Apply for Long-Term Care Benefits in Kind for Those Covered by Long-Term Care Insurance
Service description
Under the home care program, as a person in need of care, you are entitled to benefits in kind, such as personal care, nursing care, or assistance with household chores.
This home care assistance is typically provided by outpatient nursing or care services. Home care assistance is also available if you live in a shared care residence or with family members who are providing care, but not if you live in a nursing home or another full-time residential facility.
Depending on your care level, you are entitled to a specific monthly budget for in-kind care benefits (as of 2021):
- For Care Level 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 use the maximum amount of outpatient nursing care benefits, you can:
- Convert unused in-kind long-term care benefits into a long-term care allowance. This is referred to as a combined benefit.
In addition to in-kind long-term care benefits, you may use the relief allowance. This is a monthly amount intended to reimburse expenses incurred by the insured person in connection with the use of, among other things, outpatient care services as defined in Section 36 of SGB XI; however, for care levels 2 through 5, this does not include services related to self-care.
Procedure
You can submit your application for long-term care benefits in kind (home care assistance provided by outpatient services) by mail, for example, or—with many long-term care insurance providers—in person at their office or online.
- You should submit the application for long-term care benefits in kind to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing to act on your behalf.
- 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 agencies to determine whether you require care at a level equivalent to at least care level 2.
- The long-term care insurance fund will review the assessment report, evaluate your application, and notify you of the decision.
- Your long-term care insurance provider can also give you a list of approved long-term care service providers, which you can use to compare services and prices.
- Your long-term care insurance provider bills the home care service directly.
Prerequisites
- You have a care level of 2, 3, 4, or 5
- If you are in Care Level 1, you can only apply for the respite care allowance
- In-kind long-term care benefits are provided by an approved outpatient nursing or care service (or individual caregivers) that has entered into a contract with your long-term care insurance fund.
- You have a care level of 2, 3, 4, or 5
What documents are required?
- If you already have a care level: Notice from the long-term care insurance fund regarding the determination of your care level (report from the Medical Service of the Long-Term Care Insurance)
- If applicable: Power of attorney, guardian ID card
- if applicable: medical records
- If applicable: Disability ID card
Depending on the specific circumstances, additional documents may be required. Please check with your long-term care insurance provider for more information.
What fees apply?
You do not have to pay anything for the application.
What deadlines do I have to observe?
Entitlement to in-kind long-term care benefits takes effect on the date the application is filed, but no earlier than the date on which the eligibility requirements are met. If the application is not submitted in the calendar month in which the need for long-term care arose, but at a later date, benefits will be granted starting from the beginning of the month in which the application was submitted. Therefore, you should submit the application in a timely manner.
If the long-term care insurance fund does not issue a written decision within 25 business days of receiving the application, or if any of the assessment deadlines specified by law are not met, the long-term care insurance fund must pay you EUR 70.00 immediately for each week the deadline is exceeded after the deadline has passed. This does not apply if the long-term care insurance fund is not responsible for the delay or if you are receiving full-time inpatient care and have already been assigned at least care level 2.
If you are receiving a combined benefit for persons in need of long-term care, you are bound by the decision regarding the allocation of in-kind and cash benefits for a period of 6 months.
Processing time
Processing typically takes about 1 to 2 business days.
To ensure prompt processing and a timely decision, your long-term care insurance provider must have all the necessary information and, if applicable, any required documents—complete and detailed.
The long-term care insurance provider will make a decision on applications in a timely manner.
Please note that the processing time indicated is an average across 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 extended accordingly. The same applies if documents or records are sent by mail to you or your long-term care insurance provider.
If the need for long-term care or the entitlement to long-term care benefits has not yet been determined in your case, or if an application for a higher care level is submitted, the Medical Service must be involved. In certain situations, the Medical Service must conduct an assessment within 1 or 2 weeks of receiving the application.
Legal basis
Legal remedy
- Objection
- Lawsuit in Social Security Court
Applications / Forms
- Forms: yes
- Online application available: Many long-term care insurance providers offer an online application process.
- Written form required: no
- In-person appearance required: no
Additional Information
Issuing body
Redirect Service: Deep link to the original portal Redirect Service: Deep link to the original portal- Housekeeping Assistance in Hesse
Display of performance in the source portal
- Apply for Long-Term Care Benefits in Kind for Those Covered by Long-Term Care Insurance
Display of performance in the source portal
- Housekeeping Assistance in Hesse