Leistungen A-Z

- Forms: yes

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

- Written form required: no

- Personal appearance required: no

• To apply for home care for people with disabilities via the health insurance navigator of the GKV-Spitzenverband

Do you live as a person with a disability in a residential home or another fully inpatient facility that enables you to participate socially and supports you in integrating into working life? If so, your long-term care insurance fund will cover 15 percent of the costs under certain conditions.

However, the nursing care insurance fund pays a maximum of EUR 266.00 per month. You bear the remaining costs yourself. If your income is not sufficient for this, you are entitled to benefits from the basic security in old age and in case of reduced earning capacity or housing allowance. For this, you must apply to the social welfare agency. As a rule, this is the social welfare office in your place of residence.

This also applies to special forms of housing such as a residential home or a residential group for people with disabilities. In this case

• the focus must be on shared living and integration into society,
• the Housing and Care Act must be applied, and
• the extent of care largely corresponds to care in a fully inpatient facility.

If you are at home with your relatives on weekends or vacations, you are entitled to the following benefits for this time:

• Care benefits in kind: This refers to the services of an outpatient care service. Your entitlement to care benefits in kind is reduced by the amount paid by the long-term care insurance fund in that month for accommodation in a residential home or boarding school. For example, if you are at home 10 days a month, the amount your long-term care insurance fund paid for the 20 days you spent in the residential home or boarding school will be deducted from the amount you are entitled to in-kind benefits each month.
• Long-term care allowance: If you are assisted by family members or volunteers during the time you are at home, you may receive caregiver allowance. For each day you spend at home, you will receive 1/30th of the monthly care allowance. The day of arrival and departure each counts as a full day at home. You will receive care allowance even if you receive care benefits at the same time. Your care allowance will not be reduced as a result.
  
  

• You have care degree 2, 3, 4 or 5.
• You live in a
  • in a fully inpatient facility for people with disabilities or
  • comparable form of living.

• If applicable: power of attorney, guardian's card
• Notification from the nursing care insurance company about the degree of nursing care (expert opinion of the medical service of the nursing care insurance company)
• if applicable: medical documents
• If applicable: severely disabled person's ID card
• Proof of health and long-term care insurance

Depending on the individual case, further documents may be required. Please contact your nursing care insurance fund for more information.

You do not have to pay anything for the application.

You can submit the application for cost coverage for care in a fully inpatient facility for people with disabilities by mail, for example, as well as - for many long-term care insurance funds - in person at the office or submit it online.

• Submit the application for full inpatient care in facilities for people with disabilities to your long-term care insurance fund. If you are unable to do so yourself, you can authorize someone in writing.
• The long-term care insurance fund will review your application and inform you of the result.
• After your application has been processed, your long-term care insurance fund will transfer the monthly benefit contribution directly to your facility.
• Your long-term care insurance fund can also give you a list of approved facilities for the disabled, where you can compare services and prices.

You will receive the benefit from your long-term care insurance fund only from the month in which you submitted the application, but at the earliest from the time when the eligibility requirements are met. If the application is not made in the calendar month in which the need for long-term care occurred, but later, the benefits will be granted from the beginning of the month in which the application was made.

Your care insurance fund

• § Section 43a of the Eleventh Book of the Social Code (SGB XI)

• Information on partial and full inpatient care on the "einfach teilhaben" online portal of the Federal Ministry of Labor and Social Affairs
• Online portal with information on the status of implementation of the Federal Participation Act in the federal states

Federal Ministry of Health