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Apply for care benefits in kind for those with long-term care insurance
Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6PLus)
In the case of home care, you as a person in need of care are entitled to benefits in kind such as body-related care, nursing care measures or help with household management.
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 apartment or in the household of family caregivers, but not in a nursing home or other full inpatient facility.
Depending on the care degree, you have a certain monthly budget for care benefits in kind at your disposal (as of 2021):
- for care degree 2 a maximum of EUR 689.00
- for care level 3 a maximum of EUR 1,298
- for care level 4 a maximum of EUR 1,612
- for care level 5 a maximum of EUR 1,995
If you do not make use of the outpatient care benefits in kind up to the maximum amount, you can:
- convert unused care benefits in kind into care allowance. This is referred to as a combination benefit.
In addition to the care benefits in kind, you can use the relief amount. This is a monthly amount that serves to reimburse expenses incurred by the insured person in connection with the use of, among other things, services provided by outpatient care services within the meaning of Section 36 of Book XI of the Social Code, but not self-care services in care grades 2 to 5.
You can apply for care benefits in kind (home care assistance from outpatient services) by mail, for example, as well as - for many care insurance companies - in person at the office or submit it online.
- You submit the application for care benefits in kind 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 care to at least care level 2.
- 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 also give you a list of approved nursing care services where you can compare services and prices.
Your long-term care insurance fund settles directly with the outpatient care service.
You have care degree 2, 3, 4 or 5
- With care level 1, you can only apply for the relief amount.
The care benefit in kind is provided by an approved outpatient care or support service (or individual workers) who have concluded a contract with your care insurance fund.
Which documents are required?
- If you already have a care degree: Notification from the nursing care insurance company about the determination of the nursing care degree (expert opinion of the medical service of the nursing care insurance)
- if necessary: power of attorney, guardian's identity card
- if necessary: medical documents
- if applicable: severely disabled person's ID card
Depending on the individual case, further documents may be required. Please contact your long-term care insurance company 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 care benefits in kind applies from the date of application, but not earlier than 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, 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 nursing care insurance fund is not responsible for the delay or if you are in full inpatient care and at least care level 2 has already been determined.
If you are claiming a combination benefit for those in need of care, you are bound to the decision on the distribution of benefits in kind or in cash for 6 months.
Processing usually takes about 1 to 2 working days.
For a quick processing and decision, your 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. In certain cases, the Medical Service must conduct an assessment within 1 or 2 weeks of receipt of the application.
- 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 required: no
Technically approved by
Federal Ministry of Health