  • You have care level 2, 3, 4 or 5.
  • You are cared for at home.
  • You do not make full use of care benefits in kind.
Which documents are required?
  • If applicable: Power of attorney, guardian's certificate
  • If applicable: notification from the long-term care insurance fund about the determination of the degree of care (expert opinion from the medical service of the long-term care insurance)
  • If applicable: medical documents
  • if applicable: certificate of severe disability

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?

If you claim a combination benefit, you are bound to this decision for 6 months. This means that you cannot change the ratio in which you combine care benefits in kind and care allowance. There is an exception if your condition deteriorates significantly and you need more care.

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.
The medical service may need to be involved. This usually extends the processing of your request by around 2 to 3 weeks.

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

22.11.2021

Teaser

If you are cared for at home by relatives, you can receive a combination of care allowance and the services of an outpatient care service at the same time.

Process flow

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

  • Calculate the share of the care benefit in kind of the maximum monthly amount that you are entitled to according to your care degree for care benefits in kind.
    • For example, if the monthly costs of the care benefit in kind amount to 70 percent of the maximum amount, you will still receive 30 percent of the care allowance.
  • Submit the application for combined benefits to your care insurance fund. If you are not in a position to do this 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 have a need for care of at least care level 2.
  • The long-term care insurance fund evaluates the report, checks your application and informs you of the result.
  • Your care insurance fund can provide you with a list of approved care services where you can compare services and prices.
  • Your care insurance fund will settle the care benefit in kind directly with the outpatient care service.

Requirements

  • You have care level 2, 3, 4 or 5.
  • You are cared for at home.
  • You do not make full use of care benefits in kind.

Which documents are required?

  • If applicable: Power of attorney, guardian's certificate
  • If applicable: notification from the long-term care insurance fund about the determination of the degree of care (expert opinion from the medical service of the long-term care insurance)
  • If applicable: medical documents
  • if applicable: certificate of severe disability

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?

If you claim a combination benefit, you are bound to this decision for 6 months. This means that you cannot change the ratio in which you combine care benefits in kind and care allowance. There is an exception if your condition deteriorates significantly and you need more care.

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.
The medical service may need to be involved. This usually extends the processing of your request by around 2 to 3 weeks.

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

22.11.2021

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