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Schleswig-Holstein

Applying for home nursing care for people with statutory health insurance

Source: Zuständigkeitsfinder Schleswig-Holstein (Linie6PLus)

Service Description

If you need qualified nursing care at home due to an illness, you can apply for home nursing care from your statutory health insurance provider. You will need a doctor's prescription for this.

Your doctor can prescribe home nursing care if you need support after an operation or serious illness, for example.

If you have statutory health insurance, home nursing care must be approved in advance by your health insurance provider. You can then - if you wish, with the help of your health insurance company - select a suitable care service that is a contractual partner of your health insurance company.

The care can take place in your home, with your family or at another suitable location. These include, for example, assisted living facilities as well as schools and kindergartens for children and young people.

Home nursing care can include

  • Basic care: this includes, for example, personal hygiene, nutrition and mobility.
  • Treatment care: Treatment care helps to cure the illness or prevent it from getting worse. This includes, for example, giving injections or treating wounds.
  • Domestic care: This is help in the household, for example shopping, washing or cleaning the home.

Supportive care

Supportive care is necessary

  • if you have a serious illness,
  • an illness worsens acutely
  • and you need support, particularly after a stay in hospital, an outpatient operation or outpatient hospital treatment.

Supportive care usually includes basic care and housekeeping. The statutory health insurance funds cover supportive care for up to 4 weeks for each case of illness. An extension for medical reasons is possible.
Backup care

If home nursing care ensures the success of medical treatment, your statutory health insurance will pay for so-called backup care. This includes treatment care for as long as it is medically necessary.

Some health insurance companies have stipulated in their statutes that basic care and domestic care can also be paid for in addition to treatment care.

Hospital avoidance care

You receive so-called hospital avoidance care

  • if treatment in hospital is not possible,
  • home nursing care allows you to return home earlier after hospital treatment,
  • or hospital treatment can be avoided altogether by providing home nursing care.

Hospital avoidance care includes treatment care and - if necessary - additional basic care and housekeeping. Hospital avoidance care is covered by statutory health insurance for up to 4 weeks per case of illness. An extension for medical reasons is possible.


Process flow

To receive home nursing care, you normally proceed as follows:

  • Your doctor prescribes home nursing care for you.
  • You choose a nursing service that is a contractual partner of your health insurance company. If you wish, your health insurance company will help you choose a suitable provider.
  • You present the doctor's prescription to the care service. As a rule, the care service will take care of the application to your health insurance company. Alternatively, you can also submit the doctor's prescription directly to your health insurance company.
  • Your health insurance company will check whether you are eligible for home nursing care.
  • If your health insurance company has approved the application, the nursing service will invoice your health insurance company directly.
Requirements
  • You have been prescribed home nursing care by a doctor.
  • There is no one in your household who could care for you to the extent required.
  • for supportive care: you are not in need of care with care level 2, 3, 4 or 5
Which documents are required?
  • Medical prescription
What are the fees?

Adults pay EUR 10.00 for each prescription and 10 percent of the costs as a statutory co-payment. This applies for the first 28 days per calendar year.

The statutory co-payment does not apply if

  • you require home nursing care due to pregnancy or childbirth.
  • you are exempt from the statutory co-payment obligation.
What deadlines do I have to pay attention to?

You do not have to observe any deadlines. You or your nursing service must submit the doctor's prescription to your health insurance fund before the start of home nursing care.

If you are already receiving home nursing care or wish to receive it immediately, the health insurance company will only cover the costs of the services provided by the nursing service until a decision on approval is made if the prescription is received by the health insurance company no later than 3 working days after the prescription is issued.

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

- Forms: no
- Online procedure possible: no
- Written form required: no
- Personal appearance required: 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

25.12.2020

Teaser

If you need qualified nursing care at home due to an illness, you can apply for home nursing care from your statutory health insurance provider. You will need a doctor's prescription for this.

Process flow

To receive home nursing care, you normally proceed as follows:

  • Your doctor prescribes home nursing care for you.
  • You choose a nursing service that is a contractual partner of your health insurance company. If you wish, your health insurance company will help you choose a suitable provider.
  • You present the doctor's prescription to the care service. As a rule, the care service will take care of the application to your health insurance company. Alternatively, you can also submit the doctor's prescription directly to your health insurance company.
  • Your health insurance company will check whether you are eligible for home nursing care.
  • If your health insurance company has approved the application, the nursing service will invoice your health insurance company directly.

Requirements

  • You have been prescribed home nursing care by a doctor.
  • There is no one in your household who could care for you to the extent required.
  • for supportive care: you are not in need of care with care level 2, 3, 4 or 5

Which documents are required?

  • Medical prescription

What are the fees?

Adults pay EUR 10.00 for each prescription and 10 percent of the costs as a statutory co-payment. This applies for the first 28 days per calendar year.

The statutory co-payment does not apply if

  • you require home nursing care due to pregnancy or childbirth.
  • you are exempt from the statutory co-payment obligation.

What deadlines do I have to pay attention to?

You do not have to observe any deadlines. You or your nursing service must submit the doctor's prescription to your health insurance fund before the start of home nursing care.

If you are already receiving home nursing care or wish to receive it immediately, the health insurance company will only cover the costs of the services provided by the nursing service until a decision on approval is made if the prescription is received by the health insurance company no later than 3 working days after the prescription is issued.

Legal basis

Appeal

  • Contradiction
  • Action before the social court

Applications / forms

- Forms: no
- Online procedure possible: no
- Written form required: no
- Personal appearance required: 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

25.12.2020

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